Chapter 2. Quality of Health Care (continued, 4)

National Healthcare Disparities Report, 2008

Patient Centeredness

The Institute of Medicine identifies patient centeredness as a core component of quality health care.2 Patient centeredness is defined as:

[H]ealth care that establishes a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients' wants, needs, and preferences and that patients have the education and support they need to make decisions and participate in their own care. 95

Patient centeredness "encompasses qualities of compassion, empathy, and responsiveness to the needs, values, and expressed preferences of the individual patient."2

Patient centered care is supported by good patient-provider communication so that patients' needs and wants are understood and addressed, and patients understand and participate in their own care.95-98 This style of care has been shown to improve patients' health and health care.96, 97, 99,100, 101 Unfortunately, there are barriers to good communication.

About a third of Americans are not "health literate,"102-103 which means they lack the "capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions."104 They experience many difficulties, including:

  • Less preventive care105
  • Poorer understanding of their conditions and care,102, 106-107
  • Higher use of emergency and inpatient services, higher rates of rehospitalization,108-109
  • Lower adherence to medications,108
  • Lower participation in medical decision-making.110

Low health literacy costs an estimated $29 billion to $69 billion per year.111 Providers also differ in communication proficiency, including varied listening skills and views of symptoms and treatment effectiveness compared with their patients' views.112

When health care is patient centered, both underuse and overuse of medical services are reduced113 and can reduce strains on system resources or save money by reducing the number of diagnostic tests and referrals.99 Additional factors influencing patient centeredness and patient-provider communication include:

  • Language barriers.
  • Racial/ethnic concordance between the patient and provider.
  • Effects of disabilities on patients' health care experiences.
  • Providers' cultural competency.

Efforts to remove these possible impediments to patient centeredness are underway. For example, the Office of Minority Health, part of the Department of Health and Human Services, has developed a set of Cultural Competency Curriculum Modules that aim to equip providers with cultural and linguistic competencies to help promote patient-centered care.114, xxi These modules are based on the National Standards on Culturally and Linguistically Appropriate Services (CLAS). These standards are directed at health care organizations and aim to improve the patient centeredness of care for people with limited English proficiency (LEP). In addition, the HHS Office for Civil Rights has issued Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons. This guidance explains that the failure of a recipient of Federal financial assistance to take reasonable steps to provide LEP persons with a meaningful opportunity to participate in HHS-funded programs may violate the prohibition under Title VI of the Civil Rights Act of 1964, 42 U.S.C. 2000d, against national origin discrimination.115

The NHDR includes one core measure of patient centeredness—a composite measure on the patient experience of care—and two new supplemental measures. Because having a diverse workforce of health care providers may be an important component of patient centered health care for many patients, this year's report includes a new supplemental measure of workforce diversity—race/ethnicity of the Nation's registered nurse (RN) workforce. A supplemental measure focusing on health literacy of U.S. adults is also presented in Chapter 4. (For findings related to all core measures of patient centeredness, go to Tables 2.3a and 2.3b.)


xxi This online program (available at www.thinkculturalhealth.org) is accredited for 9 Continuing Medical Education credits for physicians and 10.8 and 0.9 Continuing Education Units for nurses and pharmacists, respectively.


 

Patients' Experience of Care

Using methods developed for the CAHPS® (Consumer Assessment of Healthcare Providers and Systems) survey,116 the NHDR uses a composite measure that combines four measures of patient-provider communication into a single core measure—providers who sometimes or never listen carefully, explain things clearly, respect what patients say, and spend enough time with patients.

Figure 2.54. Composite measure: Ambulatory patients age 18 and over who reported poor communication with health providers,* by race (top left), ethnicity (top right), and income (bottom left), 2002-2005.

Total, 2002, 10.8; 2003, 9.8; 2004, 9.6; 2005, 9.7; White, 2002, 10.4; 2003, 9.4; 2004, 9.0; 2005, 9.1; Black, 2002, 11.4; 2003, 11.3; 2004, 11.3; 2005, 12.7; Asian, 2002, 14.5; 2003, 13.5; 2004, 14.3; 2005, 13.0; > 1 Race, 2002, 13.8; 2003, 15.2; 2004, 14.4; 2005, 9.7. Non-Hispanic White, 2002, 9.9; 2003, 8.9; 2004, 8.7; 2005, 8.8; Hispanic, 2002, 15.6; 2003, 13.6; 2004, 12.2; 2005, 11.7.

