Relationship between health system quality and racial and ethnic equity in diabetes care

Failing to consider disparities in quality measures, such as by race and ethnicity, may obscure inequities in care, which could exist in facilities with overall high-quality ratings. We examined the relationship between overall quality and racial and ethnic disparities in diabetes care quality by healthcare facility-level performance on a diabetes-related quality measure within a national dataset of Veterans using Veterans Health Administration (VA) ambulatory care between 10/1/2019-9/31/2020, and were eligible for diabetes quality assessment. We found racial and ethnic disparities in diabetes care quality existed in top-performing VA medical centers (VAMCs) among American Indian or Alaska Native (AIAN; predicted probability = 30%), Black (predicted probability = 29%) and Hispanic VA-users (predicted probability = 30%)versus White VA-users (predicted probability = 26%). While disparities among Black and Hispanic VA-users were similar relative to white VA-users across VAMCs at all performance levels, disparities were exacerbated for AIAN and Native Hawaiian or Other Pacific Islander VA-users in bottom-performing VAMCs. Equity remains an issue even in facilities providing overall high-quality care. Integrating equity as a component of quality measures can incentivize greater focus on equity in quality improvement.