Presenters
- Anne C. Beal, MD, MPH, Assistant Vice President, The Commonwealth Fund
- Linda Cummings, PhD, Vice President of Research, National Association of Public Hospitals and Health Systems
- Neil S. Calman, MD, President and CEO, Institute for Family Health
Presenter: Anne C. Beal, MD, MPH, Assistant Vice President, The Commonwealth Fund
Theoretical Background on Health Disparities:
- A large portion of the documented health disparities are due to health care issues such as impaired access, delivery of less safe care, and financing barriers.
- Experts expect that organizations will hit a threshold on performance improvement, unless they address inequities in the care provided to subpopulations.
- Because high-quality care cannot be achieved without equity, disparity is a quality issue.
Presenter: Linda Cummings, PhD, Vice President of Research, National Association of Public Hospitals and Health Systems (NAPH)
Work at the Institutional Level to Eliminate Disparities:
- The federal Office of Minority Health requested that NAPH partner with IHI to create a change package to address disparities in health care.
- The group created a preliminary change package, which includes the following high-level changes:
- Use or practice? (evidence-based care)
- Establish measurement
- Analyze the data
- Use the analysis for improvement
- Minimize handovers, and encourage and ensure smooth transitions
- Communicate in the patient’s language
- Engage leaders
- Engage patients and families
- Form alliances with the community
- The change package is currently being revised, based on feedback from a group of 18 medical directors.
- The group also is working on identifying appropriate measurement strategies for the change package.
Presenter: Neil S. Calman, MD, President and CEO, Institute for Family Health
Work at the Clinical Frontline to Eliminate Disparities:
- The Institute for Family Health is a community health center network located in New York.
- In 2002, the network instituted an electronic health record (EHR).
- In this project, EHR data were analyzed to assess and better understand disparities in diabetes control.
- The data indicated that glucose control varied by race and ethnicity.
- However, data from the EHR, such as comorbid conditions, body mass index, average time between clinic visits, or average number of clinic visits per month, did not explain these differences. Treatment provided did vary by race and ethnicity, but in a direction that did not explain the health disparities — whites actually had fewer office visits and received fewer prescriptions for diabetes medications.
- The group uncovered one factor that seemed to correlate with better glucose control among a provider’s panel of diabetic patients: the rate of referral for a nutrition consultation. The patients of providers who referred more frequently to nutritionists tended to have lower average HbA1c levels.
- Based on these data, Dr. Calman’s group hopes to eliminate disparities in diabetes care by identifying interventions that result in more rapid diabetes control and targeting these treatments to patients at highest risk of poor control (i.e., those who present with worse control to begin with). The group believes that it is more efficacious to rapidly apply effective treatment paradigms than to delay such care while trying to identify all the underlying causes of health disparities.
- The group plans to continue identifying and applying strategies that effectively improve diabetes care and “tease out” and address the factors causing disparities as they proceed.
For More Information
View the PowerPoint presentations for this Forum Workshop session:
01/31/2008
