Predicting changes in staff morale and burnout at community health centers participating in the health disparities collaboratives.

OBJECTIVE: To identify predictors of changes in staff morale and burnout associated with participation in a quality improvement (QI) initiative at community health centers (HCs). DATA SOURCES: Surveys of staff at 145 HCs participating in the Health Disparities Collaboratives (HDC) program in 2004. DATA COLLECTION AND STUDY DESIGN: Self-administered questionnaire data collected from 622 HC staff (68 percent response rate) were analyzed to identify predictors of reported change in staff morale and burnout. Predictive categories included outcomes of the QI initiative, levels of HDC integration, institutional support, the use of incentives, and demographic characteristics of respondents and centers. PRINCIPAL FINDINGS: Perceived improvements in staff morale and reduced likelihood of staff burnout were associated with receiving personal recognition, career promotion, and skill development opportunities. Similar outcomes were associated with sufficient funding and personnel, fair distribution of work, effective training of new hires, and consistent provider participation. CONCLUSIONS: Having sufficient personnel available to administer the HDC was found to be the strongest predictor of team member satisfaction. However, a number of low-cost, reasonably modifiable, organizational and leadership characteristics were also identified, which may facilitate improvements in staff morale and reduce the likelihood of staff burnout at HCs participating in the HDC.

Interventions to reduce racial and ethnic disparities in health care.

In 2005, the Robert Wood Johnson Foundation created Finding Answers: Disparities Research for Change, a program to identify, evaluate, and disseminate interventions to reduce racial and ethnic disparities in the care and outcomes of patients with cardiovascular disease, depression, and diabetes. In this introductory paper, we present a conceptual model for interventions that aim to reduce disparities. With this model as a framework, we summarize the key findings from the six other papers in this supplement on cardiovascular disease, diabetes, depression, breast cancer, interventions using cultural leverage, and pay-for-performance and public reporting of performance measures. Based on these findings, we present global conclusions regarding the current state of health disparities interventions and make recommendations for future interventions to reduce disparities. Multifactorial, culturally tailored interventions that target different causes of disparities hold the most promise, but much more research is needed to investigate potential solutions and their implementation.

Reducing health disparities in depressive disorders outcomes between non-Hispanic Whites and ethnic minorities: a call for pragmatic strategies over the life course.

There are significant disparities in treatment process and symptomatic and functional outcomes in depressive disorders for racial and ethnic minority patients. Using a life-course perspective, the authors conducted a systematic review of the literature to identify modifiable mechanisms and effective interventions for prevention and treatment at specific points -- system, community, provider, and individual patient -- in health care settings. Multicomponent chronic disease management interventions have produced improvements in depression outcomes for ethnic minority populations. Case management appears to be a key component of effective interventions. Socioculturally tailored treatment and prevention interventions may be more efficacious than standard treatment programs. Future research should focus on identifying key components of case management and sociocultural tailoring that are essential for effective interventions and developing new low-cost dissemination mechanisms for treatment and preventive programs that could be tailored to racial and ethnic minorities.

Community health center quality improvement: a systematic review and future directions for research.

BACKGROUND: Leaders and policymakers need an accurate appraisal of the federally qualified community health center (CHC) quality improvement (QI) literature to make informed decisions for the CHC program. OBJECTIVES: This paper aims to (1) summarize the content and findings of CHC QI studies to date, (2) systematically rate the quality of those studies, and (3) outline 10 important areas for future CHC QI research. METHODS: We searched medical and nonmedical databases to identify QI studies in CHC settings. We systematically reviewed identified studies for the features of their QI interventions and for the methodological quality of their evaluations. We combined results from the review with input from the CHC community to generate an agenda for future CHC QI research. RESULTS: Eighteen studies were identified and reviewed. Interventions mainly targeted chronic conditions and screening practices and used 1 to 11 of 14 different QI tactics; evaluations comprised 14 observational and 4 randomized study designs. CHC QI interventions have been effective in improving processes of care for diabetes and cancer screening in the short term; their effectiveness in the long term and regarding outcomes of care have not been demonstrated. CONCLUSIONS: QI interventions in CHC setting are promising, but future interventions and evaluations should answer critical basic questions about QI, including the following: What are the best models of QI? How can QI improvements be effectively implemented and sustained? What are the global effects of QI (positive and negative)? How can QI be made financially viable and sensible from both the CHC and societal perspectives?