Health Care Quality Gaps and Disparities Persist in Every State

Electronic Newsletter, Issue 317

June 10, 2011

AHRQ News and Numbers

About 39,000 school-age children were treated for sports-related concussions at hospital emergency departments in 2008—approximately 90 percent of all emergency visits for that condition. Children ages 14 to 18 (high school age) represented 58 percent of the emergency visits treated for a sports-related concussion, 17 percent were between the age of 11 and 13 (middle school), 7 percent were 6 to 10 years old (elementary school age), and 8 percent were 19 to 23 years old (college age). [Source: Agency for Healthcare Research and Quality, HCUP Statistical Brief #114: Sports Related Concussions, 2008.]

Today's Headlines

  1. Health care quality gaps and disparities persist in every State
  2. Connecting local providers to academic medical centers using video improved hepatitis C outcomes
  3. AHRQ 2011 Annual Conference set for September 18-21/Conference Web Site now live
  4. New brief outlines strategies to put patients at the center of primary care
  5. CHIPRA Pediatric Quality Measures Program: request for nominations for expert panelists
  6. AHRQ's Health Care Innovations Exchange highlights self-management
  7. NIH State-of-the-Science panel statement: diagnosis and management of ductal carcinoma in situ
  8. New resources to care for community-dwelling patients during emergency events
  9. Second generation of EPRI has new features and is easier to install
  10. New grant funds the active aging research center
  11. AHRQ in the professional literature

1. Health Care Quality Gaps and Disparities Persist in Every State

AHRQ released the 2010 State Snapshots showing that States are seeing improvements in health care quality, but disparities for their minority and low-income residents persist. New Hampshire, Minnesota, Maine, Massachusetts and Rhode Island showed the greatest overall performance improvement in 2010. The five States with the smallest overall performance improvement were Kentucky, Louisiana, New Mexico, Oklahoma and Texas.

As in previous years, AHRQ's 2010 State Snapshots show that no State does well or poorly on all quality measures. Among minority and low-income Americans, the level of health care quality and access to services remained unfavorable. The size of disparities related to race and income varied widely across the States. The 2010 State Snapshots, an interactive Web-based tool, show whether a State has improved or worsened on specific health care quality measures. For each State and the District of Columbia, this tool features an individual performance summary of more than 100 measures, such as preventing pressure sores, screening for diabetes-related foot problems and giving recommended care to pneumonia patients. Health leaders, insurers, providers, researchers and consumers can use the State Snapshots data to examine the extent of health care quality and disparities in their states and take steps to address gaps in quality care and access to services.

A new feature this year is a State Resource Directory that provides tools and information on assessing quality measures and disparities data that states can use to develop their own health care quality and disparities measures. Also available are direct links to AHRQ's Health Care Innovations Exchange, a searchable database in which users can find information and resources on evidence-based innovations that others in their states have used to improve care. Select to access the 2010 State Snapshots.

2. Connecting Local Providers to Academic Medical Centers Using Video Improved Hepatitis C Outcomes

A new AHRQ- funded study found that widely available technology, expert training and real-time feedback helped ensure that patients treated for Hepatitis C in local communities did as well as patients treated at a university-based medical center. To bring effective treatment to persons with the Hepatitis C virus (HCV) infection in underserved areas, researchers at the University of New Mexico Health Sciences Center (UNMHSC) developed a model called Extension for Community Healthcare Outcomes, or ECHO, that brings state-of-the art medical knowledge to primary care providers and nurses. Using videoconference or teleconference lines, community-based medical teams, including physicians and nurses, take part in weekly clinics with specialists. Together, they discuss patients' medical histories, review lab results and other key findings and collaborate on treatment plans using evidence-based treatment approaches. Study authors examined outcomes for 407 patients undergoing treatment for HCV infection at 21 community settings, including five prisons, and at a UNMHSC-affiliated clinic in Albuquerque. They found that the HCV infection was cured at a similar rate for patients who were treated at these community-based settings as patients who were treated at the university clinic (58.2 percent vs. 57.5 percent). Because a majority of patients at the community setting were Hispanic, the study also achieved a related goal of increasing treatment for underserved and minority patients.

