National Healthcare Disparities Report Research Articles

Issue Overview

Issue Overview Claudia Baquet, MD, MPH (bio) and Ronald L. Braithwaite, PhD This special issue of the Journal of Health Care for the Poor and Underserved (JHCPU) highlights a few of the daunting health disparity (HD) issues that affect underserved and racially or ethnically diverse communities, including African American, underserved and Samoan communities. Health disparities are related to a wide range of complex factors requiring systematic and consistent approaches that include focus on reduction and elimination of inequities in health and resources. Multidisciplinary and interdisciplinary teams of researchers, communities, health professionals, nontraditional practitioners and policymakers have roles in ensuring the use of evidence-guided solutions that can close and eliminate gaps in prevention, and access to high-quality, affordable, and culturally appropriate public health practices, health care, and medical resources. Now, more than ever, there are tremendous opportunities to foster and implement solutions to eliminate disparities in health that have been reported for decades. Part of the approach requires the translation to clinical practice and community benefit of what we know works. Federal, state and community-based programs have produced a wealth of creativity and commitment to addressing these complex issues. The National Institutes of Health (NIH), including the National Center on Minority Health and Health Disparities (NCMHD) and the National Cancer Institute (NCI), have launched scientific investigations, community-academic research, and outreach partnerships focusing on disproportionate disease and discovery, development, delivery, and community engagement. The 2007 National Healthcare Disparities Report,1 released by the Agency for Healthcare Research and Quality (AHRQ) on behalf of the US Department of Health and Human Services, noted three major trends in health disparities; recognizing them may shed light on factors contributing to racial/ethnic health differences discussed in the manuscripts in this issue. Specifically, AHRQ noted: (1) overall disparities in heath care quality and access are not declining; (2) despite some progress, many of the larger gaps in quality and access have not been reduced; and (3) the problem of people being uninsured continues to be a major barrier to disparity reduction. This issue of JHCPU includes several articles related to cancer, and others concerning a range health conditions and diseases. Emphasis is placed on the work by Baquet and [End Page 1] colleagues at the University of Maryland, where an analysis of cancer patient participation in NCI-supported cancer treatment clinical trials is assessed as part of an overall focus on assuring diversity in clinical research participation. Nationally, African Americans and other underserved and rural communities are underrepresented in clinical trials. In a second article, attention is given to a descriptive analysis of state legislation and policies addressing clinical trial participation and coverage. A third cancer-related manuscript addresses the impact of an emerging behavioral science practice of using community-based participatory engagement among Samoan women to increase their participation in Pap smear screenings, and a fourth article examines colorectal cancer among African Americans. Other health disparity concerns addressed in the issue include studies on substance abuse and HIV dynamics in South Africa and in U.S. correctional systems. Hayes and colleagues report on health knowledge, attitudes, and behaviors within historically Black college and university students. Bramble and colleagues report on research into the eating habits of Afro-Caribbean and African American women and related obesity outcomes. Finally, K. Braithwaite and C. Xanthos address mental health disparities across underserved populations and implications for policy reform. Researchers have known for many years that the overall health status of Black Americans is substantially worse than that of White Americans. African Americans have a shorter life expectancy than the average in the U.S., which instead resembles average life expectancy in developing nations. Disease mortality and morbidity continue to increase, given the disparities in income, medical coverage, and access to care, thus making African Americans more susceptible to negative health conditions (e.g., homicide, HIV/AIDS, and respiratory disease, which are not suffered to the same magnitude by their White counterparts). Countless examples of inequities in health and social economic resources are also evident for Native Americans, Latinos, and Pacific Islander populations. While this issue of the JHCPU reports on a few of the mounting health disparity concerns affecting people of color, there is a...

Health Disparities: Examination of Evidence Relevant for Occupational Therapy

Healthy People 2010 identified elimination of health disparities as a national priority. Few studies in the occupational therapy literature document health disparities. The purpose of this study was to examine the evidence on U.S. health disparities with specific relevance to occupational therapy and by racial/ethnic groups and income levels. National survey data were used to identify variables related to occupational performance or occupational therapy services that showed evidence of disparities. Data on U.S. citizens included health and behavioral characteristics, activity profiles, home and work environments, experiences in health systems, and outcomes of health care services. On many variables, the nature of differences for non-White groups and lower income-level groups provide evidence of health disparities. The findings support the National Healthcare Disparities Reports, which concluded that health disparities are still prevalent in the United States, and opportunities remain in health professions, like occupational therapy, to improve the health of all citizens.