Poor, 2002, 15.8; 2003, 15.2; 2004, 15.8; 2005, 15.0; Near Poor, 2002, 12.5; 2003, 11.9; 2004, 11.0; 2005, 11.4; Middle income, 2002, 11.2; 2003, 10.10; 2004, 9.8; 2005, 10.4; High income, 2002, 8.9; 2003, 7.8; 2004, 7.6; 2005, 7.4.

* Average percentage of adults age 18 and over who had a doctor's office or clinic visit in the last 12 months and reported poor communication with health providers (i.e., that their health providers sometimes or never listened carefully, explained things clearly, showed respect for what they had to say, and spent enough time with them).

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2005.

Denominator: Civilian noninstitutionalized population age 18 and over.

Note: Data were insufficient for this analysis for Native Hawaiians and Other Pacific Islanders and American Indians and Alaska Natives.

  • From 2002 to 2005, the gap between Blacks and Whites and between Asians and Whites on this measure increased. In 2005, Blacks and Asians were more likely than Whites to report poor communication with their health providers (12.7% for Blacks and 13.0% for Asians compared with 9.1% for Whites; Figure 2.54).
  • The gap between Hispanics and non-Hispanic Whites in the percentage of adults who reported poor communication with their health providers decreased from 2002 to 2005. However, in 2005, the percentage was higher for Hispanics than for non-Hispanic Whites (11.7% compared with 8.8%).
  • The gap between poor and high-income people increased. In 2005, the percentage of adults who reported poor communication was higher for poor people than for high-income people (15.0% compared with 7.4%).

Racial and ethnic minorities are disproportionately of lower SES. To distinguish the effects of race, ethnicity, income, and education on patient-provider communication, this measure is stratified by education level.

Figure 2.55. Adult ambulatory patients who reported poor communication with health providers,* by race (left) and ethnicity (right), stratified by education, 2005,

White, Less than high school, 12.5; High school, 8.7, Some college, 8.3; Black, Less than high school, 18.6; High school, 13, Some college, 9.4; Asian, Less than high school, No data; High school: No data, Some college, 10.1. Non-Hispanic White, Less than high school, 12.8; High school, 8.5, Some college, 8; Hispanic, Less than high school, 11.9; High school,11.6, Some college, 11.3.

* Average percentage of adults age 18 and over who had a doctor's office or clinic visit in the last 12 months and reported poor communication with health providers (i.e., that their health providers sometimes or never listened carefully, explained things clearly, showed respect for what they had to say, and spent enough time with them).

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2005.

Denominator: Civilian noninstitutionalized population age 18 and over.

Note: Sample sizes were too small to provide estimates for Asians with less than a high school education and Asian high school graduates.

  • SES explains some but not all of the racial and ethnic differences in patient-provider communication for patients age 18 and over (Figure 2.55).
  • Among high school graduates, Blacks (13.0%) were more likely than Whites (8.7%) and Hispanics (11.6%) were more like than non-Hispanic Whites (8.5%) to report poor communication with their health providers.
  • Among people with less than a high school education, Blacks were more likely than Whites to report poor communication with their health providers (18.6% compared with 12.5%).

Communication in children's health care can pose a particular challenge, as children are often less able to express their health care needs and preferences, and a third party (e.g., a parent or guardian) is involved in communication and decisionmaking. Optimal communication in children's health care can therefore have a significant impact on receipt of high-quality care and subsequent health status. This is especially true for children with special health care needs (CSHCN).

Figure 2.56. Composite measure: Children with ambulatory visits whose parents reported poor communication* with health providers, by race (top left), ethnicity (top right), and family income (bottom left), 2002-2005

Trend line chart by race. White, 2002, 6.5, 2003, 5.5, 2004, 5.4, 2005, 5.3; Black, 2002, 7.1, 2003, 7.5, 2004, 6.3, 2005, 5.7; Asian, 2002, 10.2, 2003, 12.5, 2004, 7.6, 2005, No data; > 1 Race, 2002, 10.1, 2003, 6.7, 2004, 7.9, 2005, 6.7. Ethnicity, Non-Hispanic White, 2002, 5.6, 2003, 4.8, 2004, 4.8, 2005, 4.4; Hispanic, 2002, 10.2, 2003, 8.4, 2004, 7.9, 2005, 8.8.

