Measuring Performance

Healthcare Disparities and Cultural Competency 

Project Status: Completed

Healthcare Disparities and Cultural Competency Consensus Standards

Final Publications:


The Opportunity

One essential step to improving the quality of healthcare performance is to eliminate disparities in care. Healthcare disparities may be exacerbated by many things including specific health conditions, differences in access to care, provider biases, poor patient-provider communication, and poor health literacy. The Institute of Medicine report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, found that racial and ethnic minorities often receive lower quality of care than their white counterparts, even after controlling for factors such as insurance, socioeconomic status, comorbidities, and stage of presentation. An integral understanding of healthcare disparities measurement is needed to create a long term agenda for improving healthcare quality for vulnerable populations and others adversely affected by disparities. By analyzing the effectiveness of quality measures already in place and identifying gaps, the National Quality Forum (NQF) aims to establish a more detailed picture of how to approach measurement of healthcare disparities across settings and populations.

About the Project

The Healthcare Disparities and Cultural Competency Consensus Standards project seeks to expand on NQF’s previous work where a set of criteria to evaluate disparities-sensitive measures was identified and 35 disparity-sensitive measures for the ambulatory care setting were endorsed (National Voluntary Consensus Standards for Ambulatory Care – Measuring Healthcare Disparities). This project will begin with a commissioned paper outlining the methodological concerns with measuring disparities, such as implications of risk adjustment and stratification, unintended consequences of public reporting, and data collection; and revising the NQF disparities-sensitive evaluation criteria. This commissioned paper will help inform future efforts on developing and endorsing performance measures for disparities and cultural competency.


This project will be conducted in two phases. In Phase I, a contractor will develop a commissioned paper, which will serve as a conceptual model to guide measure development, revise the NQF disparities-sensitive criteria, and identify broader sets of disparities-sensitive measures within the NQF portfolio. Phase I of this project is scheduled to be completed in September 2011.

In Phase II, candidate standards will be considered for NQF endorsement as voluntary consensus standards. Agreement around the recommendations will be developed through NQF’s Consensus Development Process (CDP, Verison 1.8). This project involves the active participation of representatives from across the spectrum of healthcare stakeholders. A Steering Committee will oversee the work of the commissioned paper and the consensus project.


This project is funded by the Robert Wood Johnson Foundation.

Related NQF Work

Contact Information

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