The Coalition to Reduce Racial and Ethnic Disparities in Cardiovascular Disease Outcomes (credo)

Abstract

This report reviews the rationale for the American College of Cardiology's Coalition to Reduce Racial and Ethnic Disparities in Cardiovascular Disease Outcomes (credo) and the tools that will be made available to cardiologists and others treating cardiovascular disease (CVD) to better meet the needs of their diverse patient populations. Even as the patient population with CVD grows increasingly diverse in terms of race, ethnicity, age, and sex, many cardiologists and other health care providers are unaware of the negative influence of disparate care on CVD outcomes and do not have the tools needed to improve care and outcomes for patients from different demographic and socioeconomic backgrounds. Reviewed published reports assessed the need for redressing CVD disparities and the evidence concerning interventions that can assist cardiology care providers in improving care and outcomes for diverse CVD patient populations. Evidence points to the effectiveness of performance measure-based quality improvement, provider cultural competency training, team-based care, and patient education as strategies to promote the elimination of disparate CVD care and in turn might lead to better outcomes. credo has launched several initiatives built on these evidence-based principles and will be expanding these tools along with research. credo will provide the CVD treatment community with greater awareness of disparities and tools to help close the gap in care and outcomes for all patient subpopulations.

A Roadmap and Best Practices for Organizations to Reduce Racial and Ethnic Disparities in Health Care

“…The Institute of Medicine's Crossing the Quality Chasm report stated that equity was one of six components of quality, 27 and the IOM's 2010 report Future Directions for the National Healthcare Quality and Disparities Reports highlighted equity further by elevating it to a cross-cutting dimension that intersects with all components of quality care. 28 Major health care organizations have instituted initiatives that promote the integration of equity into quality efforts including the American Board of Internal Medicine (Disparities module as part of the recertification process), American College of Cardiology (Coalition to Reduce Racial and Ethnic Disparities in Cardiovascular Disease Outcomes [CREDO] initiative), 29 American Medical Association (Commission to End Health Care Disparities), American Hospital Association (Race, ethnicity, and language data collection), 22 Joint Commission (Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care: a Roadmap for Hospitals), 30 and National Quality Forum (Healthcare Disparities and Cultural Competency Consensus Standards Development). For many health care organizations and providers, this integration of equity and quality represents a fundamental change from generic quality improvement efforts that improve only the general system of care, to interventions that improve the system of care and are targeted to specific priority populations and settings.…”

Racial and Ethnic Differences in Wait-List Outcomes in Patients Listed for Heart Transplantation in the United States

“…1 Thus, disparities are differences that cannot be explained by the biology of the disease. 5 Although we adjusted for all available clinical variables, worse outcomes in Hispanic and black patients could still be due to their residual clinical risk related to access such as a late presentation for HT evaluation or a more rapid progression of heart failure. 5,24 However, socioeconomic differences among racial/ethnic groups, including among HT recipients, are well known 30 -32 and were also present in this cohort.…”

“…5 Although we adjusted for all available clinical variables, worse outcomes in Hispanic and black patients could still be due to their residual clinical risk related to access such as a late presentation for HT evaluation or a more rapid progression of heart failure. 5,24 However, socioeconomic differences among racial/ethnic groups, including among HT recipients, are well known 30 -32 and were also present in this cohort. For example, black and Hispanic patients were less likely to have a college degree, were less likely to be working for income, and were more likely to have Medicaid insurance, although these factors were not associated with the outcomes assessed.…”

“…With a gradual change in US demographics, minorities represent a growing proportion of US population and may be expected to represent a higher percentage of HT candidates over time. 5,12 It is therefore important to know if there are racial/ethnic differences in wait-list mortality in the United States in the current era. Furthermore, because the sicker patients on the HT wait-list may also be at higher risk of early posttransplant mortality, analysis of early posttransplant mortality may provide additional insights into wait-list outcomes.…”

“…1 Racial gaps in cardiovascular care have been described in utilization of coronary revascularization and coronary artery bypass surgery, in adaptation of newer technologies such as drugeluting stents and cardiac resynchronization therapy, and in utilization of evidence-based medicines for primary and secondary prevention. [2][3][4][5][6][7][8][9] Quality-improvement initiatives to promote provider adherence with evidence-based practices have not only led to improvement in performance measures, but also to narrowing of racial gaps. 10 …”