National Healthcare Disparities Report Research Articles

Children??s Health Care in the First National Healthcare Quality Report and National Healthcare Disparities Report

The first National Healthcare Quality Report (NHQR) and National Healthcare Disparities Report (NHDR) are landmark events for children's health care quality and are expected to stimulate local measurement, benchmarking, and quality improvement efforts. The authors select findings from the NHQR and NHDR, focusing on topics reflecting a range of health care and health care settings affecting children. They highlight disparities by race/ethnicity, socioeconomic status, and insurance source. They critique the first NHQR and NHDR from a child health perspective. SELECT NHQR/DR FINDINGS: Quality-of-care issues in the effectiveness domain were identified for black infant mortality, low and very low birth weight rates, antibiotic use for the common cold, and childhood hospitalizations for asthma. Immunization rates have improved. Patient centeredness and timeliness results vary by race, ethnicity and income. The NHDR found that Hispanic and low-income children are most likely to be uninsured for part of the year. Groups of children most likely to have public coverage are American Indian/Alaska native, black, and Hispanic. CRITIQUE OF REPORTS: The structure and criteria used for the first reports limit their usefulness from a child health perspective. A basic problem is that the conceptualizations of health and health care that are driving national initiatives on quality are based largely on an adult chronic care model focused on conditions with high expenditures as treated in the mainstream health care delivery system. NHQR and NHDR provide essential information on children's health care quality. Future reports can be improved by including child-relevant perspectives in priority-setting and data-gathering efforts.

Measurement Challenges in Developing the National Healthcare Quality Report and the National Healthcare Disparities Report

The objective of this study was to describe 2 measurement challenges faced in the development of the National Healthcare Quality Report (NHQR) and the National Healthcare Disparities Report (NHDR): the use of federal data on race and ethnicity and the selection of measures of socioeconomic status (SES). Over 30 federal and nonfederal data systems were examined to identify measures of race, ethnicity, and SES and to evaluate the characteristics and relative quality of the data. The availability and quality of data on race, ethnicity, and SES vary by factors such as the type of data (population or establishment based-survey, administrative/claims data, or vital statistics), the source of information (self, proxy, other, or some combination), and the transition to new federal standards. No single measure of SES could be identified, so a mix of measures is presented, including income, education, and expected source of payment (ESOP). Income relative to federal poverty level was used as the preferred SES measure from person-based surveys. Selected analyses linking hospital discharge data to annual median household income from US census data were presented for data derived from administrative data systems. Educational attainment was the variable used for examining SES using data from the Vital Statistics System. The first NHQR and NHDR maximized the presentation of data by accommodating the variation among data systems while at the same time imposing some standardization in the coding and classification of data on race, ethnicity, and SES.

NHQR/NHDR Measures for Women of Reproductive Age

This article addresses measures of importance to women of reproductive age in the first National Healthcare Quality Report (NHQR) and National Healthcare Disparities Report (NHDR). The authors review each of the 4 components of quality of care: effectiveness, safety, timeliness, and patient centeredness. The effectiveness component topics with relevance to women of childbearing age include breast cancer, cervical cancer, HIV, AIDS, mental health, and maternity care. The safety component includes 3 relevant measures of obstetric trauma. The quality aspects of timeliness of care and patient centeredness will be discussed in terms of women, although the NHQR and NHDR did not include them as a separate topic because the data were so limited regarding women. There is a foundation of knowledge about many aspects of quality health care for women of reproductive age. However, gaps are evident in some measures, usually due to insufficient data. Further development of the measure set would benefit from additional process and outcome variables that can link screening, diagnosis, and treatment with health outcomes. Such linkages will expand our knowledge and capability to improve health outcomes for women of reproductive age.

Health care disparities in cardiovascular disease: A focus on gender

Abstract Heart disease remains the number one killer of women; stroke is number three.1 Despite significantadvances in the diagnosis and treatment of cardiovascular disease (CVD), women remain at risk—in black and Hispanic women, that risk is disproportionately higher than in white women. Awareness of disparities in health care has been stimulated in part by two sweeping reports. The first, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care” released by the Institute of Medicine (IOM) in 2002, brought the issue of health care disparities prominently into our national consciousness.2 The second, the “National Healthcare Disparities Report” (NHDR),3 was prepared by the Agency for Healthcare Research and Quality (AHRQ) in response to a mandate from Congress for an annual publication regarding the inconsistencies of health care delivery. The NHDR heightened our awareness of racial, ethnic, and socioeconomic differences in the diagnosis and treatment of various diseases. AHRQ also commissioned the IOM to provide technical guidance on the findings of the NHDR. The IOM guidance document, which was released in 2003, created a construct for our understanding of where, and potentially why, such disparities exist as well as what changes in the health care system are necessary to correct them.3 It would be easy to conclude that lower socioeconomic level and less insurance coverage are themajor causes of the disparities. However, we must recognize that although these are important considerations for ethnic and racial minorities, they are not the only factors. Race and ethnicity themselves significantly influence the type of care received.3 By focusing on the quality of care accessed by and provided to racially, ethnically, socioeconomically, and geographically different populations, the IOM guidance document spotlighted an urgent need to address health care inequities and created a forum for ethical debates on any decision making that would perpetuate such disparities. National attention is also being brought to bear on this issue by the US Department of Health and Human Services through the Healthy People 2010 initiative.4 Finding solutions that would eliminate health care disparities is a key target in creating a healthier population today and in the future. Although eliminating health care disparities in minority populations should remain a focus of this effort, we cannot lose sight of gender-based disparities, especially as they relate to the diagnosis and treatment of CVD.

