Highlights from AHRQ 2009 Expert Meeting

Cecilia Rivera Casale, Senior Advisor for

Minority Health
Agency for Healthcare Research and Quality
March 7, 2011
 AHRQ’s Mission

Improve the quality, safety,

efficiency and effectiveness of
health care for all Americans
 AHRQ Portfolios

 Value
– Goal: Support the
development of health care Comparative
Effectiveness
activities that help reduce
unnecessary waste while Innovations/Emerging
Prevention and
improving quality Issues
Care Management

 Innovations/Emerging
AHRQ
Issues
– Goal: Identify and support Patient Safety
Value
ideas and projects that
have the potential for Health IT
highly innovative solutions
to health care challenges
 AHRQ Priority Populations
 Inner city and rural areas (including frontier areas)
 Low income groups
 Racial and ethnic minority groups
 Women and children
 The elderly
 Individuals with special health care needs,
including individuals with disabilities and those who
need chronic care or end-of-life health care
2010 NHQR and NHDR

Released February 28, 2011

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

 2/3: On average, people received the preventive

services tracked in the reports two-thirds of the time.

 ¾: On average, people received appropriate acute

care services three-quarters of the time.

 ¾: On average, patients received recommended

chronic disease management services three-quarters of
the time.
 1/5: On average, Americans report barriers to care one-
fifth of the time
 Quality is Improving;
Access and Disparities Are Not

 Quality is improving slowly

– Almost two-thirds of measures showed
improvement.
– Median rate of change was only 2.3% per year.
(179 measures)

 Access is not improving

– About 60% did not show improvement
– 40% were headed in the wrong direction.
–Median rate of change was -0.6% per year,
indicating no change over time.
(22 measures)
 Some Areas Merit
Urgent Attention
 Cancer screening and management of
diabetes.

 States in the central part of the

country.

 Residents of inner-city and rural

areas.

 Disparities in preventive services and

access to care.
 Why Focus on Health IT to
Start?

 Health IT as a place-based tool/facilitator

for quality improvement intervention
 Health IT implementation changes the
organization of care
 Health IT has potential to address issues
faced by under-resourced settings
 Why Is This Important?
 Health care disparities persist and in many cases are
worsening
 Ongoing and enhanced focus & activities within the DHHS
 Recognized importance of quality improvement must
include strategies for eliminating disparities
 The ACA requires establishment of offices of minority health
in HHS and focus on eliminating health disparities
 The ACA calls for National Quality and Prevention
Strategies – each includes eliminating disparities as a core
principle
 Choosing the Commissioned
Papers

Topic Driving Disparity1

Asthma B-W differences in
avoidable hospitalizations -
children
Diabetes B-W differences LEA
hospitalizations - adults
First trimester prenatal care Racial/ethnic disparities
Patient-Physician Asian-White (adult)
communication Poor-not poor (child)
Overview paper All – not condition specific

1
Source: NHDR, 2008
MCRR Supplement- 10/2010
 Reducing Disparities in Healthcare Quality: The
Role of Health IT in Underresourced Settings
 Condition-specific
 LEA due to Diabetes
 Prenatal Care
 Patient-Physician Communication among Asian
Adults and Low-income Children
 Role of Health IT to Improve Quality and Reduce
Disparities
 Meeting Recommendations

 Evaluate impact of health IT on URS, including priority

populations participants
 Research the needs for health IT education, support and
training for patients, providers, and caregivers
 Pursue collaborative funding mechanisms with private funders
to establish innovation in health IT and disparities
 Develop recommendations for public and private research
funders to ensure focus on quality improvement and disparities
reduction outcomes*
*Marshall H. Chin, MD, MPH, and Don Goldmann, MD
University of Chicago, Institute for Healthcare Improvement
 Implications for Funders
 Move beyond asking applicants simply to show that
they have included “priority populations” in their
research plan
 Ask all quality of care applicants to address
specifically how they will reduce known disparities or
gaps discovered in the course of the work
– Include a measurement plan that stratifies data
appropriately
 Design an overall portfolio of grants and grantees
that addresses improving outcomes and reducing
gaps in diverse populations and settings
 Reward applicants who address equity issues
 Promising Future

 Increased public awareness of

disparities
 Health reform legislation will
increase collection of race,
ethnicity, and language data
 Increased motivation for providers
and health care organizations to
address disparities
 An opportunity to move from
description and complaint to
action
Thank You