State Resources for Addressing Disparities in Health Care Quality

Overview

Quality health care means delivering services in ways that are safe, timely, patient centered, effective, efficient and equitable. Unfortunately, many times, our health care system distributes services inefficiently and unevenly across populations, and some Americans receive worse care than others in the U.S. Variations in health care and health status among racial and ethnic and socioeconomic groups continue to challenge the Nation.

The nature and size of quality disparities for vulnerable populations also vary across geographic areas, such that some States have larger gaps than others, as can be seen in State Snapshots. Even areas with smaller disparities between populations may warrant quality improvement efforts if the overall population is experiencing lower quality care.

The combination of unique population demographics and health care environments coupled with access to policy and program levers makes States an appropriate initiator of action to reduce health care disparities. States also have new opportunities and incentives to address health disparities in light of the Patient Protection and Affordable Care Act (ACA).

As States increasingly pursue activities to improve the health status and quality of care for vulnerable populations, such as racial and ethnic groups, AHRQ is developing and facilitating access to tools that can aid States in their efforts. Below are categories of resources available to States:

Contents

• Raising Awareness
• Collecting Data
• Analyzing Data
• Reporting Data
• Identifying Best Practices
• Tracking Success
• Focusing on Specific Vulnerable Populations

Raising Awareness

Source	Resource	Description
AHRQ	National Healthcare Quality Report (2011)	Reports trends in health care quality, including effectiveness of care, patient safety, timeliness of care, patient centeredness, and efficiency of care.
AHRQ	National Healthcare Disparities Report (2011)	Summarizes health care quality and access among various racial, ethnic, and income groups and other priority populations, such as residents of rural areas and people with disabilities
CDC	Health Disparities and Inequalities Report—United States (2011)	Consolidates the most recent national data available on disparities in mortality, morbidity, behavioral risk factors, health care access, preventive health services, and social determinants of critical health problems in the US across selected indicators
CDC	Promoting Preventive Services for Adults 50-64 (2009)	Identifies a set of recommended preventive services, provides indicators and data at national, State, and selected local levels with which to monitor progress, and promotes successful strategies to facilitate adoption and use.
CDC	Health Disparities and Social Determinants of Health Resources	Provides a list of resources and publications on health disparities and social determinants of health
HHS	Healthy People 2020	Provides science-based, 10-year national objectives for improving the health of all Americans
HHS	HHS Action Plan to Reduce Racial and Ethnic Health Disparities (2011)	Outlines goals and actions HHS will take to reduce health disparities among racial and ethnic minorities
HHS	National Stakeholder Strategy for Achieving Health Equity (2011)	Provides a common set of goals and strategies for initiatives and partnerships that can help racial and ethnic minority populations and other underserved groups reach their health potential
IOM	Unequal Treatment (2002)	Assesses the extent of disparities in the types and quality of health services received by U.S. racial and ethnic minorities and non-minorities; explores contributing factors; and recommends policies and practices to eliminate these inequities
Kaiser Family Foundation	Health Reform and Communities of Color: Implications for Racial and Ethnic Disparities (2010)	Discusses key provisions of the healthcare reform legislation as well as direct and indirect impacts on health disparities

Collecting Data

Source	Resource	Description
Commonwealth Fund	Racial, Ethnic, and Primary Language Data Collection in the Health Care System: An Assessment of Federal Policies and Practices (2001)	Provides the first comprehensive analysis of the policies and statutes governing the collection of health care data by race, ethnicity, and primary language
Health Research and Educational Trust	The HRET Disparities Toolkit: A Toolkit for Collecting Race, Ethnicity, and Primary Language Information from Patients	Provides hospitals, health systems, clinics, and health plans information and resources for systematically collecting race, ethnicity, and primary language data from patients
IOM	Race, Ethnicity, and Language Data: Standardization for Healthcare Quality Improvement (2009)	Recommends collection of more granular ethnicity and language data according to national standards
National Public Health and Hospital Institute	Race, Ethnicity, and Language of Patients: Hospital Practices Regarding Collection of Information to Address Disparities in Health Care (2006)	Reports on the race/ethnicity and language data collection practices of non-federal acute care hospitals and safety net hospitals
OMB	Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity	Provides a minimum standard for maintaining, collecting, and presenting data on race and ethnicity for all Federal reporting purposes
Robert Wood Johnson Foundation	The National Health Plan Collaborative Toolkit	Provides resources, lessons, best practices and case studies to help health plans join the effort to reduce disparities

Analyzing Data

Source	Resource	Description
AHRQ	State Snapshots	Provides State-specific health care quality information, including strengths, weaknesses, and opportunities for improvement
AHRQ	NHQRDRnet	Provides access to national and State data on the quality of, and access to, health care from scientifically credible measures and data sources
AHRQ	Preventable Hospitalization Costs and Mapping Tool	Maps AHRQ's Prevention Quality and Pediatric Quality indicators for a State or county and estimates the expected cost savings that could be achieved by reducing potentially avoidable hospitalizations
AHRQ	Creation of New Race-Ethnicity Codes and Socioeconomic Status (SES) Indicators for Medicare Beneficiaries (2008)	Provides a validated measure of socioeconomic status (SES) and compiles tabulations in the use of selected Medicare services by race and ethnicity and SES nationally and within the largest metropolitan statistical areas (MSAs) in which elderly Hispanics and Asians reside
ASTHO	Health Equity Snapshot Map	Provides stand-alone documents that can serve as a quick reference regarding state/territorial minority health and health disparities activities

