National Healthcare Disparities Report Research Articles

Advancing Diversity, Equity, and Inclusion in Scientific Publishing

Advancing Diversity, Equity, and Inclusion in Scientific Publishing

PNS103 DIRECT PRIMARY CARE: COMPARISON OF QUALITY METRICS TO AHRQ, CDC, AND HEALTHY PEOPLE 2020 INDICATORS

Direct Primary Care (DPC) is an evolving patient-centered, prevention-oriented, fixed-fee-for-membership ambulatory care model designed to facilitate direct patient-provider communication and contact. The study objective was to identify primary care quality (PCQ) metrics from electronic health records (EHR) and claims data for comparison to measures from similar populations benchmarked by the Agency for Healthcare Research and Quality’s National Healthcare Quality and Disparities Reports (AHRQ-NHQDR), the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (CDC-BRFSS), and the Office of Disease Prevention and Health Promotion’s Healthy People 2020.

Disparities by Sex Tracked in the 2015 National Healthcare Quality and Disparities Report: Trends across National Quality Strategy Priorities, Health Conditions, and Access Measures

IntroductionEstablished by the Affordable Care Act, the National Quality Strategy (NQS) is the national policy goals aimed at improving the quality of health care for all Americans. The NQS established six priorities to provide better, more affordable care for individuals and communities. This is the first analysis of data on the NQS and access measures that focus on sex differences, health conditions, trends, and disparities. MethodsMeasures from the 2015 National Healthcare Quality and Disparities Report (QDR) for the four National Quality Strategy priorities (Patient Safety, Person Centered Care, Effective Treatment, and Healthy Living), access to care, and health conditions for women were compared to measures for men. Trends were analyzed for women by health condition and the four NQS priorities and access to care. Baseline year (2000-2002) and most current year (2012-2013) were compared to assess disparity trends. All non-institutionalized women and men in the U.S. over the age of 18 were included in the sample. ResultsDisparities between males and females for the four NQS priority and access measures did not change for 83 percent of measures (n=81); disparities remained constant. The greatest improvement over time for females from the baseline year was in the patient safety measures (3.66 percent increase per year). Access of care measures showed the least amount of improvement with a median change of -1.20 percent per year. The greatest improvement in quality of care by health condition was amongst chronic kidney disease (11.95 median percent change) and HIV/AIDS (6.63 median percent change) measures. Behavioral health measures showed the least amount of improvement with a median change of -0.33 percent per year. ConclusionsThis analysis highlights cardiovascular disease, behavioral health, and access to care as problem areas for women that require immediate attention. It is of concern that 83% of the measures showed a persistent disparity over time between men and women. These results indicate that there is room for improving the quality of healthcare received by women and reducing sex-based disparities experienced by women in the healthcare delivery system.

Abstract P309: Vulnerabilities to Health Disparities and Statin Use in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Introduction: Statins reduce the incidence of major cardiovascular disease events, but many individuals do not receive them. The AHRQ National Healthcare Disparities Report identifies several vulnerable populations, but few studies have examined statin use from the perspective of the presence of multiple vulnerabilities in the same individual. Hypothesis: A greater number of vulnerabilities is associated with lower statin use. Methods: This study used data from the REGARDS study, which included 30,239 adults of age 45 and older recruited between 2003 and 2007 from the 48 contiguous US states. Baseline data included a 45-minute telephone interview and an in-home visit. Vulnerabilities included older age, black race, being a woman, rural/small city residence, area level poverty, Southeastern residence, and lack of health insurance. Prevalence ratios were estimated from Poisson models and adjusted for factors influencing health services utilization (education, awareness of hyperlipidemia, medication adherence, cigarette smoking, depressive symptoms, obesity, high-density lipoprotein cholesterol, physical functioning and Adult Treatment Panel III Framingham Risk Group). Results: The study sample included 18,047 individuals of mean age 65.8 years with indications for statin therapy; 41.7% were black, 50.8% were women, 8.7% lived in a rural area/small city, 25.2% lived in areas with >25% of residents living below the Federal poverty line, 55.0% lived in the Southeastern states and 6% did not have health insurance. Older age, being black, being a woman, area level poverty, and health insurance were significantly associated with lower statin use. Statin use decreased as the number of vulnerabilities increased. Conclusions: A greater burden of healthcare disparity vulnerabilities was associated with a graded pattern of lower statin use. Individuals with multiple vulnerabilities have the greatest risk of under treatment and should be targeted for intervention.