Family Income. Poor, 2002, 11.3, 2003, 9.5, 2004, 9.1, 2005, 9.3; Near poor, 2002, 9.3, 2003, 8.8, 2004, 7.5, 2005, 7.3; Middle income, 2002, 6.2, 2003, 5.4, 2004, 5.4, 2005, 5.3; High income, 2002, 3.4, 2003, 3.3, 2004, 3, 2005, 2.5.

* Children under 18 years of age whose parents or guardians reported that their child's health providers sometimes or never listened carefully, explained things clearly, respected what they had to say, and spent enough time with them.

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2004.

Denominator: Civilian noninstitutionalized population under age 18.

Note: Average percentage of children who had a doctor's office or clinic visit in the last 12 months and were reported to have had poor communication with health providers (i.e., that their health providers sometimes or never listened carefully, explained things clearly, showed respect for what they had to say, and spent enough time with them). Data for Asians (2005 only) and Native Hawaiians and Other Pacific Islanders and American Indians and Alaska Natives did not meet criteria for statistical reliability.

  • Overall, the percentage of children whose parents or guardians reported poor communication with their health providers decreased from 6.7% in 2002 to 5.5% in 2005 (data not shown).
  • In 2005, there were no statistically significant differences between Blacks and Whites in the percentage of children whose parents or guardians reported poor communication with their health providers.
  • From 2002 to 2005, the gap between Hispanics and non-Hispanic Whites in the percentage of children whose parents or guardians reported poor communication with their health providers decreased (Figure 2.56). However, in 2005, the percentage was still two times higher for Hispanics than for non-Hispanic Whites (8.8% compared with 4.4%).
  • The gap between poor people and high-income people in the percentage with poor communication decreased. However, in 2005, the percentage was still significantly higher for poor (9.3%), near-poor (7.3%), and middle-income (5.3%) people than for high-income people (2.5%).

Racial and ethnic minorities are disproportionately of lower SES. To distinguish the effects of race, ethnicity, income, and education on patient-provider communication, this measure is stratified by income level.

Figure 2.57. Composite measure: Children with ambulatory visits whose parents reported poor communication with health providers,* by race (left) and ethnicity (right), stratified by income, 2005.

Bar chart by race. Percent. Poor, White, 13.5, Black, 20, Asian, No data; Near Poor, White, 10.8, Black, 13.3, Asian, No data; Middle Income, White 10, Black, 10.7, Asian, 17.9; High Income, White, 7.2, Black, 8.7, Asian, 10.1. Bar chart by ethnicity. Percent. Poor, Non-Hispanic White, 13.2, Hispanic, 13.7, Near Poor, Non-Hispanic White, 10.9, Hispanic, 10.5, Middle income, Non-Hispanic White, 9.7, Hispanic, 13.8, High Income, Non-Hispanic White, 7.1, Hispanic, 9.1.

* Children under 18 years of age whose parents or guardians reported that their child's health providers sometimes or never listened carefully, explained things clearly, respected what they had to say, or spent enough time with them.

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2005.

Denominator: Civilian noninstitutionalized population under age 18.

Note: Sample sizes were too small to provide estimates for poor and near-poor Asians. The seemingly large difference between middle-income Asians and Whites is not statistically significant due to small sample sizes.

  • SES explains some but not all of the racial and ethnic differences in patient-provider communication for patients under age 18 (Figure 2.57).
  • In 2005, among poor people, Blacks were more likely than Whites to report poor communication with their health providers (20.0% compared with 13.5%).
  • Among people with middle income, Hispanics were more likely than non-Hispanic Whites to report poor communication with their health providers (13.8% compared with 9.7%).

 

Diversity of the Nurse Professionals Workforce

In 2000, more than 30% of Americans identified themselves as members of racial or ethnic minority groups. It is estimated that by 2050, half of Americans will be members of minority groups.117 Minority providers are more likely than their White colleagues to practice in underserved minority communities.118,119 Health care workforce diversity is considered to be important for health care research, education, administration, and policy both to provide role models and to shape a health care system that meets the needs of all individuals.

Diversity increases the opportunities for race and language-concordant health care visits. It also can improve cultural competency at the system, organization, and provider levels in several ways. These include appropriate program design and policies, organizational commitment to culturally competent care, and cross-cultural education of colleagues.120 As such, diversity is an important element of a patient-centered health care encounter.

Previous reports have presented data on diversity in the physician and RN workforces. This year, the NHDR presents data on diversity in the licensed practical nurse (LPN) workforce.

