Measuring Racial Equity and Institutional Racism in Primary Care (EQUIP)

Abstract: Measuring Racial Equity and Institutional Racism in Primary Care (EQUIP) Disparities in healthcare quality and health outcomes for Black patients compared to White patients have been demonstrated across a range of diseases even after accounting for access to care. In addition, studies document poorer health outcomes for Black compared to White patients who receive care within the

same practice setting, highlighting the role of healthcare systems and organizations as contributors to disparities. Yet, there are no validated measures of healthcare practice-level determinants of health disparities. Racism is a fundamental cause of inequities in health. A large body of research has focused on the

influence of interpersonal racism and more recently structural racism on health outcomes for Black individuals. In this application, we focus on another level of racism--practice-level institutional racism. Based on a review of the literature and stakeholder engagement, we define practice-level institutional racism as structures,

practices, policies, processes, and norms within a healthcare setting which create or reinforce healthcare inequities between White and Black or other minoritized patients. Factors such as racial diversity of providers, standardized processes to facilitate evidence-based care, and equity-focused quality improvement have been

proposed as important to practice-based efforts to address disparities. However, to-date, the domains of practice-level institutional racism have not been clearly defined, and no validated measures of the concept exist. The goals of this research are to develop a measure to: (1) identify equity-promoting processes and

practice-level institutional racism, and (2) determine its association with variation in Black-White disparities in health outcomes across practice settings. Because high quality primary care results in better health outcomes and reduced disparities, we propose a collaboration with primary care practice-based research networks

(PBRNs) across the Southeast. We will use the infrastructure of PBRNs to conduct in-depth interviews with patients, providers, and clinic leaders and access electronic health record data (EHR) for patients across approximately 100 clinics to achieve the following Specific Aims: (1) Identify practice-level structures,

processes, policies, and norms that may either promote equity or create and reinforce inequities in health outcomes between Non-Hispanic Black and White patients. (2) Design, pre-test, and determine the psychometric properties of the practice-level EQUIP Measure. (3) Explore the modifying effects of institutional

racism and equity-promoting practices as measured by EQUIP on the relationship between area-level structural racism (residential-segregation, racial inequities in income, etc.) and health outcomes (cancer screening, blood pressure control, etc.) for Black patients. This proposal to develop a validated measure of

practice-level equity and institutional racism is a necessary first step to expand research on the effectiveness of practice-level interventions to promote health equity.