Racial and Ethnic Disparities in the Quality of Health Care

The annual National Healthcare Quality and Disparities Reports document widespread and persistent racial and ethnic disparities. These disparities result from complex interactions between patient factors related to social disadvantage, clinicians, and organizational and health care system factors. Separate and unequal systems of health care between states, between health care systems, and between clinicians constrain the resources that are available to meet the needs of disadvantaged groups, contribute to unequal outcomes, and reinforce implicit bias. Recent data suggest slow progress in many areas but have documented a few notable successes in eliminating these disparities. To eliminate these disparities, continued progress will require a collective national will to ensure health care equity through expanded health insurance coverage, support for primary care, and public accountability based on progress toward defined, time-limited objectives using evidence-based, sufficiently resourced, multilevel quality improvement strategies that engage patients, clinicians, health care organizations, and communities.

Racial/Ethnic disparities in patient experience with communication in hospitals: real differences or measurement errors?

An important aspect of medical care is clear and effective communication, which can be particularly challenging for individuals based on race/ethnicity. Quality of communication is measured systematically in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, and analyzed frequently such as in the National Healthcare Disparities Report. Caution is needed to discern differences in communication quality from racial/ethnic differences in perceptions about concepts or expectations about their fulfillment. To examine assumptions about the degree of commonality across racial/ethnic groups in their perceptions and expectations, and to investigate the validity of conclusions regarding racial/ethnic differences in communication quality. We used 2007 HCAHPS data from the National CAHPS Benchmarking Database to construct racial/ethnic samples that controlled for other patient characteristics (828 per group). Using multiple-groups confirmatory factor analyses, we tested whether the factor structure and model parameters (ie, factor loadings, intercepts) differed across groups. We identified support for basic tests of equivalence across 7 racial/ethnic groups in terms of equivalent factor structure and loadings. Even stronger support was found for Communication with Doctors and Nurses. However, potentially important nonequivalence was found for Communication about Medicines, including instances of statistically significant differences between non-Hispanic whites and non-Hispanic blacks, Asians, and Native Hawaiian/other Pacific Islanders. Our results provide strongest support for racial/ethnic comparisons on Communication with Nurses and Doctors, and reason to caution against comparisons on Communication about Medicines due to significant differences in model parameters across groups; that is, a lack of invariance in the intercept.

Reframing the Disparities Agenda: A Time to Rethink, a Time to Focus

The release of the Institute of Medicine’s reports Unequal Treatment: Confronting Racial and Ethnic Disparities in Health and Crossing the Quality Chasm: A New Health System for the 21st Century over a decade ago led to numerous efforts in programs, practice, and research to improve health equity and health care quality.1,2 The pediatric community has been in the forefront of this effort providing “high touch” community participatory efforts to reduce health disparities among children. However, the article in this month’s Academic Pediatrics by Dougherty and colleagues describing broad trends using the 2011 National Healthcare Quality Report (NHQR) and National Healthcare Disparities Report (NHDR) database highlight that at the macro level, little measurable change has occurred.

Child and Adolescent Health Care Quality and Disparities: Are We Making Progress?

ObjectiveChildren and adolescents are known to experience poor health care quality; some groups of children have poorer health care than others. We sought to examine trends over time in health care quality and disparities by race, Hispanic ethnicity, income, insurance, gender, rurality, and special health care needs. MethodsSource data were extracted from the 2011 National Healthcare Quality Report (NHQR) and National Healthcare Disparities Report (NHDR) database, which contains aggregated data from many government and private sources for the years 2000 through 2009. The NHQR and NHDR approaches to calculating disparities and trends in quality and disparities were used. Within each quality measure with available data, results for demographic subgroups of children characterized by race/ethnicity, income, insurance, residence, special health care need, and gender were compared to those of a reference group to determine whether disparities existed and whether disparities had changed over time. ResultsOf 68 measures with data for calculating potential disparities, 50 showed disparities in quality for at least 1 comparison subgroup in the most recent year of data available, while 18 measures showed no such disparities. Of the 50 measures with current disparities, 39 measures had sufficient data to calculate trends. Among the 137 comparisons made within these 39 measures, there was no change in disparities over time for 126 comparisons, 3 comparisons worsened, and 8 comparisons improved. ConclusionsThere was some progress in health care quality and reducing disparities in children's health care quality from 2000 to 2009; opportunities for targeting improvement strategies remain.

