Guidance for the National Healthcare Disparities Report (2002) / Chapter Skim
Currently Skimming:
4 Measuring Disparities in Access to Care
4 Measuring Disparities in Access to Care
Pages 99-148
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 99... ...
Hence, in its reauthorization in 1999, the Agency for Healthcare Research and Quality (AHRQ) was directed to prepare a National Healthcare Disparities Report (NHDR)
|
From page 100... ...
This paper is intended to provide background and fresh thinking for the Committee for Guidance in Designing a National Healthcare Disparities Report on the leading issues surrounding the measurement of disparities in access to care.
|
From page 101... ...
Explicit attention to responsibilities for enrollees (or identification of a denominator population) creates important opportunities to measure both access and quality within health plans.
|
From page 102... ...
Specifically, it is now estimated that up to 50 percent of health status can be accounted for by health behaviors and only 15 to 20 percent by the health care delivery system (McGinnis et al., 2002~. In other words, health care system factors contribute proportionately less to health status when compared to other factors, although the benefits are greatest for those in poor health and without access to care.
|
From page 103... ...
The IOM revisited the issue of access to care in 1993, defining access as "the timely use of personal health services to achieve the best possible health outcomes"2 (IOM, 1993~. Of note, in choosing indicators that represented access-related outcome measures, it more explicitly linked access to quality and implied that everyone should have access to care to make these "best possible" outcomes achievable.
|
From page 104... ...
Neither the frameworks for describing access nor that for the National Healthcare Quality Report yet incorporate our knowledge of what creates health or evolution in the health care system. The Docteur et al.
|
From page 105... ...
It is well documented that low income and minority children have poorer oral health and less access to preventive or restorative dental services. Fluoridation is the single most effective intervention in preventing caries, but approximately one-third of the U.S.
|
From page 106... ...
· ~ 1nancmg Issues Insurance Status Provider Reimbursement Paths through Care* Personal Delivery System Quality ~ e hi ~> Staying Healthy Getting Better .
|
From page 107... ...
The following is a discussion of the relationship of access to the framework's four components of health care quality (timeliness, safety, effectiveness, and patient centeredness) and to the four consumer perspectives on health care needs (staying healthy, getting better, living with illness or disability, and coping with the end of life)
|
From page 110... ...
As is often the case, it may not be possible to disentangle access and quality because so many factors are involved. For example, insurance status is clearly related to arthritis care in general and to knee replacement rates in specific, which could lead one to conclude that knee replacement rates reflect financial access to care.
|
From page 111... ...
, 2001~. Each of the consumer perspectives on health care needs identified by the framework for the National Healthcare Quality Report should be examined for their implications for our understanding of health and what creates it.
|
From page 112... ...
If these models are demonstrated to be pathways for achieving the "best possible outcome," access to chronic disease management services will become even more important. Because minority patients are disproportionately affected by some of the conditions most amenable to disease management programs, including diabetes or asthma, access to these services should be a consideration in the NHDR.
|
From page 113... ...
Additional factors such as geographic access; the ability to understand the clinician or to participate in informed decision making; the ability to navigate the health care system; language access and availability of translation services; and access to understandable information before, during, and after the health care encounter all affect care throughout the continuum. This discussion has highlighted the relationships between access and quality in terms of the framework presented in Envisioning the National Health Care Quality Report.
|
From page 114... ...
/ · e :'e v 'e 'e .= o v v co lo lo lo 'e · - ~ A, o .~ 'e / In cO ~ -I .cn ~ .— =, lo ~ ~ cO lo ~ cO ~ a .= o A ~ Q o .' \ .
|
From page 115... ...
African- and Caribbean-born Blacks clearly have different health status and health outcomes than American-born Blacks. Hispanics and Asians come from many countries, and they differ widely in the health behaviors and cultural patterns that affect access and use.
|
From page 116... ...
in individual health plans, particularly within given diagnoses. Recent attempts to examine such data for Medicare+Choice health plans found no plans with at least 30 enrollees in each of the major race and ethnicity classifications and less than a dozen plans in which there were sufficient numbers of Asian Americans or Hispanics to analyze.
|
From page 117... ...
Controlling for health status can move us in that direction. Certainly, adjustment for socioeconomic status will be important in some areas where presenting data by race and ethnicity within income or educational groupings may help in interpretation.
|
From page 118... ...
They also indicate large plan-to-plan variation in the degree of disparities, highlighting the heterogeneity among health plans (Lurie et al., 2002~. A significant problem with CAMPS is the inability to examine response rates, particularly those for different racial, ethnic, or geographic populations.
|
From page 119... ...
access. Minority populations, particularly African Americans anc!
|
From page 120... ...
