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Chartbook for Hispanic Health Care

Part 3: Trends in Access and Priorities of the National Quality Strategy—National Quality Strategy Priorities

NQS Priorities

Patient Safety
Person-Centered Care
Care Coordination
Effective Treatment
Healthy Living
Care Affordability

Trends in Quality

QUALITY: Through 2012, most measures of health care quality for Hispanics improved

Chart shows measures of health care quality for Hispanics. Total (n=144): Worsening - 3; No Change - 49; Improving - 92. Patient Safety (n=18): No Change - 6; Improving - 12. Person-Centered Care (n=22)): No Change - 6; Improving - 16. Effective Treatment (n=51)): Worsening - 2; No Change - 18; Improving - 31. Healthy Living (n=38)): No Change - 14; Improving - 24.

Key: n = number of measures.
Improving = Quality is going in a positive direction at an average annual rate greater than 1 percent per year.
No Change = Quality is not changing or is changing at an average annual rate less than 1 percent per year.
Worsening = Quality is going in a negative direction at an average annual rate greater than 1 percent per year.

  • Quality of care for Hispanics:
    • Improved for 64% (92 out of 144) of the measures.
    • Worsened for 2% (3 out of 144) of the measures.
    • Did not change for 34% (49 out of 144) of the measures.
  • Among the NQS priorities, quality of care for Hispanics:
    • Improved for 67% (12 of 18) of Patient Safety measures and did not change for 33% (6 of 18).
    • Improve for 73% (16 of 22) of Person-Centered Care measures and did not change for 27% (6 of 22).
    • Improved for 61% (31 of 51) of Effective Treatment measures, worsened for 4% (2 of 51), and did not change for 35% (18 of 51).
    • Improved for 63% (24 of 38) of Healthy Living measures and did not change for 37% (14 of 38).
    • There are insufficient numbers of reliable measures of Care Coordination and Care Affordability to summarize in this way.

Trends in Quality Disparities

QUALITY DISPARITIES: Disparities remained prevalent across a broad spectrum of quality measures

Chart shows Number and Percentage of Quality Measures for Which Members of Selected Groups Experienced Disparities. Poor vs. High Income (n=109): Better - 6; Same - 41; Worse - 62. Black vs. White (n=165): Better - 20; Same - 85; Worse - 60. Hispanic vs. White (n=150): Better - 30; Same - 77; Worse - 43. Asian vs. White (n=146): Better - 36; Same - 78; Worse - 32. AI/AN vs. White (n=85): Better - 15; Same - 50; Worse - 20.

Key: AI/AN = American Indian or Alaska Native; n = number of measures.
Note: Poor indicates family income less than the Federal poverty level; High Income indicates family income four times the Federal poverty level or greater. Numbers of measures differ across groups because of sample size limitations. For most measures, data from 2012 are shown. Measures that achieve an overall performance level of 95% or better are not reported in the QDR and are not included in these analyses. Because disparities are typically eliminated when overall performance reaches 95%, our analyses may overstate the percentage of measures exhibiting disparities.

The relative difference between a selected group and its reference group is used to assess disparities.

  • Better = Population received better quality of care than reference group. Differences are statistically significant, are equal to or larger than 10%, and favor the selected group.
  • Same = Population and reference group received about the same quality of care. Differences are not statistically significant or are smaller than 10%.
  • Worse = Population received worse quality of care than reference group. Differences are statistically significant, are equal to or larger than 10%, and favor the reference group.

 

  • Groups With Disparities:
    • People in poor households experienced the largest number of disparities, followed by Blacks and Hispanics.
    • People in poor households received worse care than people in high-income households on more than half of quality measures (green).
    • Blacks received worse care than Whites for about one-third of quality measures.
    • Hispanics, American Indians and Alaska Natives, and Asians received worse care than Whites for some quality measures and better care for some measures.
    • For each group, disparities in quality of care are similar to disparities in access to care, although access problems are more common than quality problems.

Quality Disparities Among Hispanics

QUALITY DISPARITIES: Hispanics received poorer quality of care across many NQS priorities

Chart shows Number and Percentage of Quality Measures for Which Hispanics Experienced Disparities Compared With Non-Hispanic Whites. Patient Safety (n=25): Better - 6; Same - 17; Worse - 2. Person-Centered Care (n=17): Same - 5; Worse - 12. Effective Treatment (n=51): Better - 12; Same - 23; Worse - 16. Healthy Living (n=47): Better - 7; Same - 29; Worse - 11.

Key: n = number of measures.
Note: For most measures, data from 2012 are shown. Measures that achieve an overall performance level of 95% or better are not reported in the QDR and are not included in these analyses. Because disparities are typically eliminated when overall performance reaches 95%, our analyses may overstate the percentage of measures exhibiting disparities.

The relative difference between a selected group and its reference group is used to assess disparities.

