• GP practices serving more socioeconomically deprived patient populations receive similar funding per registered patient to those serving less deprived patient populations. Once these populations are adjusted to account for increased workload associated with greater health needs in poorer areas, practices serving more deprived populations receive around 7% less funding per need adjusted * registered patient than those serving less deprived populations. * Measuring health need directly is not possible. In our analysis we use workload as a proxy for need. This has limitations, but is consistent with the methodology used in the Carr-Hill resource allocation formula for general practice. Briefing: Level or not? 2 • GP practices serving more deprived patient populations on average earn fewer quality and outcomes framework (QOF) points, have worse Care Quality Commission (CQC) ratings and lower patient satisfaction scores than practices serving less deprived populations. These measures of assessing quality may themselves be affected by deprivation (for example increased patient deprivation may make it harder to achieve high QOF scores). Further research is needed across other aspects of quality to explore whether patients living in more deprived areas receive a systematically lower quality of care.

Context: Racial and ethnic disparities in the quality of health care are well documented in the U.S. health care system. Reducing these disparities requires action by health care organizations. Collecting accurate data from patients about their race and ethnicity is an essential first step for health care organizations to take such action, but these data are not systematically collected and used for quality improvement purposes in the United States. This study explores the challenges encountered by health care organizations that attempted to collect and use these data to reduce disparities. Methods:Purposive sampling was used to identify eight health care organizations that collected race and ethnicity data to measure and reduce disparities in the quality and outcomes of health care. Staff, including senior managers and data analysts, were interviewed at each site, using a semi-structured interview format about the following themes: the challenges of collecting and collating accurate data from patients, how organizations defined a disparity and analyzed data, and the impact and uses of their findings. Findings:To collect accurate self-reported data on race and ethnicity from patients, most organizations had upgraded or modified their IT systems to capture data and trained staff to collect and input these data from patients. By stratifying nationally validated indicators of quality for hospitals and ambulatory care by race and ethnicity, most organizations had then used these data to identify disparities in the quality of care. In this process, organizations were taking different approaches to defining and measuring disparities. Through these various methods, all organizations had found some disparities, and some had invested Conclusion:If policymakers wish to hold health care organizations accountable for disparities in the quality of the care they deliver, common standards will be needed for organizations' data measurement, analysis, and use to guide systematic analysis and robust investment in potential solutions to reduce and eliminate disparities.Keywords: Data collection, ethnic groups/statistics and numerical data, quality of health care, health policy, qualitative research. Many regulations govern the collection and reporting of race and ethnicity data for Medicare and other federally funded programs (Youdelman and Hitov 2001), but it is not clear how consistently the data have been collected and whether the health care organizations themselves use the information or simply report it, as required. In 2009 the Institute of Medicine (IOM) strongly recommended consistent standards for collecting and reporting data on patients' race, ethnicity, and language (Ulmer, McFadden, and Nerenz 2009). In addition, the recent federal reforms of health care and health information technology (IT) provide for widening the data collection by extending investment in electronic health records to health care providers that receive public funds (Siegel and Nolan 2009). To date, however, only pilot programs and limited impleme...

BackgroundA Massachusetts regulation implemented in 2007 has required all acute care hospitals to report patients' race, ethnicity and preferred language using standardized methodology based on self-reported information from patients. This study assessed implementation of the regulation and its impact on the use of race and ethnicity data in performance monitoring and quality improvement within hospitals.MethodsThematic analysis of semi-structured interviews with executives from a representative sample of 28 Massachusetts hospitals in 2009.ResultsThe number of hospitals using race, ethnicity and language data internally beyond refining interpreter services increased substantially from 11 to 21 after the regulation. Thirteen of these hospitals were utilizing patient race and ethnicity data to identify disparities in quality performance measures for a variety of clinical processes and outcomes, while 16 had developed patient services and community outreach programs based on findings from these data. Commonly reported barriers to data utilization include small numbers within categories, insufficient resources, information system requirements, and lack of direction from the state.ConclusionsThe responses of Massachusetts hospitals to this new state regulation indicate that requiring the collection of race, ethnicity and language data can be an effective method to promote performance monitoring and quality improvement, thereby setting the stage for federal standards and incentive programs to eliminate racial and ethnic disparities in the quality of health care.