At a decade: centers of excellence in culturally competent care.

Introduction The rapidly increasing racial and ethnic diversity among Kaiser Permanente (KP) membership mirrors the demographic changes across the nation (Lynette DeSantis, personal communication, 2008 Nov). This diversity calls for interventions that are culturally specific to improve patients’ health outcomes and to eliminate health disparities (see Kaiser Permanente Diversity Demographics). This need is unequivocally demonstrated by scientific evidence that shows differential disease prevalence between population groups. The impact of disparities and the human story is repeatedly told: in the reports that prompted the creation, in 1999, of The Office of Research on Minority Health and, in 2000, the Culturally and Linguistically Appropriate Services Standards (CLAS); in the Institute of Medicine’s 2002 report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care; and in the Annual 2007 National Healthcare Disparities Report (NHDR) by the Agency for Healthcare Research and Quality. Despite these significant efforts, disparities have not been reduced since the first NHDR in 2003. During the 1990s, frameworks emerged to reverse health-disparity trends—a complex process. In particular, the practice-based, community-informed approaches to health and health care—that placed culture in the nexus of essential elements for solving health disparities—created a rich body of experience and examples now known as the discipline of culturally competent care. By 1998, the KP National Diversity Council, on the basis of the ever-growing body of knowledge and practice, began integrating these principles through a deliberate, research-driven strategy. KP membership data, health-disparities data, and the organization’s mission and purpose required a breakthrough to address differential population health outcomes. The Centers of Excellence are an innovative and specific response to these imperatives.