The Population Value Of Quality Indicator Reporting: A Framework For Prioritizing Health Care Performance Measures

The Agency for Healthcare Research and Quality (AHRQ) National Healthcare Quality and Disparities Reports contain more than 250 quality indicators, such as whether a patient with a suspected heart attack received an aspirin. The Department of Health and Human Services National Quality Measures Clearinghouse identifies more than 2,100 such indicators. Because resources for making quality improvements are limited, there is a need to prioritize among these indicators. We propose an approach to assess how reporting specific quality indicators would change care to improve the length and quality of life of the US population. Using thirteen AHRQ quality indicators with readily available data on the benefits of indicator reporting, we found that seven of them account for 93percent of total benefits, while the remaining six account for only 7percent of total benefits. Use of a framework such as this could focus resources on indicators having the greatest expected impact on population health.

Effects of Race and Language on Patient-Centered Cancer Nursing Care and Patient Outcomes

Nursing prides itself on the ability to advocate for patients. However, questions are raised in the National Health Care Disparities Reports from the Agency for Healthcare Research and Quality about how well nurses communicate with African Americans, Hispanics, and people who speak languages other than English. Our secondary analysis of patient data collected at an urban safety-net hospital oncology unit examined the relationships among race, language, patient-centered nursing care, and patient outcomes. Using path modeling techniques, findings indicate that patient-centered care and associated outcomes for African American/Black and Others differ from those for Whites. For the African American/Black and Others group, individualization played a more significant role in achieving a sense of well-being, optimism, and authentic self-representation. Patients who spoke a language other than English at home had different perceptions of their nurses' responsiveness; nurses' responsiveness in turn affected patients' trust in nurses. Future testing is recommended for relationships between patient-centered nursing care and patient outcomes in underserved populations.

Commentary: Measuring What Matters Most

We read with great interest Frank and Haw's (2011) “best practice” guidelines for monitoring socioeconomic inequalities in health status because of its direct relevance to our work on the National Healthcare Disparities Report. The National Healthcare Disparities Report is an annual report mandated by Congress on “prevailing disparities in health care delivery as it relates to racial factors and socioeconomic factors” (AHRQ 2012). Our agency, the Agency for Healthcare Research and Quality (AHRQ), leads the production of the report and its companion report, the National Healthcare Quality Report, which focuses on quality of care. Together, the reports track about 250 measures of health care quality and access to provide a snapshot of health care in the United States and to assess changes in health care quality and disparities over time.

Taking the Measure of Health Care Disparities

Despite growing public and private efforts to reduce disparities in health care, these disparities persist in the United States. Soon after the Institute of Medicine (IOM) Unequal Treatment report systematically documented disparities in multiple components of the health care system (Smedley, Stith and Nelson 2003), Congress mandated the Agency for Healthcare Research and Quality to monitor national trends in health care disparities through the annual National Healthcare Disparities Report (Agency for Healthcare Research and Quality 2011). For health services researchers and policy makers, numerous methodological challenges have arisen in identifying disparities in health care, tracking them over time, understanding their underlying mechanisms, and evaluating the effects of practices and policies to reduce them.

Cultural competency in health care: Web sites for health care providers and educators

As the United States becomes more culturally diverse, inequities in health care have been identified. It is a sad truth that, for Americans, the quality of health care received varies greatly depending on race, ethnicity, ability to speak English, socioeconomic group, or place of residence (especially if it is rural). One organization bridging this gap is the Agency for Healthcare Research and Quality, which for the past eight years has published the National Healthcare Disparities Report detailing trends in health care equity and identifying inequalities. In it, for example, readers can find that Blacks, American Indians, and Alaska Natives…

Health Information Technology and Disparities in Quality of Care

Health Information Technology and Disparities in Quality of Care

Families Are Key in Improving Quality

From Family Voices, Inc, Lexington, MA (Ms Wells); and National Partnership for Women and Families Washington, DC (Ms Partridge) The opinions expressed herein are those of the authors and do not necessarily represent the views of the US Department of Health and Human Services, the Agency for Healthcare Research and Quality, or the Centers for Medicare & Medicaid Services. The authors have no conflicts of interest to disclose. Publication of this article was supported by the US Department of Health and Human Services or the Agency for Healthcare Research and Quality. Address correspondence to NoraWells, MSEd, Family Voices, Inc, c/o ERG, 110, Hartwell Avenue, Lexington,Massachusetts 02421 (e-mail: nwells@familyvoices.org).

