Impact of Quality Improvement Efforts on Race and Sex Disparities in Hemodialysis

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Abstract
Race and sex disparities in health outcomes have been extensively documented.1 For example, blacks and women are less likely to receive kidney transplantation than whites and men.2,3 By improving the process of care, quality improvement efforts have the potential to reduce race and sex disparities in health outcomes.4,5 Alternatively, the patient, clinician, and societal factors that created disparities in the first place may persist and result in a continued gap between whites and blacks (or men and women) even as outcomes for both white and black patients improve.6,7 Examples of such factors include affordability of health care, geographic access, transportation, education, knowledge, literacy, health beliefs, racial concordance between patient and clinician, patient attitudes and preferences, competing demands such as work or child care, and clinician bias.8