Reporting Data

Source	Resource	Description
AHRQ	Talking Quality	Provides guidance on how to communicate health care quality information in understandable and useful ways
AHRQ	Health Care Report Card Compendium	Provides a searchable list of over 200 health care quality reports for consumers
IOM	Future Directions for the National Healthcare Quality and Disparities Reports (2010)	Provides recommendations on how the NHQR and NHDR can be improved to make them more influential in promoting change in the health care system
NASHP	State Documentation of Racial and Ethnic Health Disparities to Inform Strategic Action (2011)	Summarizes how leading states analyze race/ethnicity data in strategic plans and reports aimed at reducing racial and ethnic disparities in health status and health care
NASHP	State Uses of Hospital Discharge Databases to Reduce Racial and Ethnic Disparities (2010)	Summarizes how leading states that participate in the Healthcare Cost and Utilization Project (HCUP) and their clients use hospital discharge data on patient race/ethnicity to inform state health care disparities reduction activities
Robert Wood Johnson Foundation	Creating Equity Reports: A guide for Hospitals (2008)	Provides a framework for equity reporting and shares lessons learned from experiences creating and using such reports

Identifying Best Practices

Source	Resource	Description
AHRQ	Innovations Exchange	Provides innovations and quality tools to help users to solve problems, improve health care quality, and reduce disparities
AHRQ	Quality Diagnostic Tools for States	Consists of events and technical assistance opportunities that disseminate and encourage the use of AHRQ Quality Improvement tools to support State policymakers with their health care quality improvement efforts
AHRQ	Diabetes Care Quality Improvement: A Resource Guide for State Action (2008)	Helps States assess the quality of diabetes care and create quality improvement strategies
AHRQ	Asthma Care Quality Improvement: A Resource Guide for State Action (2009)	Helps States assess the quality of asthma care and create quality improvement strategies
IOM	Challenges and Successes in Reducing Health Disparities: Workshop Summary (2008)	Summarizes workshop designed to increase the visibility of disparities and to develop strategies to reduce disparities
NQF	Comprehensive Framework and Preferred Practices for Measuring and Reporting Cultural Competency (2009)	Outlines a comprehensive framework for measuring and reporting cultural competency and provides a detailed set of preferred practices for culturally competent care
National Public Health and Hospital Institute	Assuring Healthcare Equity: A Healthcare Equity Blueprint (2008)	Offers strategies and practices that can be tailored to individual hospitals to address equity in providing quality care
Robert Wood Johnson Foundation	Improving Quality and Achieving Equity: A Guide for Hospital Leaders (2009)	Serves as a health care quality improvement guide for CEOs, high-level managers in hospitals, and other leaders in the fields of safety, finance and risk reduction in hospitals
Robert Wood Johnson Foundation	Expecting Success Toolkit: Excellence in Cardiac Care (2008)	Provides tips for hospitals on improving the quality of care and reducing disparities based on the experience of 10 participating hospitals

Tracking Success

Focusing on Specific Vulnerable Populations

Source	Resource	Description
Children and Adolescents
AHRQ	Child and Adolescent Healthcare: Selected Findings (2011)	Summarizes key findings from the National Healthcare Quality and Disparities Reports related to health care for children
AHRQ	Child Health Care Quality Toolbox: Measuring Quality in Children’s Health Programs	Provides concepts, tips, and tools for evaluating the quality of health care for children
NASHP	Enhancing State and Local Capacity to Promote Healthy Weight in Children: Addressing Disparities in the Real World (2005)	Provides practical information that states and community groups can use to implement projects aimed at reducing disparities in childhood overweight
Racial and Ethnic Minority Groups
AHRQ	Disparities in Healthcare Quality Among Racial and Ethnic Minority Groups: Selected Findings (2011)	Discusses differences between racial and ethnic groups in terms of relative rates
Low Income Groups
CMS	Health Care Coverage Analyses of the 2006 National Healthcare Quality and Disparities Report (2008)	Presents for the first time data on quality and racial and ethnic disparity measures by payer
Older Americans
CDC	Clinical Preventive Services for Older Adults	Offers examples of recent activities and interventions that have focused on increasing the use of clinical preventive services in diverse communities
CDC	Promoting Preventive Services for Adults 50-64	Identifies a set of recommended preventive services, provides indicators and data with which to monitor progress, and promotes successful strategies to facilitate adoption and use
Women
AHRQ	Healthcare Quality and Disparities in Women: Selected Findings (2011)	Summarizes key findings from the National Healthcare Quality and Disparities Reports related to health care for women
Persons with Disabilities
AHRQ	Statistical Brief #312: Patient-Provider Communication by Race/Ethnicity and Disability Status: United States, 2007 (2011)	Examines patient-provider communication by race/ethnicity and disability status using data from the Household Component of the Medical Expenditure Panel Survey (MEPS-HC)
AHRQ	Developing Quality of Care Measures for People with Disabilities: Summary of Expert Meeting (2010)	Summarizes the discussion and recommendations arising out of a 1-day meeting of nationally recognized experts to begin the process of developing measures to assess quality of care for people with disabilities