LPNs, known as licensed vocational nurses (LVNs) in California and Texas, provide patient care under the supervision of physicians and registered nurses (RNs). Their scope of practice varies by State but may include duties such as providing basic bedside care, assisting patients in daily living activities, performing routine laboratory tests, monitoring patient response to medications or treatments, and gathering patient information.

Compared with RNs, LPNs are less likely to work in hospitals and more likely to work in long-term and personal care settings. Practical training programs are typically shorter than RN programs and are therefore less costly to trainees seeking licensure. In May 2006, the median income of LPNs was approximately $20,000 less than that of RNs. As the U.S. population ages and overall demand for health care services increases, employment of LPNs is expected to grow faster than the average for all occupations, particularly in long-term care facilities. Increases in hiring and in LPN-to-RN programs may also help alleviate the national RN shortage.121-122

Figure 2.58. U.S. nurse professionals compared with the U.S. population, by race/ethnicity, 2000.

Registered nurses: White, 77.74, Hispanic, 4.14, Black, 9.52, Asian 7.3, NHOPI, .09, AI/AN 0.41, > 1 Race, .8; LPN/LVN, White, 66.11, Hispanic, 6.11, Black, 22.39, Asian 3.34, NHOPI, .07, AI/AN 0.83, > 1 Race, 1.15; U.S. population, White, 69.25, Hispanic, 12.57, Black, 12.08, Asian 3.6, NHOPI, .13, AI/AN 0.74, > 1 Race, 1.64.

Key: AI/AN = American Indian or Alaska Native; NHOPI = Native Hawaiian or Other Pacific Islander.

Source: U.S. Census 2000 and U.S. Census Bureau American Community Survey, 2000.

Note: All racial groups are non-Hispanic.

  • Of the RNs in the United States, 77.7% were White; 66.1% of LPNs/LVNs in the United States were White (Figure 2.58).
  • Relative to the U.S. population, Blacks were overrepresented in the LPN workforce, while Hispanic individuals were underrepresented.
  • In contrast, Whites and Asians were overrepresented in the RN workforce. The percentage of Hispanics in the RN workforce (4.1%) was even smaller than the percentage in the LPN/LVN workforce (6.1%).

Summary Tables

Table 2.1a. Racial and Ethnic Differences in Effectiveness of Care

Core Report MeasureRacial DifferenceiEthnic Differenceii
BlackAsianNHOPIAI/AN>1 RaceHispanic
Cancer
Adults age 50 and over who received a sigmoidoscopy, colonoscopy, or = proctoscopy or fecal occult blood test in the last 2 yearsiii =
Colorectal cancer diagnosed at advanced stageiv 
Colorectal cancerv deaths per 100,000 population per year 
Diabetes
Composite: Adults with diabetes who had hemoglobin A1c measurement, dilated eye exam, and foot exam in the past yearvi=    
Hospital admissions for lower extremity amputations in patients per 1,000 population with diabetes age 18 and overvii     
End Stage Renal Disease
Adult hemodialysis patients with adequate dialysisviii = 
Dialysis patients under age 70 who were registered on the waiting list for transplantationix= = =

i Compared with Whites.
ii Compared with non-Hispanic Whites.
iii Source: National Health Interview Survey, 2005.
iv Source: Surveillance, Epidemiology, and End Results Program, 2005. This source does not provide rate estimates for Asians and NHOPIs separately but in aggregate as Asian and Pacific Islander. This source did not collect information for >1 race.
v Source: National Vital Statistics System-Mortality, 2005. This source did not collect information on Asians and NHOPIs separately but in aggregate as Asian and Pacific Islander. This source did not collect information for >1 race.
vi Source: Medical Expenditure Panel Survey, 2005. vii Source: National Hospital Discharge Survey, 2003-2006. This source did not collect information for >1 race. Missing rates preclude analysis by ethnicity.
viii Source: CMS End Stage Renal Disease Clinical Performance Measures Project, 2006.
ix U.S. Renal Data System, 2004. This source did not collect information on Asians and NHOPIs separately but in aggregate as Asian and Pacific Islander. This source did not collect information for >1 race.

Key: NHOPI=Native Hawaiian or Other Pacific Islander; AI/AN=American Indian or Alaska Native.

