highlights from ahrq 2009 expert meeting, cecilia rivera casale

8/7/2019 Highlights from AHRQ 2009 Expert Meeting, Cecilia Rivera Casale

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Highlights from AHRQ 2009 Expert MeetingHighlights from AHRQ 2009 Expert Meeting

Cecilia Rivera Casale, Senior Advisor forCecilia Rivera Casale, Senior Advisor for

Minority HealthMinority HealthAgency for Healthcare Research and QualityAgency for Healthcare Research and Quality

March 7, 2011March 7, 2011


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AHRQs MissionAHRQs Mission

Improve the quality, safety,Improve the quality, safety,

efficiency and effectiveness ofefficiency and effectiveness of

health care for all Americanshealth care for all Americans


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AHRQ PortfoliosAHRQ Portfolios

ValueValue

Goal: Support theGoal: Support the

development of health caredevelopment of health care

activities that help reduceactivities that help reduce

unnecessary waste whileunnecessary waste while

improving qualityimproving quality

Innovations/EmergingInnovations/Emerging

IssuesIssues

Goal: Identify and supportGoal: Identify and supportideas and projects thatideas and projects that

have the potential forhave the potential for

highly innovative solutionshighly innovative solutions

to health care challengesto health care challenges


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AHRQ Priority PopulationsAHRQ Priority Populations

Inner city and rural areas (including frontierInner city and rural areas (including frontierareas)areas)

Low income groupsLow income groups

Racial and ethnic minority groupsRacial and ethnic minority groups

Women and childrenWomen and children

The elderlyThe elderly

Individuals with special health care needs,Individuals with special health care needs,including individuals with disabilities and thoseincluding individuals with disabilities and thosewho need chronic care or endwho need chronic care or end--ofof--life healthlife healthcarecare


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2010 NHQR and NHDR2010 NHQR and NHDR

Released February 28, 2011Released February 28, 2011


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Health care quality and access are suboptimal,Health care quality and access are suboptimal,especially for minority and lowespecially for minority and low--income groups.income groups.

2/32/3::On average, people received theOn average, people received thepreventive services tracked in the reportspreventive services tracked in the reportstwotwo--thirds of the time.thirds of the time.

: On average, people received: On average, people receivedappropriate acute care services threeappropriate acute care services three--quarters of the time.quarters of the time.

: On average, patients received: On average, patients receivedrecommended chronic disease managementrecommended chronic disease managementservices threeservices three--quarters of the time.quarters of the time.

1/51/5: On average, Americans report barriers: On average, Americans report barriersto care oneto care one--fifth of the timefifth of the time


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Quality is Improving;Quality is Improving;Access and Disparities Are NotAccess and Disparities Are Not

Quality is improving slowlyQuality is improving slowly

Almost twoAlmost two--thirds ofmeasures showedthirds ofmeasures showedimprovement.improvement.

Median rate of change was only 2.3%Median rate of change was only 2.3%

per year.per year.(179 measures)(179 measures)

Access is not improvingAccess is not improving

About 60% did not show improvementAbout 60% did not show improvement

40% were headed in the wrong40% were headed in the wrongdirection.direction.

Median rate of change wasMedian rate of change was --0.6% per0.6% peryear, indicating no change over time.year, indicating no change over time.

(22 measures)(22 measures)


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Some Areas MeritSome Areas MeritUrgent AttentionUrgent Attention

Cancer screening andCancer screening andmanagement of diabetes.management of diabetes.

States in the central part ofStates in the central part ofthe country.the country.

Residents of innerResidents of inner--city andcity and

rural areas.rural areas.

Disparities in preventiveDisparities in preventive

services and access to care.services and access to care.


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Why Focus on Health IT toWhy Focus on Health IT toStart?Start?

Health IT as a placeHealth IT as a place--basedbasedtool/facilitator for quality improvementtool/facilitator for quality improvement

interventionintervention Health IT implementation changes theHealth IT implementation changes the

organization of careorganization of care

Health IT has potential to address issuesHealth IT has potential to address issuesfaced by underfaced by under--resourced settingsresourced settings


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Why Is This Important?Why Is This Important?

