National Healthcare Disparities Report - LDI Health Economist

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Care Coordination Also, in the NHQR: n Overall, rehospitalization rates did not vary by age. In some individual States, however, rates were higher among patients age 65 and over compared with patients ages 18-64. Chapter 6 Medication Information Patients often seek care from many providers, and different providers may prescribe medications for the same patient. Patients are responsible for keeping track of all their medications, but medication information can be confusing, especially for patients on multiple medications. When care is not well coordinated and some providers do not know about all of a patient’s medications, patients are at greater risk for adverse events related to drug interactions, overdosing, or underdosing. In addition, providers need to periodically review all of a patient’s medications to ensure that they are taking what is needed and only what is needed. Medication reconciliation has been shown to reduce both medication errors and adverse drug events (Whittington & Cohen, 2004). Management: Provider Asking About Medications From Other Doctors Medication information generated in different settings may not be sent to a patient’s primary care provider. In the absence of communication from other providers, the patient is the primary source of medication information. Actively gathering and managing all of a patient’s medical information is an important part of care coordination. Figure 6.5. People with a usual source of care whose health provider usually asks about prescription medications and treatments from other doctors, by race and activity limitations, United States, 2002-2008 100 White Black Asian NHOPI AI/AN >1 Race 100 Basic Complex Neither Basic Nor Complex 90 90 Percent 80 Percent 80 70 70 60 60 50 Z 50 Z 0 2002 2003 2004 2005 2006 2007 2008 0 2002 2003 2004 2005 2006 2007 2008 Key: AI/AN = American Indian or Alaska Native, NHOPI = Native Hawaiian or Other Pacific Islander. Source: Agency for Healthcare Research and Quality, Center for Financing, Access, and Cost Trends, Medical Expenditure Panel Survey, 2002-2008. Denominator: Civilian noninstitutionalized population who report a usual source of care. Note: Data for NHOPIs were insufficient for analysis except in 2004 and 2005. 186 National Healthcare Disparities Report, 2011
Care Coordination n From 2002 to 2008, the percentage of people with a usual source of care whose health provider usually asked about prescription medications and treatments from other doctors improved from 75% to 81% (data not shown). n Improvements were observed among all racial and disability groups (Figure 6.5). n In 2008, the percentage of patients with a usual source of care whose health provider usually asked about prescription medications and treatments from other doctors was significantly lower for Asians than for Whites (74% compared with 81%). Also, in the NHQR: n From 2002 to 2008, children’s health providers were less likely to ask about medications from other doctors. In all years except 2003, the health providers of older adults were also less likely to ask about medications from other doctors. Structure: Electronic Exchange of Medication Information Chapter 6 Ideally, information about medications prescribed for a patient by one provider would be available to all providers taking care of that patient. One way to exchange this information efficiently is to build this function into health information technologies. The American Hospital Association recently surveyed hospitals about their use of health information technologies. Questions about whether a hospital electronically exchanged patient information on medication history with other providers were included, and 2,112 hospitals responded. Data are shown by region and geographic location of the hospitals (urban or rural). Urban hospitals and public hospitals provide a disproportionate share of care to low-income and minority patients. Figure 6.6. Hospitals with electronic exchange of patient information on medication history, by region and geographic location, 2009 100 Hospitals in System Hospitals Outside System Ambulatory Providers Outside System 80 Percent 60 40 20 0 Northeast Midwest South West MSA Non-MSA Key: MSA = metropolitan statistical area. Source: American Hospital Association Annual Survey Information Technology Supplement, 2009. National Healthcare Disparities Report, 2011 187
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