Reducing disparities and improving quality: understanding the needs of small primary care practices.

OBJECTIVES Small practices provide a significant proportion of care in the United States and should be an essential focus of efforts to reduce racial/ethnic disparities and improve the quality of care for minority patients. This project sought to identify the resources and tools small practices need to conduct quality improvement activities to reduce disparities. DESIGN We surveyed small practices about their capabilities for conducting quality improvement activities for minority and limited English proficiency patients. A subset of practices also completed a brief chart review. SETTINGS Grantees of the National Committee for Quality Assurance Program were independent practices required to have five or fewer physicians with little or no experience with quality improvement (mean number of physicians = 1.4). At least one-quarter of the patients served by the practice were required to be minorities. PARTICIPANTS Twenty-two practices from California and New Jersey. MAIN OUTCOME MEASURES Surveys assessed clinician preparedness, use of systematic processes, and availability of information technology to improve care for minority patients. The chart review exercise elicited information on challenges and enabling factors in recent encounters with racial/ethnic minority patients. RESULTS Small practices face considerable challenges in caring for minority patients. They have limited staff and fewer resources than larger group practices, increasing the difficulty of making improvements on their own. The main challenges identified were patient adherence to treatment recommendations, staffing, language barriers and lack of information systems. CONCLUSIONS Small practices will require substantial support from external organizations in order to contribute to national reductions in racial/ethnic disparities in health care.