discussion of quality, disparities, and health literacy. Race, gender, class, and age can define us as well as divide us. Yet, to improve quality, reduce health disparities, and enhance health literacy, the principles of equity and patient-centeredness in health care must drive the discussion of health care reform.

The reports To Err Is Human: Building a Safer Health System (IOM, 2000) and Crossing the Quality Chasm: A New Health System for the 21st Century (IOM, 2001) focused attention on the need to improve the quality of health care in the United States. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (IOM, 2003) explored the ways in which race and ethnicity are significant predictors of the quality of health care received. This report also highlighted the importance of not exacerbating the health disparities that do exist in the pursuit of quality. Finally, Health Literacy: A Prescription to End Confusion (IOM, 2004) highlighted the importance of health literacy to health outcomes and the provision of high-quality health care and illustrated the need for communication in the health care context that is clear and effective. Together, these reports illustrate that reducing health disparities and improving health literacy are important components of increased quality in health and health care for the American public.

While the reduction of health care disparities focuses on populations experiencing and suffering from inequities, its impact is much broader. Interventions to improve access to care and quality of care for populations experiencing the greatest disparities can also positively affect others. For example, ramps for the disabled can also be used by those pushing strollers, and large print and more “plain English” signs and labels are beneficial to those with vision impairments and low health literacy, thereby benefiting us all. Ultimately, reduction of health care disparities requires that prevention of disease and morbidity be addressed, requiring broader and longer-term interventions at the population and community levels.

Similarly, many interventions that address the needs of specific populations can benefit other populations, as providers can learn to adapt these skills in the care of all patients, allowing for clearer, more effective communication and increased patient understanding and engagement in their own treatment and care. Efforts to make the health care system more equitable can therefore benefit the whole population, not just targeted populations. Achieving equity requires changes at the systems level not for the purpose of segregating the population but rather for the purpose of respecting patients’ cultural, spiritual, and religious beliefs and individual needs.

To examine the role of quality improvement in improving health

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