Diverse community leaders\u2019 perspectives about quality primary healthcare and healthcare measurement: qualitative community-based participatory research

Kathleen A Culhane-Pera,Cindy N Kaigama,Michael Scandrett,Marcela Alison,Mai See Thao,Andrew M Pattock,Maiyia Y Kasouaher,David J Satin,Naima Dhore,Shannon L Pergament

doi:10.1186/s12939-021-01558-4

Abstract

BackgroundHealthcare quality measurements in the United States illustrate disparities by racial/ethnic group, socio-economic class, and geographic location. Redressing healthcare inequities, including measurement of and reimbursement for healthcare quality, requires partnering with communities historically excluded from decision-making. Quality healthcare is measured according to insurers, professional organizations and government agencies, with little input from diverse communities. This community-based participatory research study aimed to amplify the voices of community leaders from seven diverse urban communities in Minneapolis-Saint Paul Minnesota, view quality healthcare and financial reimbursement based on quality metric scores.MethodsA Community Engagement Team consisting of one community member from each of seven urban communities —Black/African American, Lesbian-Gay-Bisexual-Transgender-Queer-Two Spirit, Hmong, Latino/a/x, Native American, Somali, and White—and two community-based researchers conducted listening sessions with 20 community leaders about quality primary healthcare. Transcripts were inductively analyzed and major themes were identified.ResultsListening sessions produced three major themes, with recommended actions for primary care clinics.#1: Quality Clinics Utilize Structures and Processes that Support Healthcare Equity.#2: Quality Clinics Offer Effective Relationships, Education, and Health Promotion.#3: Funding Based on Current Quality Measures Perpetuates Health Inequities.ConclusionCommunity leaders identified ideal characteristics of quality primary healthcare, most of which are not currently measured. They expressed concern that linking clinic payment with quality metrics without considering social and structural determinants of health perpetuates social injustice in healthcare.

Highlights

Healthcare quality measurements in the United States illustrate disparities by racial/ethnic group, socio-economic class, and geographic location
Through community-based participatory research (CBPR) [17], we explored the viewpoints of diverse urban community leaders in the Minneapolis-Saint Paul MN
Theme #1: quality clinics utilize structures and processes that support healthcare equity Recognize and address historical trauma, structural racism, and social determinants of health (SDOH) Many community leaders discussed how the social injustices resulting from historical trauma, institutional racism, and structural inequities have negatively impacted the health of their communities

Summary

Introduction

Healthcare quality measurements in the United States illustrate disparities by racial/ethnic group, socio-economic class, and geographic location. Quality healthcare is measured according to insurers, professional organizations and government agencies, with little input from diverse communities. This community-based participatory research study aimed to amplify the voices of community leaders from seven diverse urban communities in Minneapolis-Saint Paul Minnesota, view qual‐ ity healthcare and financial reimbursement based on quality metric scores. Healthcare quality measurements in the United States illustrate disparities in healthcare quality when examined by racial/ethnic group, socio-economic class, insurance, sex/gender identity, and geographic location [1]. No studies have sought diverse community perspectives on defining and measuring quality primary care

Methods

Results

Discussion

Conclusion