As is the case with socioeconomic position, stratifying measures by health status permits comparison of populations with similar needs. Use of emergency departments for nonacute, first contact care is a slightly different issue.
|
From page 121... ...
4-5. PRINCIPLES GUIDING MEASUREMENT OF ACCESS IN THE NATIONAL HEALTHCARE DISPARITIES REPORT Outlined below are key principles that should guide the development of access measures for the NHDR: I
|
From page 122... ...
These should account for the trends described above, including increase in chronic disease, a broader definition of health, and a recognition that factors outside of the immediate delivery system have major effects on access.
|
From page 123... ...
These are relevant regardless of whether the focus is on racial and ethnic disparities or on the general population. First, multiple federal and private data collection efforts assess insurance status.
|
From page 124... ...
It may be most useful to present information about premiums, covered benefits, any co-payments, and any deductibles for different races and ethnicities by income groupings, thus allowing the reader to further interpret the data and avoid the pitfalls discussed above. Proportion of Adults and Children without a Visit and Their Health Status These measures of utilization are often considered to measure access to care.
|
From page 125... ...
As managed care continues to evolve, attributes of the system may become more important than having a regular provider. These measures are readily available from national surveys, and the bulk of the evidence suggests that they continue to be useful, particularly if conditioned on health status.
|
From page 126... ...
Reducing Effects of Chronic Disease: Preventable Hospitalizations for Ambulatory Care Sensitive Contlitions Preventable hospitalizations for ambulatory care sensitive (ACS) conditions are most useful as measures of access when used alongside hospitalization for conditions not associated with access to
|
From page 127... ...
As an alternative, it would be useful to stratify this measure by those in fair or poor health to allow further inferences about timely treatment for exacerbations of chronic disease. While access for those usually in good health is also a concern, this information is harder to interpret absent a need-based measure (TOM, 1993~.
|
From page 128... ...
4. Proportion needing care and not getting it, stratified by health status.
|
From page 129... ...
4. Proportion of adolescents with no visit and their health status.
|
From page 130... ...
Avoiding complications of chronic diseases such as diabetes can be achieved with access to high quality care. However, this requires that individuals know they have the condition and that they need care.
|
From page 131... ...
Because chronic renal failure is such a prevalent condition among some minority populations, examining incident cases of renal failure whose first presentation is dialysis would be a similar indicator. Finally, the proposed measure for oral health care (percent of adults who are edentuTous)
|
From page 132... ...
measures regarding substance abuse reflect the importance of this problem for the population as a whole, the reporter! disparities in access to substance abuse treatment, ant!
|
From page 133... ...
remaining in the health care system itself. Disparity in access to specialty services for people with chronic disease is a wellclocumentec!
|
From page 134... ...
4. Proportion of the population who needed mental health care or substance abuse treatment, but who did not receive it.
|
From page 135... ...
Nonetheless, the presence of providers in a community is a prerequisite to actually getting an appointment. Information about language capability of mental health professionals is available from health plans and professional societies.
|
From page 136... ...
TABLE 4-2 Staying Healthy MEASURE PROPOSED SOURCE Rates of Neonatal Centers for Disease Control and Transmission of HIV Prevention (CDC) Proportion of Children with Centers for Medicare and Medicaid EPSDT Screening Services (CMS)
|
From page 137... ...
~ , Substance Abuse Provider National Household Survey on Drug Accessibility, SAMHSA OAS , Breast Cancer Survival, Adjusted for Surveillance, Epidemiology and End Stage at Presentation Results (SEER) , CMS Cultural competency.
|
From page 138... ...
Evaluation or Receiving Renal Transplant Proportion of Medicare Patients Centers for Medicare and Admitted for Heart Failure or Medicaid Services (CMS) Acute Myocardial Infarction (AMI)
|
From page 139... ...
Measures of access to specialty care and to disease management services. As chronic diseases become more prevalent and complicated to treat, access to specialty care may be necessary to achieve the best possible outcomes.
|
From page 140... ...
The following identifies the measure and explains the rationale: 1. Proportion of adolescents with no visit, and their health status.
|
From page 141... ...
This measure addresses health care for a major chronic disease.
|
From page 142... ...
Additional measures should be developed, particularly those representing the contribution of community and public health measures to access as well as those focusing on prevalent health conditions in minority populations.
|
From page 143... ...
2000. Can cultural competency reduce racial and ethnic health disparities?
|
From page 144... ...
2002. Diverse communities, common concerns: accessing health care quality for minority Americans, Report #523.
|
From page 145... ...
In Improving Healthcare Quality for Minority Patients. National Quality Forum.
|
From page 146... ...
2000. Oral Health in America: A Report of the Surgeon General.
|
From page 147... ...
2001. Racial and ethnic data collection: a review of state laws.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.