National Healthcare Disparities Report - LDI Health Economist

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Highlights available to the public (Rosenthal & Takach, 2007). Other States promote safer care by denying payment to providers for preventable adverse events. Building on CMS nonpayment policies under Medicare, 12 States have implemented policies to refuse payment by Medicaid and other public purchasers for specific hospitalacquired conditions or serious reportable events. As more States begin nonpayment policies for adverse events, focus is shifting to alignment of activities across payers (Rosenthal & Hanlon, 2009). Provider: In the Michigan Health & Hospital Association’s Keystone: ICU project, Johns Hopkins University partnered with 120 participating intensive care units (ICUs) to reduce bloodstream infections and ventilator-associated pneumonia. Each participating ICU assembled an improvement team to lead a comprehensive unit-based safety program to enhance the culture of patient safety. The program prevented many catheter-associated bloodstream infections, leading to more than 1,800 lives saved, more than 140,000 hospital days avoided, and at least $270 million in savings over a 5-year period (HCIE #2668). National Priority: Ensuring Person- and Family-Centered Care To effectively navigate the complicated health care system, providers need to ensure that patients can access culturally and linguistically appropriate tools. Strategies to support patient and family engagement enable patients to understand all treatment options and to make decisions consistent with their values and preferences. This NQS priority aligns with chapters on Patient Centeredness in the NHQR and NHDR. The NQS identifies opportunities to ensure person- and family-centered care: integrating patient feedback on preferences, functional outcomes, and experiences of care into all care delivery; increasing use of electronic health records (EHRs) to capture the patient’s voice and integrate patient-generated data; and routinely measuring patient engagement and self-management, shared decisionmaking, and patient-reported outcomes. The HHS Disparities Action Plan includes this priority under its strategies to increase the ability of the health care system to address disparities and to increase the diversity of health care and public health workforces. Progress in Patient Centeredness n Patient centeredness is improving: o The NHQR and NHDR track 13 measures of patient perceptions of care, involvement in decisionmaking, and ability to get language assistance. Eleven of these measures show improvement over time (data not shown). 18 National Healthcare Disparities Report, 2011
Highlights Figure H.12. Number and proportion of patient centeredness measures for which members of selected groups experienced better, same, or worse quality of care compared with reference group Better Same Worse 100 1 3 80 6 7 8 6 7 60 Percent 40 20 0 65+ vs. 18-44 (n=10) 10 4 7 6 3 7 Black vs. White (n=14) Asian vs. White (n=14) AI/AN vs. White (n=9) Hispanic vs. NHW (n=15) Poor vs. High Income (n=13) Key: AI/AN = American Indian or Alaska Native; NHW = non- Hispanic White; n = number of measures. Better = Population received better quality of care than reference group. Same = Population and reference group received about the same quality of care. Worse = Population received worse quality of care than reference group. n Most disparities in patient centeredness mirror disparities in overall quality of care: o Most racial and ethnic minorities experienced less patient-centered care for about 40% of measures, similar to disparities in quality of care overall. o Income-related disparities in patient-centeredness were significant for 77% of measures and were more common than income-related disparities in overall quality. o Adults age 65 and over had more patient-centered care than adults ages 18-44. n Workforce diversity is limited: o Beginning in 2006, the reports have tracked workforce diversity among physicians and surgeons, registered nurses, licensed practical and licensed vocational nurses, dentists, dental hygienists, dental assistants, pharmacists, occupational therapists, physical therapists, and speech-language pathologists. For almost all of these occupations, Whites and Asians are overrepresented while Blacks and Hispanics are underrepresented. o Two exceptions were noted. Blacks are overrepresented among licensed practical and licensed vocational nurses while Hispanics are overrepresented among dental assistants. Of the health care occupations tracked, these two required the least amount of education and have the lowest median annual wages. National Healthcare Disparities Report, 2011 19
Page 1: NATIONAL HEALTHCARE DISPARITIES REP
Page 4 and 5: Acknowledgments The NHQR and NHDR a
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Patient Safety To Err Is Human does
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Care Coordination Importance Chapte
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U.S. Department of Health and Human
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