Heart Disease and Prevention

The objective of this study was to analyze race and age differences in the distribution of health promotion and cardiovascular screening tests, and the prevalence of serious heart disease and cardiovascular mortality in the United States. DATA SOURCES/STUDY POPULATION: Data are from 7 federal datasets represented in the first National Healthcare Quality Report and the National Healthcare Disparities Report, and include surveys, administrative and vital statistics data systems. The study analyzes blacks and whites. Counseling on diet and nutrition, exercise, and tobacco during an outpatient visit indicate the availability of health promotion services, and screening for high blood pressure and cholesterol represent preventive services. Hospitalizations for heart-related conditions and use of certain cardiac procedures identify serious heart disease. Deaths from coronary artery disease and stroke are the heart-related mortality measures. Counseling and education services tend to occur more on outpatient visits by individuals aged 45 to 64 years than in younger age groups. Screening rates among individuals aged 45 to 64 years of approximately 90% for hypertension and 80% for high cholesterol suggest progress in early detection of cardiac risk factors. However, blacks aged 45 to 64 years are 5.6 times more likely than their white counterparts to be hospitalized for hypertension, approximately one third less likely to receive a cardiac procedure, and almost twice as likely to die of coronary heart disease. Although findings indicate few racial differences in health promotion services in ambulatory care or screening for cardiac risk factors, the prevalence of serious cardiovascular disease, use of cardiac procedures, and heart-related mortality suggest continuing racial disparities in heart disease.

Compiling The Evidence: The National Healthcare Disparities Reports

Disparities in health care have been described extensively in the literature. The next step in resolving this national problem is to develop the necessary infrastructure for monitoring and tracking disparities. The congressionally mandated National Healthcare Disparities Report begins to build this infrastructure. The 2003 report addressed many of the methodological challenges inherent in measuring disparities. The recently released 2004 report continues the process by summarizing the status of U.S. health care disparities and beginning to track changes over time. Both reports emphasize the need to integrate activities to reduce disparities and to improve the quality of health care.

Preparing the National Healthcare Disparities Report

Efforts to quantify, monitor, understand, and reduce disparities in health care are critically dependent on the collection of high-quality data that support such analyses. In producing the first National Healthcare Disparities Report (NHDR), a number of gaps in data were encountered that limited the ability to assess racial, ethnic, and socioeconomic disparities in health care. The objectives of this study were to identify and quantify gaps in data related to disparities in health care and discuss efforts to fill these gaps in future NHDRs. : Data on specific racial, ethnic, and socioeconomic groups were often not collected or collected in formats that differed from federal standards. When collected, data were often insufficient to generate reliable estimates for specific racial, ethnic, and socioeconomic groups. These effects were magnified when attempting to assess disparities within many of the agency's priority populations such as women, children, the elderly, low-income populations, and rural residents. Future NHDRs begin to fill some of these gaps in data, but some gaps will likely persist and new gaps will likely arise as the availability of data for specific populations vary from year to year. Gaps in data limit the ability to address racial, ethnic, and socioeconomic disparities in health care. Although many federal efforts are underway to improve data collection, some groups and populations pose unique challenges for data collection that will be difficult to overcome.

The First National Reports on United States Healthcare Quality and Disparities

In the Healthcare Research and Quality Act of 1999 (Public Law 106-129), Congress mandated that the Agency for Healthcare Research and Quality (AHRQ) produce annual reports on healthcare quality and disparities in the United States. The National Healthcare Quality Report and the National Healthcare Disparities Report were first released in 2003 by the AHRQ. These reports include broad sets of performance measures to portray the nation's progress toward improving the quality of care provided to all Americans. This article provides an overview of the framework, development, and future uses of the reports by consumers, practitioners, researchers, and policy makers.

Disparities in health care--from politics to policy.

This first report clearly demonstrates that racial, ethnic and socioeconomic disparities are national problems that affect health care at all points in the process, at all sites of care, and for all medical conditions — in fact, disparities in the health care system are pervasive. — National Healthcare Disparities Report, as submitted to the Department of Health and Human Services (DHHS) by the Agency for Healthcare Research and Quality (AHRQ), July 2003. 1 This first report finds that, while most Americans receive exceptional quality of health care and have excellent access to needed services, some socioeconomic, racial, and ethnic differences exist. . . .

Assessing the nation's progress toward elimination of disparities in health care.

The Agency for Healthcare Research and Quality submitted the first annual National Healthcare Disparities Report to Congress in December, 2003. This first report will provide a snapshot of the state of racial, ethnic, and socioeconomic disparities in access and quality of care in America. It examines disparities in the general population and within the Agency's priority populations. While focused on extant data, the first report will form the foundation for future versions, which examines causes of disparities and shape solutions to the problem. As patient advocates and agents of change, primary care physicians play a critical role in efforts to eliminate disparities in health care. Continuing participation by primary care physicians in the development and refinement of the National Healthcare Disparities Report is essential.