Letter to Senator Frist on Racial Disparities in Health Outcomes

The Honorable Bill Frist
416 Russell Office Building
U.S. Senate
Washington, D.C. 20510

Dear Senator Frist:

On behalf of the 93,700 members of the American Academy of Family Physicians, thank you for your commitment to address racial disparities in health outcomes. The evidence for the persistence of such disparities is clear. As reports from both the Institute of Medicine (IOM) and the Agency for Healthcare Research and Quality (AHRQ) have shown, health care outcomes are different for racial and ethnic minorities as well as for people with lower socioeconomic status. Whether such differences are due to restricted access to health care, poorer quality of care being delivered, or health provider ignorance of cross-cultural communication, the result is unacceptable. Given the complexity of the problem, the Academy supports the multi-faceted approach adopted in the legislation you are introducing, since it addresses effective data collection and analysis; provides grants to expand access; supports efforts to educate health care providers in cultural competency; and authorizes enhanced research.

Title I of the draft bill, Closing the Health Care Gap, would direct the development of performance measures by clinicians, institutions and health plans across all federally supported health care delivery programs. With previous research suggesting a lack of continuity-based primary care as an indicator of poor health outcomes, we believe that ambulatory settings (where the majority of health care is provided) should be considered within the scope of this bill. The Academy would recommend that the adoption of ambulatory care performance measures be restricted to those quality indicators that have been established by the AMA's Physician Consortium for Performance Improvement. The Academy appreciates the inclusion of language guiding the development of additional performance measures. The Academy would support a process using measures that are evidence-based, relevant to patients and physicians, and precisely defined for areas where improvement is attainable. Likewise, implementation must be achievable even for extremely small, rural practices.

If performance measures are developed utilizing these principles, they are likely to be easily implemented into an Electronic Health Record (EHR). The Academy sees the adoption of appropriate medical technology, such as an EHR, as transforming health care quality efforts. Therefore, any encouragement for the adoption of EHR technology in the physician’s office is useful.

Your draft bill also establishes grants to facilitate access and outreach for underserved populations. The Academy supports efforts to expand access to health care and appreciates the inclusion of these provisions. The bill contains efforts to promote the diversity of the medical workforce and improve cultural competency training for clinicians. The Academy supports these provisions, as well. The bill also addresses enhanced medical research. In particular, the Academy believes emphasis on AHRQ’s practice-based research network is vital to the future success of improved health outcomes for racial and ethnic minorities. The Academy appreciates the bill’s focus on primary care research.

The Academy believes that this bill address disparities in health care outcomes through quality improvement efforts that are likely to improve all of medicine. Thank you for your efforts and we look forward to working with you for passage of this important piece of legislation.

Sincerely,



James C. Martin, M.D., FAAFP
Board Chair