1 Bridging health equity gaps: strategies for transformative change

<h3>Background</h3> Healthcare’s landscape is marred with health disparities. A type 1 diabetes (T1D) team identified only 49% of black patients were using continuous glucose monitors (CGM), compared to 77% of white patients. This demonstrates critical inequities, as it is well established that CGMs accelerate patients toward glucose targets. <h3>Objectives</h3> The aim was to achieve excellent and equitable outcomes for patients with T1D. Specifically, increase the percentage of black patients using CGM from 49% to 77%, and thereby narrow the black-white gap. <h3>Methods</h3> Quality improvement tools and multi-faceted interventions were used to activate transformative change. The team utilized failure analysis and process maps to assess the current landscape, Voice of the Customer to envision an ideal environment, a bridge tool and PDSA (Plan-Do-Study-Act) testing to bridge equity gaps (figures 1–3). <h3>Results</h3> CGM usage increased from 49% to 89% for black patients, and from 77% to 94% for white patients. Thus, narrowing the black-white gap from 28% to 5% (figure 4). <h3>Conclusion and Implications</h3> Quality improvement methodology and targeted interventions resulted in improved health outcomes. Learnings from this project can be applied in other settings to create bridges, remove barriers, and ultimately eliminate all gaps.