Guidance for the National Healthcare Disparities Report (2002) / Chapter Skim
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3 Measuring Disparities in Health Care Quality and Service Utilization
3 Measuring Disparities in Health Care Quality and Service Utilization
Pages 75-98
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From page 75... ...
While the pattern of racial and ethnic disparities in health has been well documented and reported, consensual explanations for racial and ethnic health disparities have been elusive. This is because much of the published research on racial disparities has focused on descriptions rather than on explanations (LaVeist, 20001.
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From page 76... ...
On one end of the continuum is health care equality, which can be characterized as health care services in which the rates of utilization for racial or ethnic minorities are equal to the rates for comparable White populations. In the middle are health care disparities, or differences in the rates of utilization of health care services where racial or ethnic minorities have substantively Tower rates of utilization.
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From page 77... ...
examined utilization of hormone replacement therapy among African American and White patients in the National Ambulatory Medical Care Survey for 1989 and 1996. This analysis found that racial disparities in hormone replacement therapy diminished over time, particularly for women without menopausal symptoms.
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From page 78... ...
Further exploration of racial disparities in the VA system compared with the active military system may be fruitful in understanding the etiology of racial disparities in health care. Disparities in Health Care Services and Quality Racial and ethnic differences in access and utilization of health services comprise the largest category of studies of disparities in health care.
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From page 79... ...
However, the problem of racial and ethnic disparities in health care extends beyond access to health care facilities. It also includes disparities in the availability of health care resources in the facilities where racial and ethnic minorities receive care.
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From page 80... ...
found that Hispanic women were less likely to receive Pap smears than White women. 1 It should be noted that variability across sample populations, settings, and databases in the studies reviewed can affect overall conclusions and generalizations on racial and ethnic health care disparities.
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From page 81... ...
(Todd et al., 2000) demonstrated that 43 percent of African American patients with extremity fractures at one university hospital went untreated for pain, while only 26 percent of White patients with similar fractures went untreated.
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From page 83... ...
~: ;~: 1 :4 D c is 3 ~ 3 ~ 3 11~i 1 ~ ~ : CO^^ · _ Cd Ct ~ 3 ~ · =, o ~ .
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From page 84... ...
Yet these same hospitals have significantly higher rates of adverse events due to medical negligence or errors compared to those hospitals not treating predominantly minority patients. Even after controlling for hospital characteristics and for disease severity and complexity, the only factor that remains
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From page 85... ...
3-2. CREATING A NATIONAL HEALTHCARE DISPARITIES REPORT There are numerous factors to consider in determining the types of disparities that should be the focus of the NHDR.
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From page 86... ...
Once the set of candidate measures is completed, then secondary considerations can be employed to select a set of measures for the report. TABLE 3-3 Assessment of Measures for Health Care Disparities CONTINUUM OF DISPA RITIES CONSUMER HEALTH HEALTH PERSPECTIVES CARE CARE ON HEALTH EQUALITIES DISPARITIES CARE NEEDS Staying Healthy Getting Better Living with Illness Coping with the End of Life HEALTH CARE HYPERDISPARITIES The following are recommended secondary considerations: Indicators are applicable to multiple racial and ethnic groups.
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From page 87... ...
Medical/Administrative Record Data Audits There is a large literature demonstrating racial differences in the medical and surgical management of conditions within health care settings. After controlling for access to care, studies have found that a patient's race predicts treatment decision making across a variety of conditions including breast cancer (Burns et al., 1996)
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From page 88... ...
, and psychiatric conditions (Chung et al., ~ 995~. Health Status Outcomes A growing body of health care quality data suggests that iatrogenic injury should be considered an important component of the total quality of care picture.
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From page 89... ...
Thus Risk Ratio=.33 . 57.=.58 This statistic represents the risk of receiving catheterization for African Americans relative to Whites.
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From page 90... ...
This statistic can be computed by first computing predicted and observed percentages of catheterization received by each group. This can be done as follows: determine the number of total patients that African Americans and Whites represent (75 - 250 = .3 X 100 = 30 percent for African Americans.
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From page 91... ...
In addition, adopt a set of criteria to use in the selection of individual measures. Criteria suggested include applicability to multiple racial and ethnic groups; accessibility to a broad population of health care consumers; limited confounding; and replicability.
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From page 92... ...
1991a. Hospital characteristics associated with adverse events and substandard care.
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From page 93... ...
In Minority Health in America: Findings and Policy Implications from The Commonwealth Fund Minority Health Survey .
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From page 94... ...
2000. Vulnerable Populations and Medicare Services; Why Do Disparities Exist.
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1999. Racial differences in hormone replacement therapy prescriptions.
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From page 96... ...
1999. Racial/ethnic disparities in health: the interplay between discrimination and socioeconomic status.
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From page 97... ...
1998. The declining impact of race and insurance status on hormone replacement therapy.
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From page 98... ...
1993. Racial differences in the use of invasive cardiovascular procedures in Veterans Affairs medical system.
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