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Prior literature suggests that practice level characteristics mediate racial/ethnic disparities in clinical outcomes.1 One such practice level characteristic, use of electronic health records (EHRs) with clinical decision support (CDS), has been associated with improved blood pressure (BP) control in a national study.2 However, we do not know whether these effects differ across racial/ethnic groups.3 We sought to determine whether physician use of EHRs with and without CDS is associated with a reduction in racial/ethnic disparities in BP control in a nationally representative sample. Methods We examined data from primary care visits in the 2007-2008 National Ambulatory Medical Care Survey (NAMCS), a nationally representative survey of nonhospital-based ambulatory visits administered by the National Center for Health Statistics (NCHS).4 In a recent article, we examined visits to NAMCS physicians who answered questions about EHRs and electronic guideline-based reminders.2 Primary care . . .

Background The Health Resources and Services Administration Health Disparities Collaboratives (HDCs) were developed to improve care for chronic medical conditions in community health centers (CHCs). Methods We examined whether HDCs reduced disparities in quality by race/ethnicity or insurance status in CHCs nationally. We performed a controlled preintervention/postintervention study of 44 CHCs participating in HDCs for asthma, diabetes mellitus, or hypertension and 20 “external” control CHCs that had not participated. Each intervention center also served as an “internal” control for another condition. For each condition, we created an overall quality score, defined disparities in care as the differences in care between racial/ethnic groups and insurance groups, and examined changes in disparity through a series of hierarchical models using a 3-way interaction term among period, patient characteristics of interest, and treatment group. Results Overall, HDCs had little effect on disparities in composite measures for asthma, diabetes, and hypertension. For asthma care, collaborative centers had a baseline Hispanic-white disparity of 6.5%, which changed to a higher quality of recommended care for Hispanic patients over white patients by 0.8%, resulting in a significantly reduced Hispanic-white disparity compared with the change in disparity seen in external controls (P = .04). There were no other improvements in racial/ethnic or insurance disparities for any other conditions. Conclusions Although HDCs are known to improve quality of care in CHCs, they had minimal effect on racial/ethnic and insurance disparities. In addition to targeting improvement in overall quality, future initiatives should include activities aimed at disparity reduction as an outcome.