Linking Equitability to Quality

Over the past decade, many initiatives have been directed toward eliminating racial and ethnic disparities in healthcare. Despite these efforts, the 2007 National Healthcare Disparities Report revealed that overall disparities in healthcare quality and access have not decreased. Although the disparities described vary in magnitude by category and population, they were identified in almost every aspect of healthcare. Improving the quality of care may not reduce disparities; therefore, ensuring the collection of better patient reported race and ethnicity data, whereas linking it to clinical performance may be one of the first challenges to overcome. Eliminating disparities in healthcare is particularly important in the provision of pediatric care because children of immigrant families are the fastest growing sector of the pediatric population in the United States. This article describes an approach to the stratification of nursing-sensitive measures by race, ethnicity, and insurance group, which integrally links cultural competence to quality of care, identifies disparities in patient outcomes related to nursing care, and informs the development of tailored interventions to meet the needs of diverse patients and their families.

Women's Narratives on Quality in Prenatal Care: A Multicultural Perspective

Although significant progress has been made to increase prenatal care access, national organizations concerned with health equity emphasize that eliminating disparities will require greater attention to quality of care, assessed from both the biomedical and patient perspectives. In this study, we examined narratives about pregnancy experiences from low-income primiparous African American, Mexican American, Puerto Rican, and White women who participated in focus groups conducted in 1996. We reanalyzed transcripts from these discussions, extracting passages in which women talked about the content and quality of their prenatal care experiences. Data were mapped to four domains reflecting patient-centeredness markers identified in the 2005 U.S. National Healthcare Disparities Report (NHDR). These markers include the extent to which the women perceived that their provider listened carefully, explained things, showed respect, and spent enough time with them. The narratives provided by the study participants suggest a critical and intuitive understanding of the NHDR patient-centeredness markers and some shared understanding across cultural groups. Implications for improving quality and its measurement in prenatal care are discussed.

Measuring Trends in Mental Health Care Disparities, 2000 2004

Measuring Trends in Mental Health Care Disparities, 2000 2004

Development of Systems of Care for ST-Elevation Myocardial Infarction Patients

Creating an ideal system of care to address the care forpatients with ST-elevation myocardial infarction (STEMI) iscomplex from both the system’s and patient/family’s perspec-tives. In general, this care is unlike most other hospital care.It typically involves very fast and complex decision makingand, often, sudden transportation to another facility forpercutaneous coronary intervention (PCI). All of this occurswith a potentially critically ill patient and at a time when thefamily is often not immediately available. In this report, weaddress key perspectives from the patient and public point ofview of the current system of care for STEMI patients andhighlight the barriers and gaps that must be addressed by anideal system of care (Table 1).

AHRQs National Healthcare Quality and Disparities Reports: An Ever‐Expanding Road Map for Improvement

In my April 2006 AHRQ Update (Clancy 2006) I discussed enhancements to the National Healthcare Quality Report (NHQR 2006) and the National Healthcare Disparities Report (NHDR 2006), annual reports produced by the Agency for Healthcare Research and Quality (AHRQ). In this issue, my colleagues and I would like to continue our conversation with you about these reports which have become vitally important tools in our efforts to eliminate heath care disparities and improve the quality of health care services. Since I last wrote about them in this journal, we have an additional year of trend data for many of the measures included in the reports, and we released a new website which provides quality, and some disparities data by state, and we are poised to release a new online resource that will make national health care quality and disparities data even more accessible. For those of you who are new to these reports, a little background: the NHQR and NHDR are congressionally mandated reports that have been produced by AHRQ since 2003. The latest versions were presented to Congress in January 2007. The quality report, examines the quality of health care system, as indicated by quality measures such as the proportion of heart attack patients who receive recommended care when they arrive at a hospital. Its companion, the disparities report, summarizes the same information according to various racial, ethnic, and income groups that are most likely to benefit from improvements in health care. The two reports—the fourth annual reports—are published together because it is important to consider overall health care quality improvement in conjunction with the disparities that continue to plague our health care system.

Research Issues for Improving Treatment of U.S. Hispanics With Persistent Mental Disorders

Research Issues for Improving Treatment of U.S. Hispanics With Persistent Mental Disorders

The Agency for Healthcare Research and Quality’s National Healthcare Quality and Disparities Reports: Action Agendas for the Nation

The Agency for Healthcare Research and Quality’s National Healthcare Quality and Disparities Reports: Action Agendas for the Nation

AHRQs National Healthcare Quality and Disparities Reports: Resources for Health Services Researchers

Health Services ResearchVolume 41, Issue 2 p. xiii-xx AHRQs National Healthcare Quality and Disparities Reports: Resources for Health Services Researchers Carolyn M. Clancy, Carolyn M. ClancySearch for more papers by this author Carolyn M. Clancy, Carolyn M. ClancySearch for more papers by this author First published: 09 March 2006 https://doi.org/10.1111/j.1475-6773.2006.00539.xCitations: 5Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume41, Issue2April 2006Pages xiii-xx RelatedInformation

Quality of health care for older women: What do we know?