  • Better = Population received better quality of care than reference group. Differences are statistically significant, are equal to or larger than 10%, and favor the selected group.
  • Same = Population and reference group received about the same quality of care. Differences are not statistically significant or are smaller than 10%.
  • Worse = Population received worse quality of care than reference group. Differences are statistically significant, equal to or larger than 10%, and favor the reference group.

 

  • Groups With Disparities:
    • Hispanics received worse care for 70% of Person-Centered Care measures.
    • Hispanics received worse care for about 30% of measures of Effective Treatment and Healthy Living.
    • Hispanics received worse care for 8% of Patient Safety measures.

Change in Quality Disparities

QUALITY DISPARITIES: Through 2012, some disparities were getting smaller but most were not improving across a broad spectrum of quality measures

Chart shows Number and Percentage of Quality Measures for Which Disparities Were Improving, Not Changing, or Worsening. Poor vs. High Income (n=98): Worsening - 13; No Change - 76; Improving - 9. Black vs. White (n=148): Worsening - 9; No Change - 126; Improving - 13. Hispanic vs. White (n=130): Worsening - 5; No Change - 109; Improving - 16. Asian vs. White (n=123): Worsening - 9; No Change - 97; Improving - 17. AI/AN vs. White (n=64): Worsening - 5; No Change - 55; Improving - 4.

Key: AI/AN = American Indian or Alaska Native; n = number of measures.
Note: Poor indicates family income less than the Federal poverty level; High Income indicates family income four times the Federal poverty level or greater. Numbers of measures differ across groups because of sample size limitations. For the majority of measures, trend data are available from 2001-2002 to 2012.

For each measure, average annual percentage changes were calculated for select populations and reference groups. Measures are aligned so that positive rates indicate improvement in access to care.

Differences in rates between groups were used to assess trends in disparities.

  • Worsening = Disparities are getting larger. Differences in rates between groups are statistically significant and reference group rates exceed population rates by at least 1% per year.
  • No Change = Disparities are not changing. Differences in rates between groups are not statistically significant or differ by less than 1% per year.
  • Improving = Disparities are getting smaller. Differences in rates between groups are statistically significant and population rates exceed reference group rates by at least 1% per year.

 

  • Disparity Trends:
    • Through 2012, most disparities in quality of care related to race, ethnicity, or income showed no significant change (blue), neither getting smaller nor larger.
    • When changes in disparities occurred, measures of disparities were more likely to show improvement (black) than decline (green). However, for people in poor households, more measures showed worsening disparities than improvement.

Elimination or Widening of Quality Disparities

Several quality measures showed elimination or widening of Hispanic-White disparities

  • One quality measure showed elimination of a Hispanic-White disparity:
    • Adults with obesity who ever received advice from a health professional about eating fewer high-fat foods.
  • Two quality measures showed widening of Hispanic-White disparities:
    • Hospice patients who received care consistent with their stated end-of-life wishes.
    • Hospice patients who received the right amount of medicine for pain management.

State Variation in Quality

QUALITY DISPARITIES: Overall quality and quality among Hispanics varied widely across States and often did not match

Two maps of the United States are color-coded by state to compare overall quality and quality among Hispanics.

Source: Agency for Healthcare Research and Quality, 2014 State Snapshots.
Note: An overall quality score is computed for each State based on the number of quality measures that are above, at, or below the average across all States; States are ranked and quartiles are shown in the top map. A quality score for Hispanics is computed in a similar manner but only using data for Hispanics. Go to State Snapshots at http://nhqrnet.ahrq.gov/inhqrdr/state/select for more detailed methods.

  • Geographic Disparities:
    • There was significant variation in overall quality among States. States in the New England, Middle Atlantic, West North Central, and Mountain census divisions tended to have higher overall quality (blue and green) while States in the South census region tended to have lower quality (yellow and red).
    • There was also significant variation among States in quality for Hispanics. Hispanics tended to receive higher quality care in States in the South Atlantic and East South Central census divisions (blue and green) and lower quality care in States in the New England, Middle Atlantic, and West South Central census divisions (yellow and red).
    • The variation in State performance on overall quality and among specific priority populations may point to differential strategies for improvement. States with high overall quality but poor quality for Hispanics might target this population for support; States with low overall quality and high quality for Hispanics might seek to improve care for everyone.
    • The State Snapshots tool (http://nhqrnet.ahrq.gov/inhqrdr/state/select), part of the QDR Web site, focuses on variation across States and helps State health leaders, researchers, and consumers understand the status of health care in individual States and the District of Columbia. It is based on more than 100 QDR measures for which State estimates are possible.

Return to Contents

Page last reviewed May 2018
Page originally created November 2015

Internet Citation: Part 3: Trends in Access and Priorities of the National Quality Strategy—National Quality Strategy Priorities. Content last reviewed May 2018. Agency for Healthcare Research and Quality, Rockville, MD.
https://www.ahrq.gov/research/findings/nhqrdr/2014chartbooks/hispanichealth/part3-nqs.html

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