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Reducing Racial and Ethnic Disparities in Health Care Cecilia Rivera-Casale Ph.D. Cecilia Rivera-Casale Ph.D. Senior Advisor for Minority Health Agency.

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Presentation on theme: "Reducing Racial and Ethnic Disparities in Health Care Cecilia Rivera-Casale Ph.D. Cecilia Rivera-Casale Ph.D. Senior Advisor for Minority Health Agency."— Presentation transcript:

1 Reducing Racial and Ethnic Disparities in Health Care Cecilia Rivera-Casale Ph.D. Cecilia Rivera-Casale Ph.D. Senior Advisor for Minority Health Agency for Healthcare Research and Quality Washington, D.C. – January 29, 2010

2 Overview AHRQ: The BIG Picture AHRQ: The BIG Picture Quality/Disparities Report Findings Quality/Disparities Report Findings Comparative Effectiveness Research Comparative Effectiveness Research Summary Summary

3 AHRQs Mission Improve the quality, safety, efficiency and effectiveness of health care for all Americans

4 Research At HHS What is AHRQs Space? NIH Basic biomedical, lab bench research and efficacy clinical trials CDC The public health system, community based interventions AHRQ Effectiveness of health care services and the health care delivery system

5 AHRQ Priorities Effective Health Care Program Medical Expenditure Panel Surveys Ambulatory Patient Safety Patient Safety Patient Safety Health IT Patient Safety Organizations New Patient Safety Grants Comparative Effectiveness Reviews Comparative Effectiveness Research Clear Findings for Multiple Audiences Quality & Cost-Effectiveness, e.g. Prevention and Pharmaceutical Outcomes U.S. Preventive Services Task Force MRSA/HAIs Visit-Level Information on Medical Expenditures Annual Quality & Disparities Reports Safety & Quality Measures, Drug Management and Patient-Centered Care Patient Safety Improvement Corps Other Research & Dissemination Activities

6 AHRQs National Reports on Quality and Disparities The median annual rate of change for all quality measures was 1.4% The median annual rate of change for all quality measures was 1.4% – Of 190 measures, 132 (69%) showed some improvement Some reductions in disparities of care according to race, ethnicity, and income Some reductions in disparities of care according to race, ethnicity, and income – Disparities persist in health care quality and access Reports Released May 9th

7 2008 Healthcare Disparities Report Key Themes: Key Themes: – Disparities persist in health care quality and access – Magnitude and pattern of disparities are different within subpopulations – Some disparities exist across multiple priority populations

8 2008 National Healthcare Disparities Report 60% of quality measures have not improved for minorities in past 6 years 60% of quality measures have not improved for minorities in past 6 years 1 in 7 Medicare patients have one or more adverse events 1 in 7 Medicare patients have one or more adverse events Patient safety measures worsened by 1% each year for past 6 years Patient safety measures worsened by 1% each year for past 6 years Central-line associated bloodstream infections affect hundreds of thousands of patients each year Central-line associated bloodstream infections affect hundreds of thousands of patients each year

9 Disparities Report: Key Findings 60% of measures of quality not are improving for Blacks, Asians, American Indians/Alaska Natives (AI/AN), Hispanics, poor populations; trend for 6 years 60% of measures of quality not are improving for Blacks, Asians, American Indians/Alaska Natives (AI/AN), Hispanics, poor populations; trend for 6 years 80% of access measures stayed the same or got worse for Hispanics 80% of access measures stayed the same or got worse for Hispanics 60% of access measures stayed the same or got worse for Blacks and Asians 60% of access measures stayed the same or got worse for Blacks and Asians 57% of access measures stayed the same or got worse for poor populations 57% of access measures stayed the same or got worse for poor populations

10 Disparities Report: Biggest Gaps by Population Proportion of new AIDS cases was 9.4 times as high for Blacks as Whites Proportion of new AIDS cases was 9.4 times as high for Blacks as Whites Rate of new AIDS cases more than 3 times as high for Hispanics as for non-Hispanic Whites Rate of new AIDS cases more than 3 times as high for Hispanics as for non-Hispanic Whites AI/AN women more than twice as likely to lack prenatal care as White women AI/AN women more than twice as likely to lack prenatal care as White women Asians more likely than Whites to not get timely care for illness or injury Asians more likely than Whites to not get timely care for illness or injury Poor adults more than twice as likely as high- income adults not to get timely care for an illness or injury Poor adults more than twice as likely as high- income adults not to get timely care for an illness or injury

11 Example of Local Level Application: Hispanic Elderly Initiative HHS pilot initiative aimed at improving the health and quality of life for Hispanic elders. HHS pilot initiative aimed at improving the health and quality of life for Hispanic elders. Eight large metropolitan communities selected to participate in the pilot: Chicago, Houston, Los Angeles, McAllen, Miami, New York, San Antonio and San Diego. Eight large metropolitan communities selected to participate in the pilot: Chicago, Houston, Los Angeles, McAllen, Miami, New York, San Antonio and San Diego. Medicare participation and diabetes care are target areas of work for each of the communities Medicare participation and diabetes care are target areas of work for each of the communities

12 Comparative Effectiveness and the Recovery Act The American Recovery and Reinvestment Act of 2009 includes $1.1 billion for comparative effectiveness research: The American Recovery and Reinvestment Act of 2009 includes $1.1 billion for comparative effectiveness research: – AHRQ: $300 million – NIH: $400 million (appropriated to AHRQ and transferred to NIH) – Office of the Secretary: $400 million (allocated at the Secretarys discretion) Federal Coordinating Council appointed to coordinate comparative effectiveness research across the federal government

13 Definition: IOM Comparative effectiveness research (CER) is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat and monitor a clinical condition or to improve the delivery of care. The purpose of CER is to assist consumers, clinicians, purchasers and policy makers to make informed decisions that will improve health care at both the individual and population levels. Comparative effectiveness research (CER) is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat and monitor a clinical condition or to improve the delivery of care. The purpose of CER is to assist consumers, clinicians, purchasers and policy makers to make informed decisions that will improve health care at both the individual and population levels. National Priorities for Comparative Effectiveness Research Institute of Medicine Report Brief June 2009

14 Conceptual Framework Dissemination & Translation Horizon Scanning Evidence Need Identification Evidence Synthesis Evidence Generation Career Development Research Training Stakeholder Input & Involvement

15 CER and Innovation CER will enhance the best and most innovative strategies CER will enhance the best and most innovative strategies Can include new populations and sub- populations i.e. minorities and other priority populations, children, elderly, patients with multiple chronic conditions, persons with disabilities and other. Can include new populations and sub- populations i.e. minorities and other priority populations, children, elderly, patients with multiple chronic conditions, persons with disabilities and other. Can bring early attention to emerging issues Can bring early attention to emerging issues

16 CER and Priority Populations Include data sources for evidence based studies in diverse populations Include data sources for evidence based studies in diverse populations Increase minority participation in research protocols using pragmatic settings Increase minority participation in research protocols using pragmatic settings Prepare next generation of diverse researchers that focus on underserved populations Prepare next generation of diverse researchers that focus on underserved populations Utilize more CBPR studies Utilize more CBPR studies

17 Comparative Effectiveness Challenges/Opportunities Anticipating downstream effects of policy applications Anticipating downstream effects of policy applications Making sure that comparative effectiveness is "descriptive, not prescriptive Making sure that comparative effectiveness is "descriptive, not prescriptive Creating a level playing field among all stakeholders, including patients and consumers Creating a level playing field among all stakeholders, including patients and consumers Using research to address concerns of diverse patients and clinicians Using research to address concerns of diverse patients and clinicians

18 Questions & Comments?


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