As the proportion of the population age 65 and over continues to grow--to a projected 20.5% or 77.2 million by the year 2040--tracking the quality, access, and receipt of care for older women becomes more important, since the majority of older citizens are women. This article establishes a rough baseline for the quality of care, primarily preventive care, received by older women compared to older men, using selected measures and data of the 2004 National Healthcare Quality Report and National Healthcare Disparities Report. It highlights significant differences between women and men, as well as differences for racial, ethnic, and educational subgroups. Generally, older non-Hispanic white women frequently score higher than their Hispanic and non-Hispanic black counterparts, and more educated women often score significantly higher than their less-educated peers on several measures of quality of care. Compared to their male counterparts, older women are significantly less likely to have any colorectal screening test, to keep high blood pressure under control, and to receive aspirin or beta-blockers upon hospital admission or discharge for acute myocardial infarction. Results are mixed for the process measures related to diabetes, but improvements are clearly needed toward increased rates of eye and foot examinations. Rates of influenza and pneumococcal vaccinations are low but can be improved through Medicare-covered services. We also found that older women are screened less often for breast cancer than those ages 40 to 64. There is still a pervasive lack of knowledge in the research and clinical communities about the unique health care needs of and appropriate processes of care for older adults. More research needs to focus on the quality of care for this growing population in order to allow the development of geriatric-based quality measures and models of care that will set the standards of healthcare for older adults in general, and older women in particular.

Gender differences across racial and ethnic groups in the quality of care for diabetes

High-quality care for diabetes is based on proper prevention, coordination of care among a multidisciplinary team of health care professionals, enhanced patient-provider relationships, and patient self-management skills. This paper discusses gender differences across racial and ethnic groups in the quality of care for type 2 diabetes according to 10 measures defined by the National Healthcare Quality Report and the National Healthcare Disparities Report. These measures include 5 process measures and one composite measure derived from the Medical Expenditure Panel Survey and 4 outcome measures derived from the Healthcare Cost and Utilization Project. National rates for 2 process measures--measurement of HbA1c (women 89.70% versus men 90.10%) and lipid profile (women 92.9% versus men 95.3%)--are high, but only 28.9% of women and 33.9% of men with diabetes received all 5 recommended process measures (HbA1c, lipid profile, eye exam, foot exam, and influenza immunization). Screening rates for retinal and foot exams and influenza immunization should be improved for all, but the need is particularly urgent for Hispanics and non-Hispanic blacks. Women and men have similar rates of hospital admissions for uncontrolled diabetes, but rates for lower extremity amputations were higher for men, particularly non-Hispanic blacks and Hispanics. Avoidable hospitalizations for diabetes decreased as income increased across racial/ethnic groups, but other factors (e.g., quality of primary care, age, relationship with providers, patients' self-management skills) may influence such rates. Moreover, any improvements in the diabetes outcomes measures may lag many years behind any measurable improvements in quality of care. Well-designed interventions that reallocate resources for diabetes self-care should be developed to ensure that gender differences are addressed across racial/ethnic groups. Because much of this care involves the management of risk factors, self-management education should be tailored to the lifestyles and beliefs specific to gender and racial/ethnic groups.

Racial and Ethnic Differences in Patient Assessments of Interactions With Providers: Disparities or Measurement Biases?

Patient assessment surveys have established a primary role in health care quality measurement as evidence has shown that information from patients can affect quality improvement for practitioners and lead to positive marketwide changes. This article presents findings from the recently released National Healthcare Disparities Report revealing that although most clinical quality and access indicators show superior health care for non-Hispanic whites compared with blacks and Hispanics, blacks and Hispanics assess their interactions with providers more positively than non-Hispanic whites do. The article explores possible explanations for these racial/ethnic differences, including potential pitfalls in survey design that draw biased responses by race/ethnicity. The article then suggests strategies for refining future research on racial/ethnic disparities based on patient assessment of health care.

Gaps in Data for American Indians and Alaska Natives in the National Healthcare Disparities Report

The aim of this study was to identify and quantify gaps in health care data for American Indians and Alaska Natives. Findings indicate that only 42% of measures of health care quality and access tracked in the National Healthcare Disparities Report could be used to assess disparities among American Indians and Alaska Natives. Patient safety data was especially limited. Data from American Indians and Alaska Natives need to be improved to allow better targeting of interventions to reduce health care disparities and monitoring the success of these activities.

