These reports can serve as the basis for determining whether and where

These reports can serve as the basis for determining

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progress assessment. These reports can serve as the basis for determining whether and where structural improvements are needed. Feedback loops are also created in disease management programs through open-lines of communication between the patient and his disease management team. By discussing care with individual patients, the teams can determine if changes in the program are necessary to meet a patient's needs and disease management goals. Although disease management programs primarily espouse a desire to achieve quality, they also indirectly can achieve equality in healthcare by reducing racial disparities. [FN49] The uniform clinical care provided to all patients involved in a disease management program can reduce disparate provision of healthcare due to socioeconomic status, race or ethnicity. Because every individual is receiving care derived from the same evidence- based guidelines, there is little room for conscious or unconscious biases to affect the quality of care. [FN50] The creation of information systems infrastructure and systematic monitoring further diminishes the possibility for variation in the provision of healthcare on the basis of either conscious or *403 unconscious biases. Finally, the shift in focus towards chronic care diseases has a positive effect, especially for racial and ethnic minorities. B. REFORMIST INSTITUTIONS: TWO EXEMPLARY PROJECTS Healthcare systems are implementing programs to provide equitable healthcare via a disease management approach. The Health Disparities Collaboratives and programs within certain physician-led managed care systems are two exemplary projects that have adopted this method. The Health Disparities Collaboratives demonstrates a shift to a disease management approach within the community health center system that has traditionally served racial and ethnic minorities. Physician-led managed care organizations have also embarked on emphasizing quality by creating disease management programs to improve outcomes, to attract patients and to provide cost-effective service. 1. Community Health Center Based System The federally funded Health Disparities Collaboratives is a comprehensive initiative to address racial, ethnic and socioeconomic health disparities through disease management. [FN51] This program is part of the Healthy People 2010 Campaign to (1) increase the quality of healthy life for all Americans and to (2) eliminate health disparities through the use of evidence- based medicine, which entails incorporating key scientific findings into medical practice and measuring the associated outcomes. [FN52] a. Background The Health Resources Services Administration (HRSA) created the Health Disparities Collaboratives program. In the late 1990s, HRSA sought to improve healthcare quality and outcomes at community health centers, which serve predominantly low-income, racial and ethnic minority populations. [FN53] Using the *404 Collaborative Chronic Care Model for disease management, developed by the Institute for Healthcare Improvement (IHI) and the MacColl
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