National Healthcare Disparities Report - LDI Health Economist

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Care Coordination Chapter 6 n Overall, the rate of ED visits for asthma was 513 per 100,000 among adults and 852 per 100,000 for children (Figure 6.7). About 21% of ED visits for asthma among adults led to hospitalization (107 per 100,000), and 79% had other dispositions (406 per 100,000). About 11% of ED visits for asthma among children led to hospitalization (93 per 100,000) and 89% had other dispositions (759 per 100,000). n Compared with residents of high-income neighborhoods, residents of all other income quartiles had higher rates of both ED visits for asthma that led to hospitalization and ED visits that did not end in hospitalization (this was true for adults as well as children). n Compared with residents of other geographic locations, noncore residents had the lowest rates of both ED visits for asthma that led to hospitalization and ED visits that did not end in hospitalization (this was true for adults as well as children). Also, in the NHQR: n Compared with adults ages 18-44, all older age groups had lower rates of ED visits for asthma, but an increasing percentage that led to hospitalization. n Children ages 0-4 had the highest overall rates of ED visits for asthma compared with any group presented. References Bodenheimer T. Coordinating care—a perilous journey through the health care system. New Engl J Med 2008;358(10):1064- 71. Coleman EA, Parry C, Chalmers S, et al. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med 2006;166(17):1822-8. Powell-Davies G, Williams AM, Larsen K, et al. Coordinating primary health care: an analysis of the outcomes of a systematic review. Med J Aust 2008;188(8 Suppl):S65-68. Shojania K, McDonald K, Wachter R, et al. Closing the quality gap: a critical analysis of quality improvement strategies— Volume 7: Care Coordination. Rockville, MD: Agency for Healthcare Research and Quality; 2007. Available at: http://www.ahrq.gov/clinic/tp/caregaptp.htm. Weighted national estimates from HCUP Nationwide Emergency Department Sample. Rockville, MD: Agency for Healthcare Research and Quality; 2008. Available at: http://hcupnet.ahrq.gov/. Whittington J, Cohen H. OSF Healthcare’s journey in patient safety. Qual Manag Health Care 2004;13(1):53-59. 190 National Healthcare Disparities Report, 2011
Chapter 7. Efficiency Health care cost increases continue to outpace the rise in wages, inflation, and economic growth. One approach to containing the growth of health care costs is to improve the efficiency of the health care delivery system. This approach would allow finite health care resources to be used in ways that best support highquality care. Recent work examining variations in Medicare spending and quality shows that higher cost providers do not necessarily provide higher quality care, illustrating the potential for improvement (Fisher, et al., 2003). Improving efficiency in the Nation’s health care system is an important component of Department of Health and Human Services (HHS) efforts to support a better health care system. Measures Part of the discussion about how to improve efficiency involves the question about how best to measure it. Varying perspectives and definitions of health care efficiency exist; although consensus has not yet emerged on what constitutes appropriate measurement of efficiency, AHRQ has supported development in this area. This chapter has been largely shaped by a number of documents that have developed the field of health care efficiency measurement. One major contributor is an AHRQ-commissioned report by RAND Corporation, which systematically reviewed efficiency measures, assessed their tracking potential, and provided a typology that emphasizes the multiple perspectives on health care efficiency (McGlynn, 2008). This chapter of the National Healthcare Disparities Report (NHDR) is organized around the concepts of overuse and misuse. As noted in the National Strategy for Quality in Health Care, i “Achieving optimal results every time requires an unyielding focus on eliminating patient harms from health care, reducing waste, and applying creativity and innovation to how care is delivered.” The measures this year are presented in the following layout: n Inappropriate medication use: o Adults age 65 and over who received potentially inappropriate prescription medications. n Preventable hospitalizations: o Potentially avoidable hospitalization rates for adults. o Excess avoidable hospitalizations. o Potentially avoidable hospitalizations among Medicare home health patients. o Perforated appendixes. n Potentially harmful preventive services with no benefit: o Males age 75 and over who had a prostate-specific antigen (PSA) test or a digital rectal exam (DRE) within the last 12 months. i Available at www.healthcare.gov/center/reports/quality03212011a.html. National Healthcare Disparities Report, 2011 191
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