Balancing the Nation’s Health Care Scorecard: The National Healthcare Quality and Disparities Reports

In January 2005, the U.S. Agency for Healthcare Research and Quality (AHRQ) released the congressionally mandated reports on the United States health care system--the 2004 National Healthcare Quality and Disparities Reports (NHQR and NHDR). They are intended to summarize the current state of the science of health care quality and disparities for a broad audience, including providers, consumers, researchers, and policy makers. The NHQR and NHDR are designed as balanced scorecards, yet measure imbalance is evident with respect to relative attention to the quality dimensions, condition/clinical areas, and priority population. For example, heart disease and nursing home/home health each represent more than 20 measures of the total of 179 measures, whereas mental health and HIV/AIDS care are tracked with a total of six. The measures making up the scorecards are derived directly from current national initiatives aimed at improving specific performance measures in hospitals, nursing homes, and home health agencies, which facilitates performance benchmarking at different levels of the health care system. Much work remains to be done if these reports are to be used to their fullest potential as balanced scorecards for the United States.

The Quality of Preventive Medical Care for Homeless Veterans with Mental Illness

The 2003 National Healthcare Disparities Report underscored the need for performance measurement of evidence-based preventive services for at-risk populations. This study compares receipt of primary care prevention services among homeless and nonhomeless veteran patients who received Veterans Affairs (VA) medical care services. The study used chart review data on a national sample of 94,932 veterans with chronic medical conditions whose care was reviewed through the VA External Peer Review Program during 1998 and 1999. Receipt of eight preventive services was examined: two measures of immunization, four of cancer screening, and two of tobacco use and counseling. In risk-adjusted models, recently homeless veterans received 9% fewer prevention services for which they were eligible. Modest differences in receiving prevention services between domiciled and recently homeless veterans suggest that targeted efforts are needed to facilitate access to needed medical services in this population.

Information technology as a tool to improve the quality of American Indian health care.

The American Indian/Alaska Native population experiences a disproportionate burden of disease across a spectrum of conditions. While the recent National Healthcare Disparities Report highlighted differences in quality of care among racial and ethnic groups, there was only very limited information available for American Indians. The Indian Health Service (IHS) is currently enhancing its information systems to improve the measurement of health care quality as well as to support quality improvement initiatives. We summarize current knowledge regarding health care quality for American Indians, highlighting the variation in reported measures in the existing literature. We then discuss how the IHS is using information systems to produce standardized performance measures and present future directions for improving American Indian health care quality.

Disparities in access to infertility services in a state with mandated insurance coverage

The objective of our study was to examine the demographic and socioeconomic characteristics of patients accessing infertility services in a state (Massachusetts) with mandated and comprehensive insurance coverage for such services. Even in a state with such insurance coverage, disparities in access to infertility services exist, with the majority of individuals accessing those services being Caucasian, highly educated, and wealthy.

Pediatric appendicitis rupture rate: a national indicator of disparities in healthcare access

BackgroundThe U.S. National Healthcare Disparities Report is a recent effort to measure and monitor racial and ethnic disparities in health and healthcare. The Report is a work in progress and includes few indicators specific to children. An indicator worthy of consideration is racial/ethnic differences in the rate of bad outcomes for pediatric acute appendicitis. Bad outcomes for this condition are indicative of poor access to healthcare, which is amenable to social and healthcare policy changes.MethodsWe analyzed the KID Inpatient Database, a nationally representative sample of pediatric hospitalization, to compare rates of appendicitis rupture between white, African American, Hispanic and Asian children. We ran weighted logistic regression models to obtain national estimates of relative odds of rupture rate for the four groups, adjusted for developmental, biological, socioeconomic, health services and hospital factors that might influence disease outcome.ResultsRupture was a much more burdensome outcome than timely surgery and rupture avoidance. Rupture cases had 97% higher hospital charges and 175% longer hospital stays than non-rupture cases on average. These burdens disproportionately affected minority children, who had 24% – 38% higher odds of appendicitis rupture than white children, adjusting for age and gender. These differences were reduced, but remained significant after adjusting for other factors.ConclusionThe racial/ethnic disparities in pediatric appendicitis outcome are large and are preventable with timely diagnosis and surgery for all children. Furthermore, estimating this disparity using the KID survey is a relatively straightforward process. Therefore pediatric appendicitis rupture rate is a good candidate for inclusion in the National Healthcare Disparities Report. As with most other health and healthcare disparities, efforts to reduce disparities in income, wealth and access to care will most likely improve the odds of favorable outcome for this condition as well.

Populations at risk

Populations at risk