National Healthcare Disparities Report - LDI Health Economist

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Highlights Provider: When referring patients to the Northwestern Memorial Hospital Emergency Department, community physicians send an electronic handoff note with pertinent clinical information. The note is entered into the EHR system and made available to emergency providers. Both referring and emergency physicians believe the system improves care coordination and quality of care (HCIE #3107). At the Chelsea and Westminster Hospital’s Sexual Health Clinics, standardized text messages are used to relay test results and instructions. The program led to quicker diagnosis and treatment for those testing positive and reduced staff time spent on followup care, allowing clinics to handle more new cases (HCIE #3019). National Priority: Promoting Effective Prevention and Treatment of Leading Causes of Mortality, Starting With Cardiovascular Disease Providing care to patients for whom the expected benefits, based on scientific evidence, exceed the expected risks is at the heart of health care. Focusing national quality improvement efforts on diseases that kill the most Americans is logical and places cardiovascular disease at the top of the list. Moreover, knowledge of how to prevent and treat heart disease and stroke is well documented. This NQS priority aligns well with the sections on cardiovascular disease in the Effectiveness chapters in the NHQR and NHDR. The NQS identifies several important opportunities for success in promoting effective prevention and treatment of cardiovascular disease: increasing blood pressure control in adults, reducing high cholesterol levels in adults, increasing the use of aspirin to prevent cardiovascular disease, and decreasing smoking among adults. The HHS Disparities Action Plan includes this priority under its strategies to reduce disparities in the quality of health care. Progress in Care for Cardiovascular Disease n Cardiovascular care has improved dramatically: o Measures are retired from the reports when performance exceeds 95%. Of the dozen report measures that have been retired in the past 3 years, almost all related to the management of cardiovascular risk factors or disease. o Of the seven remaining cardiovascular disease quality of care measures that could be trended, all showed improvement (data not shown). 22 National Healthcare Disparities Report, 2011
Highlights Figure H.13. Number and proportion of cardiovascular disease measures for which members of selected groups experienced better, same, or worse quality of care compared with reference group Better Same Worse 100 80 5 3 2 1 2 60 Percent 40 20 0 2 2 Black vs. White (n=9) Asian vs. White (n=9) 5 5 5 2 1 Hispanic vs. NHW (n=9) Poor vs. High Income (n=8) Key: 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 Racial and ethnic disparities in cardiovascular care are less common: o Racial and ethnic minorities often experienced better cardiovascular care than Whites. For example, Blacks received better quality care than Whites for more than half of cardiovascular measures. o Income-related disparities in cardiovascular care were significant for about 60% of measures, which is more than income-related disparities in overall quality. Examples of Initiatives Promoting Effective Prevention and Treatment of Cardiovascular Disease Federal: Million Hearts is a campaign led by CMS and the Centers for Disease Control and Prevention (CDC) to prevent a million heart attacks and strokes over the next 5 years. The campaign focuses and coordinates cardiovascular disease prevention activities such as improving control of high blood pressure and high cholesterol, using aspirin to prevent cardiovascular events in high-risk populations, reducing sodium and artificial trans fat intake, and quitting smoking (millionhearts.hhs.gov). The HHS Office on Women’s Health Make the Call, Don’t Miss a Beat campaign educates women about the signs and symptoms of a heart attack and encourages them to call 911 first (www.womenshealth.gov/heartattack/). The Know Stroke campaign led by the National Institute of Neurological Disorders and Stroke educates the public about the signs and symptoms of stroke and the importance of seeking emergency care (stroke.nih.gov). The associated Brain Attack Coalition promotes best practices to prevent and combat stroke (www.stroke-site.org). National Healthcare Disparities Report, 2011 23
Page 1: NATIONAL HEALTHCARE DISPARITIES REP
Page 4 and 5: Acknowledgments The NHQR and NHDR a
Page 6 and 7: National Healthcare Disparities Rep
Page 8 and 9: Highlights New this year, the Highl
Page 10 and 11: Highlights n Disparities in quality
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Page 22 and 23: Highlights Progress in Patient Safe
Page 24 and 25: Highlights available to the public
Page 26 and 27: Highlights Examples of Initiatives
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Page 42 and 43: Introduction and Methods With rapid
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Effectiveness of Care Multivariate
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Effectiveness of Care Focus on Indi
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Effectiveness of Care HIV and AIDS
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Effectiveness of Care To normalize
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Effectiveness of Care HIV/AIDS core
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Effectiveness of Care Outcome: Deat
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Effectiveness of Care Findings NEW
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Effectiveness of Care Figure 2.25.
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Effectiveness of Care Prevention: W
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Effectiveness of Care Mental Health
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Effectiveness of Care NEW Musculosk
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Effectiveness of Care n In all year
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Effectiveness of Care NEW Managemen
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Effectiveness of Care Findings Prev
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Effectiveness of Care Also, in the
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Effectiveness of Care Chapter 2 Res
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Effectiveness of Care Lifestyle Mod
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Effectiveness of Care Functional St
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Effectiveness of Care at admission
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Effectiveness of Care n The 2008 to
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Effectiveness of Care References 20
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Effectiveness of Care Centers for M
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Effectiveness of Care Oral health i
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140 National Healthcare Disparities
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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 Also, in the NHQR: n
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Patient Safety n From 2006-2007 to
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Patient Safety n From 2004 to 2008,
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Patient Safety Chapter 3 n From 200
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Timeliness Findings Getting Care fo
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Timeliness Chapter 4 n Not all pati
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Timeliness Chapter 4 n Among heart
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Patient Centeredness Chapter 5 Simi
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Patient Centeredness Figure 5.1. Ad
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Patient Centeredness Patient Langua
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Patient Centeredness Providers Aski
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Care Coordination Importance Chapte
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Care Coordination n In 2009, Americ
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Care Coordination Figure 6.3. Paren
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Care Coordination Also, in the NHQR
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Care Coordination Chapter 6 n Overa
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Efficiency Findings Chapter 7 Inapp
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Efficiency Figure 7.2. Potentially
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Efficiency Comparisons with the 3 S
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Health System Infrastructure Eviden
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Health System Infrastructure Table
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Health System Infrastructure Refere
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Access to Health Care Findings Heal
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Priority Populations AHRQ’s Prior
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Priority Populations criminal justi
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U.S. Department of Health and Human
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