"Every American should have access to high-quality, appropriate and safe health care, and we need to increase our efforts to achieve that goal because our slow progress is not acceptable," Carolyn Clancy, M.D., head of AHRQ, said in a press statement yesterday. She was referencing the agency's release of the 2010 State Snapshots report. AHRQ has issued the snapshot report every year since 2003. It tracks progress made in improving health care quality and reducing health disparities.
Certainly no one would argue with Clancy's sentiment. Every day, hundreds of thousands of people go to work at hospitals across the nation with the intention of providing the best and safest care possible. But the sad reality is that sometimes our best isn't enough. AHRQ notes that while there have been gains in meeting quality measures, "access and disparities are not improving." For instance:
- Blacks had worse access to care than did whites for one-third of core measures.
- Asians, American Indians and Alaska Natives had worse access to care than whites for 1 of 5 core measures.
- Hispanics had worse access to care than non-Hispanic whites for 5 of 6 core measures.
And in terms of quality, the data is equally as startling:
- Blacks, American Indians and Alaska Natives received worse care than whites for about 40 percent of core measures.
- Asians received worse care than whites for about 20 percent of core measures; for Hispanics it is 60 percent.
Nine years ago, the IOM tackled the issue of racial and ethnic disparities in its landmark report, Unequal Treatment. The IOM warned that racial and ethnic minorities "experience lower quality of health services," even if access to care is essentially equal to that of non-minorities. "A comprehensive, multi-level strategy is needed to eliminate these disparities," the IOM stated.
So why, after nearly a decade, are we still seeing such gaps? I talked about this last month with Joseph Betancourt, M.D., director of the Disparities Solutions Center at Massachusetts General Hospital. He says the problem is multi-faceted. For starters, the field has been slow to collect race and ethnicity data. And without actionable data, he says, "everything kind of stalls." Also, in areas like safety and quality, the reimbursement and accreditation systems have really applied pressure to improve. The same can't be said for equity, although that is changing, he said, referencing efforts by the Joint Commission and National Quality Forum.
Armed with relevant data though, providers can begin to bridge the gap. During our interview, Betancourt highlighted an example where Mass General improved care management for Latinos living with diabetes.
There are countless other examples happening in pockets across the nation, some of which are detailed in the AHRQ report. For those hospitals looking for solutions, tools are available. The Disparities Solutions Center has a good website. And if you are attending our Leadership Summit July 17-19 in San Diego, Betancourt is leading a discussion on equity. Also, the Health Research and Educational Trust has a highly regard disparities toolkit.
Ultimately, it will, as the IOM said, take a comprehensive approach to tackle this complicated issue. It starts with data, but that's certainly not the end point.
"Improving quality and reducing disparities require measurement and reporting, but these are not the ultimate goals," the AHRQ report concludes. "The fundamental purpose of improvement in health care is to make all patients' and families' lives better."
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