The study was published in the June 2 online issue of the New England Journal of Medicine and in the June 9 print edition. Select to read our press release and select to access the abstract on PubMed.®

3. AHRQ 2011 Annual Conference Set for September 18-21/Conference Web Site Now Live

AHRQ's 2011 Annual Conference will be held September 18-21 at the Bethesda North Marriott Hotel & Conference Center in Bethesda, Maryland. In keeping with the conference theme, "AHRQ: Leading Through Innovation & Collaboration," our event will emphasize how AHRQ is leading change in addressing today's challenges in improving access to care and its quality and cost, as well as partnering with others at the forefront of these issues. We are confident this will be another AHRQ event that you will not want to miss. We hope that you will be able to join us! For more details, including information on how to register, visit AHRQ's Annual Conference Web site.

4. New Brief Outlines Strategies to Put Patients at the Center of Primary Care

A new AHRQ brief, The Patient-Centered Medical Home: Strategies to Pub Patients at the Center of Primary Care, highlights opportunities to improve patient engagement in primary care. The brief focuses on involvement at three levels: the engagement of patients and families in their own care, in quality improvement activities in the primary care practice, and in the development and implementation of policy and research related to the patient-centered medical home (PCMH). Strategies to Put Patients at the Center of Primary Care provides a clear and concise definition of the patient-centered medical home and outlines six strategies that can be used to support primary care practices in their efforts to engage patients and families. Select to access this brief. 

5. CHIPRA Pediatric Quality Measures Program: Request for Nominations for Expert Panelists

The Children's Health Insurance Program Reauthorization Act (CHIPRA) Pediatric Quality Measures Program is seeking nominees who will help to establish criteria for recommending improved CHIPRA children's healthcare quality measures for Medicaid and CHIP programs, as required by the established by CHIPRA. We are seeking experts in measurement science, health care quality measurement, children, adolescent and perinatal health and health care, disparities, e-measurement, and Medicaid and CHIP operations. Approximately 15 experts will participate in a meeting to be held in the Washington, DC, on September 18. In future years, expert panels will be convened to evaluate new and enhanced children's health care quality measures using these criteria. Important guidance for submission of nominations is included in the June 9 Federal Register notice. Nomination packages are due June 29 to chipra@ahrq.hhs.gov.

6. AHRQ's Health Care Innovations Exchange Highlights Self-Management

This week, AHRQ's Health Care Innovations Exchange features three profiles of innovative programs that incorporated self-management into their treatment of patients with chronic conditions. One such innovation is the Urban Health Plan Asthma Relief Street program in Bronx, NY, which provides self-management support to low-income individuals with asthma at twelve health centers along with standardized screening and guideline-based treatment. The program increased the number of people diagnosed with and treated for asthma, reduced asthma hospitalizations among children, and generated significant cost savings. This issue also includes an expert commentary on Self-Management Requires Working Patient-Physician Partnership. More innovations on self-management are available on AHRQ's Health Care Innovations Exchange Web site.

7. NIH State-of-the-Science Panel Statement: Diagnosis and Management of Ductal Carcinoma In Situ

The National Institutes of Health (NIH) Consensus Program, held a State-of-the Science Conference on September 22-24 for data on the Diagnosis and Management of Ductal Carcinoma In Situ (DCIS). The panel drafted its statement based on scientific evidence presented in an open forum and on published scientific literature. The expert panel:

  • Urged the scientific community to identify appropriate biomarkers and other prognostic factors to better predict the risk of developing breast cancer.
  • Recommended efforts to ensure detailed collection of clinical, pathological, imaging, and molecular data about DCIS using standardized reporting measures, annotated specimen repositories, and multicenter databases.
  • Emphasized the importance of patient preferences and recommended improved communication between patients and providers, and serious consideration of new nomenclature that more closely reflects the excellent survival rates for this condition.

This statement is an independent report of the panel and does not represent the policy of NIH or the Federal Government. Select to access the statement findings.