Meaningful Disparities Reduction Through Research and Translation Programs

Health care disparities are unacceptable, but progress toward reducing them has been painfully slow. Each year the Agency for Healthcare Research and Quality's (AHRQ’s) National Healthcare Disparities Report documents persistent differences in care by factors such as race, ethnicity, and insurance status. 1 Public awareness of these disparities is growing, and the Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010 will hasten transparency by encouraging collection of race, ethnicity, and language data. However, recognizing the existence of disparities is not sufficient to catalyze meaningful action. Even the most motivated clinicians and health care organizations may not know how to proceed because information on which interventions work in specific contexts or at scale is limited. 2 There is broad agreement that meaningful efforts to reduce disparities are linked inextricably to quality improvement. In its 2001 report Crossing the Quality Chasm, the Institute of …

Telehealth for Communities: Toward Eliminating Rural Health Disparities

The National Healthcare Disparities Report (NHDR) (2007) documents issues in both quality of healthcare and access to healthcare providing information to policymakers, clinicians, administrators, and community leaders for the improvement of health. From this report it is apparent that disparities in healthcare still exist and that many opportunities for improvement remain across racial, ethnic, socioeconomic and geographical groups. One priority population is the rural, medically underserved areas. Residents of rural areas experience more health disparities than residents of urban areas (NHDR, 2007).

Disproportionate Use of Psychiatric Emergency Services by African Americans

Disproportionate Use of Psychiatric Emergency Services by African Americans

Racial/Ethnic and Socioeconomic Disparities in Access to Care and Quality of Care for US Health Center Patients Compared With Non–Health Center Patients

This study aims to compare racial/ethnic and socioeconomic disparities in access to care and quality of care for US health center patients and non-health center patients. Data for the study came from the 2002 Community Health Center User Survey and the 2003 National Healthcare Disparities Report. Descriptive analysis was performed using nationally representative survey data pertaining to access to care and quality of care for people of different races, ethnicities, incomes, and education levels. Results of the study show that health center patients experience fewer racial/ethnic and socioeconomic disparities in access to care and quality of care, compared with non-health center patients nationally. Racial/ethnic disparities favoring whites occur in non-health center patients in every measure of quality and access included in this study. Conversely, there are few disparities favoring whites among health center users. Education and income-related disparities occur for several measures of access and quality in both health center and non-health center patients; however, the magnitude of these disparities is usually greater among non-health center patients compared with health center patients. In conclusion, health centers have been touted for cost-efficient, high-quality care. This study adds to growing evidence that health centers may also help eliminate racial/ethnic and socioeconomic disparities in access to care and quality of care.

Racial and Ethnic Health Disparities in TRICARE

As a major provider of health care for racial and ethnic minority groups, the federal government has affirmed its commitment to the elimination of health disparities. Although numerous studies have examined health care disparities in various federal systems of care, few have examined these issues within TRICARE, the Department of Defense (DoDJ's program for providing health care coverage to members of the uniformed services and their dependents. This study provides an exploratory analysis examining apparent disparities in health status, access to and satisfaction with care, and use of preventive care using the 2007 Health Care Survey of DoD Beneficiaries. Analyses compare outcomes by race/ethnicity and between TRICARE beneficiaries and national norms derived from the National Consumer Assessment of Health Plans Study Benchmarking Database and the National Healthcare Disparities Report, and are stratified by duty status. Compared to black non-Hispanics, a higher proportion of white non-Hispanic active-duty and retiree TRICARE beneficiaries reported good to excellent health status. However, on most measures, we found no differences between white non-Hispanic beneficiaries and members of racial/ethnic groups. When differences did exist, minority populations were likely to report better access to and use of services than whites. Although health disparities exist in health status and some measures of preventive care, black non-Hispanics and Hispanics often receive more equitable care under TRICARE than in the nation as a whole. These findings suggest the need to explore the characteristics of TRICARE that may be associated with more-favorable outcomes for racial and ethnic minority groups.