Eliminating the gaps in health care experienced by racial and ethnic minorities by improving our understanding of what causes these gaps and by working directly with health care systems to improve health care for all patients.

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NSURING THAT ALL AMERICANS have access to quality health care means eliminating the gaps in care experienced by racial and ethnic minorities. The Robert Wood Johnson Foundation seeks to improve understanding of the multiple factors that lead to racial and ethnic minorities receiving poorer quality care and to work directly with health care systems to improve the quality of care for all patients.

In 2002 the Institute of Medicine issued its Unequal Treatment report, a review of multiple research studies demonstrating that racial and ethnic disparities are real and extensive. According to the report, even when insurance, income, age and severity of conditions are comparable among whites and non-whites, non-whites are less likely to be given the level of care that experts recommend across a range of treatment areas. Yet while we know these disparities exist, we know far less about which of the many complex factors contributing to disparities are most amenable to change.

The Foundation’s Disparities strategy is aimed specifically at helping health care systems—purchasers, providers and consumers of health care—address racial and ethnic disparities in treatment as a high priority in their ongoing efforts to improve the quality of care for all. Although long-term strategies are needed to address disparities—such as diversifying the health care workforce and understanding more about how bias and stereotyping affect patient care—our initial efforts aim for short-term, measurable improvements to be made within the context of the health care delivery system.

In 2004 we authorized a new national program, Expecting Success: Excellence in Cardiac Care. Based at the George Washington University School of Public Health and Health Services, Expecting Success will establish a hospital quality improvement collaborative to improve cardiac care for African Americans and Latinos. We chose cardiac care because African Americans and Latinos suffer disproportionately from heart disease, and the recommended standard of care in these treatment areas is clear. Participating hospitals will work to meet established quality benchmarks for all of their patients, focusing on improving the quality especially for African Americans and Latinos. They will be expected to share their results widely.

We also focused on research projects that will answer pressing questions in the field, make the case for addressing disparities in treatment, and, most importantly, draw attention to potentially replicable solutions. One 2004 project supports research from the New York Academy of Medicine to uncover whether the use of different health care providers contributes to gaps in the delivery of health care services and poorer health outcomes experienced by certain racial and ethnic groups. Another project, based at the Center for Health Services Research and Policy at George Washington University, is exploring some of the real and perceived legal barriers to the collection of race and ethnicity data.

Through these demonstration and research projects, complemented by consistent communications to share our strategic approach and results with the field, we believe that we will significantly improve the way care is delivered to minority populations, especially with respect to chronic conditions that affect minority patients more severely.