The only way to understand how you improve is to measure change. With disparities interventions, it’s critical to measure not only overall quality improvement, but changes in disparities. This was described in detail in
Step 1 of the Road Map: Are you closing the gap in care?
Measuring Disparities ReductionThere are some important tips to keep in mind when you’re trying to measure a disparities intervention. While these are relevant for any program evaluation, they are especially important for measuring differences in care.
- Focus on process measures initially. Process measures tell you whether a plan is being implemented as it should. That plan could be many things: for example, a new form asking about patients’ race/ethnicity/language at the front desk, or a timely referral for a colonoscopy. Process measures will help you understand if and how changes are being put into practice. They will help you demonstrate the impact of your intervention in the short term, before health outcomes improve.
- Understand satisfaction scores in their context. When patients are aware that the clinic is working towards improvement, their expectations may increase and satisfaction scores may decrease, which is a natural part of raising the bar for everyone. As an intervention is implemented, and patients see the effects of your changes, these scores usually improve.
- Plan long-term follow-up. Moving the dial on clinical outcomes often takes longer than expected: keep in mind how often patients will interact with your intervention (e.g. do most patients come in once every three months?) and develop a reasonable timeline by consulting multiple stakeholders. Work with your team to identify what kinds of improvement you will define as success. Communicate with your leadership about this timeline so they know what kinds of results to expect when. If you’re rigorously researching an intervention, you may need to track patients for several years to demonstrate statistically significant improvements in health outcomes.
- Don’t forget to measure the gap. While overall improvement is promising, it may or may not indicate a reduction in disparities, as discussed in Step 1 of the Road Map. To promote equitable care, you need to consider the causes of an identified disparity, design an intervention that will address those causes, and commit to measuring how your intervention affects those differences in care.
For basic information on how to measure improvement: We recommend the Institute for Healthcare Improvement’s (IHI) page on The Science of Improvement: Establishing Measures. IHI outlines the differences between measurement for research and measurement for process improvement, as well as the types of measures you should consider and tips for effective measures.