National Healthcare Disparities Report - LDI Health Economist

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Health System Infrastructure References Centers for Disease Control and Prevention. WISQARS [Web-based Injury Statistics Query and Reporting System] nonfatal injury death reports. Available at: http://webappa.cdc.gov/sasweb/ncipc/nfirates2001.html. 2011. Devine EB, Hansen RN, Wilson-Norton JL. The impact of computerized provider order entry on medication errors in a multispecialty group practice. J Am Inform Assoc 2010;17:78-84. Donabedian A. The definition of quality and approaches to its assessment. Chicago: Health Administration Press; 1980. Facts for Features. Older Americans Month: May 2011. Suitland, MD: U.S. Census Bureau; March 23, 2011. Publication No. CB11-FF.08. Available at: http://www.census.gov/newsroom/releases/archives/facts_for_features_special_editions/cb11- ff08.html. Chapter 8 Hanley A, Silke C, Murphy J. Community-based health efforts for the prevention of falls in the elderly. Clin Interv Aging 2011;6:19-25. Epub 2010 Dec 20. Howden LM, Meyer JA. Age and sex composition: 2010. 2010 Census Briefs. Suitland, MD: U.S. Census Bureau; May 2011. Publication No. C2010BR-03. Available at: http://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf. Accessed August16, 2011. Institute of Medicine, Board of Health Care Services. Future directions for the National Healthcare Quality and Disparities Reports. Washington, DC: National Academies Press; 2010. Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Arch Intern Med. 2003;163(12):1409-16. Resnick HE, Alwan M. Use of health information technology in home health and hospice agencies: United States, 2007. J Am Med Inform Assoc 2010;17:389-95. Romano MJ, Stafford RS. Electronic health records and clinical decision support systems: impact on national ambulatory care quality. Arch Intern Med 2011;171(10):897-903. Shih A, Davis K, Schoenbaum S, et al. Organizing the U.S. health care delivery system for high performance, 2008. New York, NY: The Commonwealth Fund Commission on a High Performance Health System. Available at: http://www.commonwealthfund.org/usr_doc/Shih_organizingushltcaredeliverysys_1155.pdf. 218 National Healthcare Disparities Report, 2011
Chapter 9. Access to Health Care Many Americans have good access to health care that enables them to benefit fully from the Nation’s health care system. Others face barriers that make it difficult to obtain basic health care services. As shown by extensive research and confirmed in previous National Healthcare Disparities Reports (NHDRs), racial and ethnic minorities and people of low socioeconomic status (SES) i are disproportionately represented among those with access problems. Previous findings from the National Healthcare Quality Report (NHQR) and NHDR showed that health insurance was the most significant contributing factor to poor quality of care for some of the core measures, and many are not improving. Uninsured people were less likely to get recommended care for disease prevention, such as cancer screening, dental care, counseling about diet and exercise, and flu vaccination. They also were less likely to get recommended care for disease management, such as diabetes care management. Poor access to health care comes at both a personal and societal cost. For example, if people do not receive vaccinations, they may become ill and spread disease to others. This increases the burden of disease for society overall in addition to the burden borne individually. Components of Health Care Access Access to health care means having “the timely use of personal health services to achieve the best health outcomes” (IOM, 1993) Attaining good access to care requires three discrete steps: n Gaining entry into the health care system. n Getting access to sites of care where patients can receive needed services. n Finding providers who meet the needs of individual patients and with whom patients can develop a relationship based on mutual communication and trust. Health care access is measured in several ways, including: n Structural measures of the presence or absence of specific resources that facilitate health care, such as having health insurance or a usual source of care. n Assessments by patients of how easily they can gain access to health care. n Utilization measures of the ultimate outcome of good access to care (i.e., the successful receipt of needed services). Facilitators and Barriers to Health Care Facilitators and barriers to health care discussed in this section include health insurance, usual source of care (including having a usual source of ongoing care and a usual primary care provider), and patient perceptions of need. i As described in Chapter 1, Introduction and Methods, income and educational attainment are used to measure SES in the NHDR. Unless specified, poor = below the Federal poverty level (FPL), low income = 100-199% of the FPL, middle income = 200-399% of the FPL, and high income = 400% or more of the FPL. The measure specifications and data source descriptions provide more information on income groups by data source. National Healthcare Disparities Report, 2011 219
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