National Healthcare Disparities Report - LDI Health Economist

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Highlights Examples of Initiatives Fostering Person- and Family-Centered Care Federal: In the first large-scale initiative to include patient experience in quality reporting, CMS encouraged hospitals to collect and publicly report information using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The Affordable Care Act includes HCAHPS performance in calculating value-based incentive payments to hospitals and expands the use of patient experience information to assess physicians and other facilities, such as nursing homes (www.cms.gov/Hospital-Value-Based-Purchasing/). The Health Profession Opportunities Grants support education and training of low-income individuals in health care occupations that pay well and are expected to either experience labor shortages or be in high demand over the next 5 years (www.acf.hhs.gov/grants/open/foa/view/HHS-2010-ACF-OFA-FX-0126). State: As part of the Strategic Plan To Eliminate Health Disparities in New Jersey, the State worked to improve language access. In collaboration with the Health Research and Educational Trust of New Jersey, bilingual hospital staff were trained to be medical interpreters. The Office of Minority and Multicultural Health supported training for community leaders to help interpret or act as liaisons for minority clients navigating the health care system. In response to increasing requests for information by Spanish speakers, the Bureau of Vital Statistics hired bilingual staff, added a Spanish customer service phone line, and translated their Web site and forms into Spanish (www.state.nj.us/health/omh/plan). Provider: The Howard University Diabetes Treatment Center offers patients a free online personal health record to help monitor blood sugar and other clinical indicators, communicate with physicians between visits, and share health information. The program enhances levels of patient engagement in self-management and improves blood glucose control (HCIE #3081). The University of California San Francisco Breast Care Center Decision Services Unit offers a visit planning, recording, and summarizing service in which trained interns help patients brainstorm and write down a list of questions and concerns for their providers. The program improves patient-provider communication and patient self-efficacy and decisionmaking and reduces decisional conflict (HCIE #95). National Priority: Promoting Effective Communication and Coordination of Care Care coordination is a conscious effort to ensure that all key information needed to make clinical decisions is available to patients and providers. Health care in the United States was not designed to be coordinated. Patients commonly receive medical services, treatments, and advice from multiple providers in many different care settings, each scrutinizing a particular body part or system. Attending to the patient as a whole is rare. Less than sufficient provider-provider and provider-patient communication is common and may lead to delays in treatment and inaccuracies in medical information. Enhancing teamwork and increasing use of health information technologies to facilitate communication among providers and patients can improve care coordination. This NQS priority aligns well with the chapters on Care Coordination in the NHQR and NHDR. The NQS identifies several important opportunities for success in promoting effective communication and coordination of care: reducing preventable hospital admissions and readmissions, preventing and managing chronic illness and disability, and ensuring secure information exchange to facilitate efficient care delivery. The HHS 20 National Healthcare Disparities Report, 2011
Highlights Disparities Action Plan includes this priority under its strategies to reduce disparities in access to primary care services and care coordination. Progress in Care Coordination Data and measures to assess care coordination are limited. Hence, an effort to summarize across this domain would be incomplete. Instead, we show findings for selected measures. n Hospital readmissions: While not all rehospitalizations can be prevented, better coordination at the point of discharge can prevent some readmissions. About 20% of patients hospitalized for heart failure are rehospitalized within 30 days for a condition related to heart failure. Considerable variation across States and by race is also observed. n Preventable emergency department visits: In patients with asthma, emergency department visits are five times as likely as hospitalizations, and some of these emergency department visits could be prevented with better coordination of outpatient care. Residents of inner cities and low-income neighborhoods have particularly high rates of emergency department visits. n Transitions of care: Among patients hospitalized for heart failure, the quality of patient discharge instructions is improving. However, race-related disparities are observed. n Medication information: Most providers ask patients about medications prescribed by other providers, and rates are improving. However, age- and insurance-related disparities are observed. Moreover, only one-third of hospitals currently support the electronic exchange of medication information with ambulatory care providers outside their own system. Examples of Initiatives Promoting More Effective Care Coordination Federal: The Health Information Technology for Economic and Clinical Health (HITECH) Act promotes the adoption of health information technology, including EHRs and electronic health information exchange. Eligible providers can receive incentive payments when they adopt and meaningfully use certified EHR technology to make needed clinical information accessible to all providers in a more complete and timely fashion. Altogether, more than $27 billion in incentive payments is available (www.cms.gov/ehrincentiveprograms/). The HHS Initiative on Multiple Chronic Conditions seeks to improve the quality of life and health status of individuals with multiple chronic conditions consistent with the Strategic Framework on Multiple Chronic Conditions issued in December 2010. This initiative promotes care coordination across multiple chronic conditions by fostering systems change, empowering individuals, equipping providers with tools and information, and enhancing research (www.hhs.gov/ash/initiatives/mcc/). State: The Assuring Better Child Health and Development Learning Collaborative brings together five States to improve linkages between pediatric primary care providers and community resources for young children. Arkansas, Illinois, Minnesota, Oklahoma, and Oregon are working to maximize use of staff to ensure effective linkages, integrating data across programs, monitoring quality related to referrals, and supporting cross-system planning (Hanlon & Rosenthal, 2011). In Rhode Island’s Pediatric Practice Enhancement Project, trained parent consultants work in pediatric practices. Providers refer families with children with special health care needs requiring care coordination. Parent consultants then work to match these families with appropriate community resources and ensure that needed services are received (Silow- Carroll, 2009). National Healthcare Disparities Report, 2011 21
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Page 4 and 5: Acknowledgments The NHQR and NHDR a
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Effectiveness of Care Diabetes Impo
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Effectiveness of Care Multivariate
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Patient Safety To Err Is Human does
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Patient Safety Figure 3.1. Adult su
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Patient Safety n From 2006-2007 to
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Patient Centeredness Chapter 5 Simi
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Care Coordination Importance Chapte
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U.S. Department of Health and Human
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