eQuality - Relating the Medical Home, Disparities, and Quality

My interest piqued as the Dr. John Tooker spoke clearly and with authority, "the IT-supported Medical Home eliminates healthcare disparities." Of course, it made intutitive sense. The computerized reminder system for preventive care is not biased by ethnicity, race or nationality.

So, all we have to do is computerize the medical home to eliminate disparities?

Is it that simple? Yes and no. The Reschovsky et.al., 2008 showed that physicians serving ethnic minorities, the uninsured and other low-income patients have difficulty delivering medical-home quality of care. Stevens et.al., 2009 confirmed that there is variation in quality in medical homes which was associated with non-white ethnicity, non-English speaking households, low-income uninsured and low education level.

The inescapable conclusion is that to ensure equality in the care delivered at medical homes, those medical homes that care for low-income, or nonEnglish speakers, or uninsured, or ethnic minorities must receive additional support. These targeted medical homes must have grants to pay for IT improvements as well as the training and organizational changes that accompany EHRs with reminders and other IT innovations.

1. Homer CJ. Health disparities and the primary care medical home: Could it be that simple? Acad Pediatr. 2009;9:203-205.
2. Raphael JL, Guadagnolo BA, Beal AC, Giardino AP. Racial and ethnic disparities in indicators of a primary care medical home for children. Acad Pediatr. 2009;9:221-227.
3. Reschovsky JD, O'Malley AS. Do primary care physicians treating minority patients report problems delivering high-quality care? Health Aff (Millwood). 2008;27:w222-31.
4. Stevens GD, Seid M, Pickering TA, Tsai KY. National disparities in the quality of a medical home for children. Matern Child Health J. 2009.
5. Turner EJ, Bazemore AW, Phillips RL,Jr, Green LA. Will patients find diversity in the medical home? Am Fam Physician. 2008;78:183.