National Healthcare Disparities Report - LDI Health Economist

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Introduction and Methods With rapid changes in health care, in 2008, AHRQ commissioned the IOM to review past reports and offer recommendations for enhancing future reports and associated products. Among the recommendations offered in Future Directions for the National Healthcare Quality and Disparities Reports (IOM, 2010), the IOM proposed that AHRQ report on progress in areas expected to yield the greatest gains in health care quality. These included patient and family engagement, population health, safety, care coordination, palliative care, overuse of services, access to care, and health system infrastructure. Chapter 1 As recommended, the 2010 reports aligned measures according to these priority areas. As also suggested by the IOM, the reports introduced measure-specific benchmarks that reflected the highest level of performance documented for a measure. Pursuant to the provisions of the Patient Protection and Affordable Care Act of 2010, iii in 2011, the Secretary of HHS submitted a report to Congress titled National Strategy for Quality Improvement in Health Care (National Quality Strategy). This report set priorities to advance three quality improvement aims: better care, healthy people, and affordable care. Six priority areas were identified as a means to achieve the quality improvement aims: n Making sure care is safer by reducing harm in the delivery of care. n Ensuring that each person and his or her family members are engaged as partners in their care. n Promoting effective communication and coordination of care. n Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease. n Working with communities to promote wide use of best practices to enable healthy living. n Making quality care more affordable for individuals, families, employers, and governments, by developing and spreading new health care delivery models. The 2011 NHQR and NHDR align measures according to the National Quality Strategy in an effort to inform policymakers, the public, and other stakeholders of the Nation’s progress in achieving National Quality Strategy aims. The National Quality Strategy priorities considerably overlap with those proposed by the IOM. While the 2011 reports introduce several measures to address the National Quality Strategy priorities, the organization of the 2011 NHQR and NHDR is similar to that used in 2010. In addition to the change in framework, the 2011 NHQR and NHDR introduce several measures and major enhancements to the methods by which trends are estimated. These enhancements are discussed below in greater detail. Organization of the NHQR and NHDR The NHQR and NHDR are designed as chartbooks that contain data on more than 250 health care quality measures from more than 45 databases. Measures in these reports are selected with guidance from the AHRQ Interagency Work Group, an advisory body of representatives from across many HHS agencies. Measures represented in these reports are among the most important and scientifically supported measures. Together, these measures provide an annual snapshot of how our Nation’s health care system is performing and the extent to which health care quality and disparities have improved or worsened over time. iii Public Law 111-148. 36 National Healthcare Disparities Report, 2011
Introduction and Methods The NHQR and NHDR are complementary reports and, with few exceptions, are similarly organized. Where applicable, key findings from the NHDR are included in the NHQR, and NHQR findings are reported in the text of the NHDR. Readers should refer to the report from which results have been drawn to gather additional details on the data presented. Report chapters include: Highlights, which immediately precede the current chapter, combine broad sets of measures to offer a highlevel overview of the progress that has been made in advancing health care quality and reducing disparities in the United States. The Highlights chapter incorporates findings from both the NHQR and NHDR, and the same Highlights chapter is used in both reports. Chapter 1: Introduction and Methods provides background on the NHQR and NHDR and modifications to the reports that have occurred over time. This chapter includes measures that have been added or retired from the measures list, along with an overview of the methods used to generate estimates, measure trends, and examine disparities. Chapter 1 Chapter 2: Effectiveness examines prevention, treatment, and outcomes for a range of conditions or population groups. The 2011 reports are organized around several clinical areas: cancer, cardiovascular disease, chronic kidney disease, diabetes, HIV and AIDS, maternal and child health, mental health and substance abuse, musculoskeletal disease, and respiratory disease. Three types of health care services that typically cut across clinical conditions are also examined: lifestyle modification, functional status preservation and rehabilitation, and supportive and palliative care. The section on musculoskeletal disease is new to the reports, as are measures related to adolescent health. Chapter 3: Patient Safety tracks safety within the hospital setting. Among the areas examined are healthcare-associated infections, postoperative and other hospital complications, and preventable hospital deaths. Chapter 4: Timeliness examines the delivery of time-sensitive clinical care and patient perceptions of how quickly they receive care. Among the measures reported in this chapter are the ability to get care when the patient needs it and emergency department wait times. Chapter 5: Patient Centeredness examines individual experiences with care in an office or clinic setting, as well as during a hospital stay. Measures reported in this chapter focus on perceptions of communication with providers and satisfaction with the physician-patient relationship. Chapter 6: Care Coordination presents data to assess the performance of the U.S. health care system in coordinating care across providers or services. Care coordination is measured, in part, using readmission measures as well as measures of success in transitioning across health care settings. Chapter 7: Efficiency is often assessed by how well the health care system promotes quality, affordable care, and appropriate use of services. The emphasis in this chapter is on overuse of health services, as measures representing misuse or underuse overlap with other sections of the report and are included in various chapters. Chapter 8: Health System Infrastructure explores the capacity of health care systems to support highquality care. Most measures of health system infrastructure were assessed on the basis of region or provider characteristics. Infrastructure measures, which are primarily structural measures of quality, include adoption of computerized data systems and the supply of selected health care professionals. The 2011 reports include National Healthcare Disparities Report, 2011 37
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 24 and 25: Highlights available to the public
Page 26 and 27: Highlights Examples of Initiatives
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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 n In 5 out of
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Effectiveness of Care NEW Outcome:
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Effectiveness of Care Chapter 2 Lif
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Effectiveness of Care Functional St
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Effectiveness of Care Chapter 2 Fun
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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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Efficiency Figure 7.2. Potentially
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Efficiency Comparisons with the 3 S
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Efficiency Figure 7.8. Males age 75
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Health System Infrastructure Refere
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U.S. Department of Health and Human
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