8. New Resources to Care for Community-Dwelling Patients During Emergency Events

AHRQ has released two new resources that can help emergency planners and responders ensure that community-dwelling patients receive appropriate care during a mass casualty event. Community-dwelling patients with daily health care needs may not be directly affected by a mass casualty event but if that event disrupts their usual care routine, they may still be at risk. Lacking a usual source of care, these patients are more likely to seek care at hospitals already overburdened with mass casualties. The "Home Health Patient Assessment Tool: Preparing for Emergency Triage," reviews existing patient categorization tools and presents a new model patient risk assessment tool. The new tool will allow home care agencies, hospitals, and emergency planners to anticipate the needs of community-dwelling patients and assess who might be most at risk of hospitalization if their traditional home support services are disrupted during an emergency. The compendium of resources available in "Data Sources for the At-Risk Community-Dwelling Patient Population," provides a summary of each data resource, including its strengths and limitations for estimating the numbers of community-dwelling patients at risk during an MCE, as well as any areas of overlap with other data resources.

9. Second Generation of EPRI Has New Features and Is Easier to Install

AHRQ has released a newly updated version of the Emergency Preparedness Resource Inventory (EPRI), a Web-based software tool to help local, regional and state planners prepare for and respond to emergency situations. Prior to an event, emergency officials can download and use EPRI to develop an inventory of resources necessary to respond to different types of events. During an emergency, EPRI can help determine what resources are available for response. EPRI is now pre-loaded with resources used in the AHRQ Hospital Surge Model, which allows users to better allocate health care resources during emergency response operations. It also provides more flexibility for local users to develop inventory reports and emergency request functions that meet their needs. The new version is also now compatible with current releases of Microsoft database and web server software. It features an easier installation process with an improved configuration and set up. Other improvements include:

  • A more user-friendly interface.
  • An updated Administrator's Guide and User Manual; and
  • Better data quality monitoring tools.

Select for more information or to download the new version of EPRI.

10. New Grant Funds the Active Aging Research Center

AHRQ awarded a 5-year $10 million grant to the University of Wisconsin for community-based participatory research on the use of communication and information technologies to improve the health and health care services for older adults. The grant aims to create a center of excellence that brings together strong research teams from various institutions and entities of the aging network. The research will focus on three broad themes:

  • The use of information technologies to extend independence and functioning of older adults and reduce unnecessary health care utilizations.
  • The expansion of service networks that place individuals and their families at the center.
  • The development of innovative approaches to translate evidence into practice.

Select to read the abstract on AHRQ's Health IT Web site.

11. AHRQ in the Professional Literature

We are providing the following hyperlinks to journal abstracts through PubMed® for your convenience. Unfortunately, some of you may not be able to access the abstracts because of firewalls or specific settings on your individual computer systems. If you are having problems, you should ask your technical support staff for possible remedies.

Nylund CM, Goudie A, Garza JM, et al. Clostridium difficile infection in hospitalized children in the United States. Arch Pediatr Adolesc Med 2011 Jan 3. Select to access the abstract on PubMed®.

Fontaine P, Flottemesch TJ, Solberg LI, et al. Is consistent primary care within a patient-centered medical home related to utilization patterns and costs? J Ambul Care Manage 2011 Jan-Mar; 34(1):10-19. Select to access the abstract on PubMed®.

Goldman LE, Walker R, Miglioretti DL, et al. Accuracy of diagnostic mammography at facilities serving vulnerable women. Med Care 2011 Jan; 49(1):67-75. Select to access the abstract on PubMed®.

Memtsoudis S, Liu SS, Ma Y, et al. Perioperative pulmonary outcomes in patients with sleep apnea after noncardiac surgery. Anesth Analg 2011 Jan; 112(1):113-21. Select to access the abstract on PubMed®.

Reynolds C, Quan V, Kim D, et al. Methicillin-resistant Staphylococcus aureus (MRSA) carriage in 10 nursing homes in Orange County, California. Infect Control Hosp Epidemiol 2011 Jan; 32(1):91-3. Select to access the abstract on PubMed®.

Saverno KR, Hines LE, Warholak TL, et al. Ability of pharmacy clinical decision-support software to alert users about clinically important drug-drug interactions. J Am Med Inform Assoc 2011 Jan; 18(1):32-7. Select to access the abstract on PubMed®.

Warriner AH, Patkar NM, Curtis JR, Delzell E, Gary L, Kilgore, Saag K. Which fractures are most attributable to osteoporosis? J Clin Epidemiol 2011 Jan; 64(1):46-53. Select to access the abstract on PubMed®.

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Current as of June 2011
Internet Citation: Health Care Quality Gaps and Disparities Persist in Every State. June 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/e-newsletter/317.html