Guidance for the National Healthcare Disparities Report (2002) / Chapter Skim
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to produce a new annual report beginning in fiscal year 2003 (October I, 2002 to September 30, 2003~. The National Healthcare Disparities Report (NHDR)
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This reflects the agency's plan to make health care quality a major focus of this report, which is appropriate since disparities often represent an 2 At the same time that the IOM Committee for Guidance in Designing a National Health Care Disparities Report was meeting, the National Quality Forum (NQF) was producing a report (National Quality Forum, 2002)
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FIGURE 1-1 Framework for the National Healthcare Quality Report and the National Healthcare Disparities Report Components of Health Care Quality Consumer ~ ~ _ Perspectives on => Heals Care Needs ~ ~ ~ ~ ~ Staying Healthy ~ _ Getting Better Living with Illness or _ Disability _ Coping with the End _ cow cow an .= ·E~ 1 . ~ 3 a To carry out this work, the IOM established the Committee for Guidance in Designing a National Health Care Disparities Report.
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The NHDR should contain analyses of racial and ethnic health care disparities that reflect the influence of socioeconomic status. There are two main reasons for paying particular attention to socioeconomic status.
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1. The National Healthcare Disparities Report should present analyses of racial and ethnic disparities in health care in ways that take into account the effects of socioeconomic status.
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This assumption, however, may not be valid. It may be, for example, that there is a significant positive relationship between socioeconomic status and a particular dependent variable among Blacks, but no significant relationship among Whites.
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Occupation is more frequently applied in British studies of the relationship between socioeconomic status and health status. Deprivation indices have not been extensively used in studies of health care.
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Those with higher incomes have a greater tendency to use preventive services while those with lower incomes have a greater tendency to use acute care sentences due in part s It should also be noted that analyses can vary depending on the cutpoints used for education, income, and other measures of socioeconomic status (Liberatos et al., 19 8 8~.
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AHRQ should sponsor research on the relationship of socioeconomic status to health care. Exploration of the relationship between socioeconomic status, health care, and other factors such as race and ethnicity would help to identify the most appropriate measures of socioeconomic status to use in studies on health care disparities.
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· The NHDR will be focused on issues of access to and within the health care system, health care service utilization, and health care quality. How are patterns in each related to a patient's socioeconomic status?
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As such, the National Healthcare Disparities Report should give it prominent attention. Access should be reconceptualized as a dimension of health care rather than as a dimension of medical care alone.
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Access to a regular source of care whether to a particular site such as a local clinic or a particular provider such as a primary care physician makes it more likely that individuals will receive a greater number of appropriate health care services. This in turn makes it more likely that individuals will experience better health outcomes (IOM, 2002a; Lurie, 2002~.
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4. The National Healthcare Disparities Report should include measures of high utilization of certain health care services that indicate poor
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1-4. MEASUREMENT OF GEOGRAPHIC DISPARITIES IN HEALTH CARE The NHDR should present national-level information on health care disparities.
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5. The National Healthcare Disparities Report should present data on disparities at the state level.
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It has supported a number of programs aimed at addressing issues such as physician supply and hospital and clinic support, and monitors the impact of programs such as Medicare and Medicaid on rural and urban health care delivery (Me6PAC, 2001~. While the NHDR should feature information on geographic disparities featuring states and rural and urban areas, it should be noted that states and rural and urban areas are heterogeneous units.
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1-5. SUBNATIONAL DATASETS A variety of datasets could help to supply the needs of the NHDR.6 These include surveys produced by single states that have sizable racial and ethnic populations and subpopulations.
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cmwf. org Fund Health Fund Care Quality Survey Community Health Resources www.communityhealth.hrsa.gov Health Status and Services Report Administration (HRSA)
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It also provides estimates for smaller subpopulations, including Asian American and Pacific Islander ethnic groups, American Indians, and Alaska Natives. AHRQ should take into account the following methodological considerations in using subnational datasets:
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The six percent criterion provided coverage of approximately sixty percent of the Chinese American population in Los Angeles. At the same time, it limited the extent to which conclusions can be drawn about all Chinese Americans living in Los Angeles since it excluded Chinese Americans in low density Chinese American geographic areas, who tend to be native born and more prosperous.
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6. In the future, if A~Q continues to rely on suhnational data sources for the National Healthcare Disparities Report, it should work with public and private organizations that sponsor key suhnational data sources to identify core elements in these surveys that can be standardized.
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Many subnational datasets are derived from crosssectional surveys that provide detailed information about specific racial or ethnic groups or about specific geographic areas. AHRQ could explore ways to encourage or support conversion of some of these cross-sectional surveys into panel studies that would follow respondents over time.
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In addition, it could mean that disparities highlighted in the NHDR should be related to national goals for health care specified in Healthy People 2010 such as access to clinical preventive care, emergency services, and Tong term care and rehabilitative services (DHHS, 2002~. As noted above, AHRQ will need to develop new measures in the areas of health care access, service utilization, and quality if the NHDR is to fulfill its potential of becoming a new and important government report on the nation's health care disparities and a critical too!
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7. AHRQ should receive adequate resources to develop datasets and measures needed for the National B:ealthcare Disparities Report.
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However, with time and adequate resources, AHRQ will have the opportunity to introduce more specific measures for use in later editions that will more accurately detect the magnitude of health care disparities. Measures could be drawn from those used in the NHQR that are particularly relevant to racial, ethnic, socioeconomic, and geographic disparities.
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Poor dissemination will mean that fewer people will leam about it, with the result that its annual updates on health care disparities will not have the impact that they should. The design and dissemination strategies for the NHQR developed by the Committee on the National Quality Report on Health Care Delivery (IOM, 2001 c)
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Presentation to the Second Meeting of the IOM Committee for Guidance in Designing a National Healthcare Disparities Report (March 19~. California Pan-Ethnic Health Network (CPEHN)
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In Guidance for the National Healthcare Disparities Report.
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2001 c. Envisioning the National Health Care Quality Report.
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In Guidance for the National Healthcare Disparities Report.
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Washington DC: National Forum for Health Care Quality Measurement and Reporting (National Quality Forum)
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In Guidance for the National Healthcare Disparities Report.
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1998. Health service use by African Americans and Caucasians with asthma in a managed care setting.
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