Current measures of equity are stratified measures of clinical effectiveness linked to race and ethnicity, limited English proficiency, and literacy. Challenges to developing better equity measures begin at the organizational level. Although 80 percent of hospitals and 45 percent of physician practices reported collecting patient race, ethnicity, and language data, less than 20 percent use data for quality improvement. It simply is not part of the culture of most providers. Little incentive exists to stratify data, which would allow data to be used to support changes. Development of equity measures would be greatly helped by creating a uniform method for collecting race, ethnicity, and primary language data at the health care organization level, coupled with providing incentives for organizations to do so.

The ideal measures of equity are measures of patient-centered-ness. Current patient-centered measures are self-reports of satisfaction, such as those used in CAHPS. These measures are important to capture, but there is reluctance to place weight on them as true measures of patient-centeredness because of their weak linkages to outcomes and the potential unintended consequences to providing care of reporting these data. To move beyond patient experiences of care, structural measures are needed, such as whether organizations know and understand their patient populations. Organizations need to be responsible for implementing ways to assess equity and disparities, suggesting that incentives to measure patient-centeredness must be developed.

Health disparities are driven by a combination of who you are and where you get your care. Studies have shown that the magnitude of disparities decreases substantially across specific quality measures when controlling for differences in care between hospitals, suggesting that where minority patients receive their care is a driver of disparities in health care. Understanding the balance between these drivers of disparities (who you are versus where you get your care) is critical when determining where interventions should be targeted.

Policies to support elimination of disparities and improved patient communication should also be developed further. The potential for performance incentives to improve quality but also to augment the disparities gap must be recognized. It is important to focus on patient-centered care to reduce disparities nationally by targeting interventions both within hospitals as well as by developing policies that improve care across hospitals and other health care settings, Hasnain-Wynia concluded.



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