Health care disparities persist and in manyHealth care disparities persist and in manycases are worseningcases are worsening

Ongoing and enhanced focus & activitiesOngoing and enhanced focus & activitieswithin the DHHSwithin the DHHS

Recognized importance of qualityRecognized importance of qualityimprovement must include strategies forimprovement must include strategies foreliminating disparitieseliminating disparities

The ACA requires establishment of offices ofThe ACA requires establishment of offices of

minority health in HHS and focus onminority health in HHS and focus oneliminating health disparitieseliminating health disparities The ACA calls for National Quality andThe ACA calls for National Quality and

Prevention StrategiesPrevention Strategies each includeseach includeseliminating disparities as a core principleeliminating disparities as a core principle


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Choosing the CommissionedChoosing the CommissionedPapersPapers

TopicTopic Driving DisparityDriving Disparity11

AsthmaAsthma BB--W differences inW differences inavoidable hospitalizationsavoidable hospitalizations --

childrenchildrenDiabetesDiabetes BB--W differences LEAW differences LEA

hospitalizationshospitalizations -- adultsadults

First trimesterprenatal careFirst trimesterprenatal care Racial/ethnic disparitiesRacial/ethnic disparities

PatientPatient--PhysicianPhysiciancommunicationcommunication

AsianAsian--White (adult)White (adult)

PoorPoor--not poor (child)not poor (child)

Overview paperOverview paper AllAll not condition specificnot condition specific

1 Source: NHDR, 2008


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MCRR SupplementMCRR Supplement-- 10/201010/2010

Reducing Disparities in HealthcareReducing Disparities in HealthcareQuality: The Role of Health IT inQuality: The Role of Health IT inUnderresourced SettingsUnderresourced Settings

ConditionCondition--specificspecific LEA due to DiabetesLEA due to Diabetes

Prenatal CarePrenatal Care

PatientPatient--Physician CommunicationPhysician Communicationamong Asian Adults and Lowamong Asian Adults and Low--income Childrenincome Children

Role of Health IT to ImproveRole of Health IT to ImproveQuality and Reduce DisparitiesQuality and Reduce Disparities


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Meeting RecommendationsMeeting Recommendations

Evaluate impact of health IT on URS,Evaluate impact of health IT on URS,including priority populations participantsincluding priority populations participants

Research the needs for health IT education,Research the needs for health IT education,support and training forpatients, providers,support and training forpatients, providers,and caregiversand caregivers

Pursue collaborative funding mechanisms withPursue collaborative funding mechanisms withprivate funders to establish innovation inprivate funders to establish innovation inhealth IT and disparitieshealth IT and disparities

Develop recommendations forpublic andDevelop recommendations forpublic andprivate research funders to ensure focus onprivate research funders to ensure focus onquality improvement and disparities reductionquality improvement and disparities reductionoutcomes*outcomes*

*Marshall H. Chin, MD, MPH, and Don Goldmann, MD*Marshall H. Chin, MD, MPH, and Don Goldmann, MD

University of Chicago, Institute for Healthcare ImprovementUniversity of Chicago, Institute for Healthcare Improvement


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Implications for FundersImplications for Funders

Move beyond asking applicants simply to showMove beyond asking applicants simply to showthat they have included priority populations inthat they have included priority populations intheir research plantheir research plan

Ask all quality of care applicants to addressAsk all quality of care applicants to address

specifically how they will reduce known disparitiesspecifically how they will reduce known disparitiesor gaps discovered in the course of the workor gaps discovered in the course of the work

Include a measurement plan that stratifies dataInclude a measurement plan that stratifies dataappropriatelyappropriately

Design an overall portfolio of grants and granteesDesign an overall portfolio of grants and granteesthat addresses improving outcomes and reducingthat addresses improving outcomes and reducinggaps in diverse populations and settingsgaps in diverse populations and settings

Reward applicants who address equity issuesReward applicants who address equity issues


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Promising FuturePromising Future

Increased public awareness ofIncreased public awareness ofdisparitiesdisparities

Health reform legislation willHealth reform legislation will

increase collection of race,increase collection of race,ethnicity, and language dataethnicity, and language data

Increased motivation forIncreased motivation forproviders and health careproviders and health careorganizations to addressorganizations to addressdisparitiesdisparities

An opportunity to move fromAn opportunity to move fromdescription and complaint todescription and complaint toactionaction


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Thank YouThank You

highlights from ahrq 2009 expert meeting, cecilia rivera casale

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