Although the quality of health care is poor for many Americans, specific racial and ethnic groups, as well as patients with limited English proficiency, continue to experience lower-quality health care. AF4Q communities work each day to address these health disparities. Today's edition of Spotlight showcases some examples of AF4Q's lessons learned and efforts to improve equity in health care.

When you slice and dice the numbers, African Americans with diabetes in Wisconsin are four times more likely than Caucasians with diabetes to have an amputation, according to 2010 Dartmouth Atlas data. The Wisconsin Collaborative for Healthcare Quality (WCHQ), leader of the Aligning Forces for Quality initiative in Wisconsin, is using a multi-pronged intervention approach to reduce racial disparities in care.

WCHQ has partnered with Wheaton Franciscan Healthcare, a non-profit integrated health care system in Wisconsin, to identify and remove barriers to diabetes management. Wheaton Franciscan Healthcare first conducted a series of focus groups with patients to identify barriers to self-management, attitudes about diabetes, and care needs.

The focus groups led Wheaton Franciscan to develop an innovative intervention program. First, community health workers help connect patients to community resources for education and support based on each patient’s unique needs. Second, a series of educational sessions and weekly support group meetings help patients discuss best practices and lessons learned.

Said Cindy Schlough, director of strategic partnerships with WCHQ, “This work is exciting because it does have the potential to have a long-lasting impact. People are getting ongoing support, and it’s giving them hope about successfully managing their chronic conditions.”

How can AF4Q Alliances and other regional improvement coalitions help primary care practices best serve Medicaid and racially and ethnically diverse patients? This Lessons Learned piece addresses a survey of 126 practices in four AF4Q communities and two Medicaid agencies. The analysis sought to: (1) assist practices in assessing their own capacity, (2) help local community Alliances better target efforts to improve care delivery, and (3) assist state agencies across the country in better preparing the nation’s primary care system to deliver high-quality care to Medicaid beneficiaries. The piece identifies five key takeaways for practices and offers suggestions for Alliance and other collaborative involvement. The study’s findings can help drive provider education, practice site improvement opportunities, and financial incentives and payment reform efforts to transform primary care practices that provide a critical safety net to the nation’s low-income and diverse populations. Regional improvement efforts across the country, such as Aligning Forces for Quality, can partner with Medicaid programs to build ambulatory quality improvement capacity in their communities and ensure these critical practices are not left behind.