Table 2.1a. Racial and Ethnic Differences in Effectiveness of Care (continued)

Core Report MeasureRacial DifferenceiEthnic Differenceii
BlackAsianNHOPIAI/AN>1 RaceHispanic
 
Heart Disease
Adults with obesity who ever received advice to exercise more=   =
Adult current smokers who received advice to quit smokingiii=    =
Composite: Hospital patients with heart attack who received recommended hospital careiv== = 
Deaths per 1,000 adult admissions with acute myocardial infarctionv=   =
Composite: Hospital patients with heart failure who received recommended hospital careiv=  =

i Compared with Whites.
ii Compared with non-Hispanic Whites.
iii Source: National Health Interview Survey, 2005.
iv Source: CMS Quality Improvement Organization Program, 2006. This source categorizes race/ethnicity information as a single item: non-Hispanic White, non-Hispanic Black, Hispanic, Asian and Pacific Islander, American Indian and Alaska Native. These contrasts compare each group with non-Hispanic Whites.
v Source: HCUP State Inpatient Databases disparities analysis file, 2005. This source categorizes race/ethnicity information as a single item: non-Hispanic White, non-Hispanic Black, Hispanic, Asian and Pacific Islander. These contrasts compare each group with non-Hispanic Whites.

Key: NHOPI=Native Hawaiian or Other Pacific Islander; AI/AN=American Indian or Alaska Native.

Table 2.1a. Racial and Ethnic Differences in Effectiveness of Care (continued)

Core Report MeasureRacial DifferenceiEthnic Differenceii
BlackAsianNHOPIAI/AN>1 RaceHispanic
HIV and AIDS
New AIDS cases per 100,000 population 13 and overiii= 
Maternal and Child Health
Pregnant women who first received prenatal care in first trimesteriv=  
Infant deaths per 1,000 live births, <1,500 gramsiv= = 
Children ages 19-35 months who received all recommended vaccinesv= ==
Children 2-17 with advice about healthy eatingvi==  =
Children ages 3- 6 who ever had their vision checkedvi    

i Compared with Whites.
ii Compared with non-Hispanic Whites.
iii Source: Centers for Disease Control and Prevention, 2006. This source categorizes race/ethnicity information as a single item: non-Hispanic White, non-Hispanic Black, Hispanic, Asian and Pacific Islander, American Indian and Alaska Native. These contrasts compare each group with non-Hispanic Whites.
iv Source: National Vital Statistics System-Natality, 2005. This source did not collect information for >1 race.
v Source: National Immunization Survey, 2006.
vi Source: Medical Expenditure Panel Survey, 2005.

Key: NHOPI = Native Hawaiian or Other Pacific Islander; AI/AN = American Indian or Alaska Native.

Key Used in Quality of Health Care Tables:
= Group and comparison group receive about same quality of health care or have similar outcomes.
↑ Group receives better quality of health care than the comparison group or has better outcomes.
↓ Group receives poorer quality of health care than the comparison group or has worse outcomes.
Blank cell: Reliable estimate for group could not be made.

Table 2.1a. Racial and Ethnic Differences in Effectiveness of Care (continued)

Core Report MeasureRacial DifferenceiEthnic Differenceii
BlackAsianNHOPIAI/AN>1 RaceHispanic
Mental Health and Substance Abuse
Adults with a major depressive episode in the last 12 months who received treatment for depression in the last 12 monthsiii    
Suicide deaths per 100,000 populationiv= 
People age 12 and over who needed treatment for illicit drug use who received such treatmentiii=    =
Respiratory Diseases
Adults 65 and over who ever received pneumococcal vaccinationv   
Composite: Hospital patients with pneumonia who received recommended hospital carevi  
Visits with antibiotics prescribed for a diagnosis of common cold per 10,000 populationvii      
Patients with tuberculosis who completed a curative course of treatment within 1 year of treatment initiationviii=== 

i Compared with Whites.
ii Compared with non-Hispanic Whites.
iii Source: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health, 2006.
iv Source: National Vital Statistics System-Mortality, 2006. This source did not collect information on Asians and NHOPIs separately but in aggregate as Asian and Pacific Islander. This source did not collect information for >1 race.
v Source: National Health Interview Survey, 2006.
vi Source: CMS Quality Improvement Organization program, 2006. This source categorizes race/ethnicity information as a single item: non-Hispanic White, non-Hispanic Black, Hispanic, Asian and Pacific Islander, American Indian and Alaska Native. These contrasts compare each group with non-Hispanic Whites.
vii Source: National Ambulatory Medical Care Survey/National Hospital Ambulatory Medical Care Survey, 2005-2006. This source did not collect information for >1 race. Missing rates preclude analysis by ethnicity.
viii Source: CDC National TB Surveillance System, 2004. This source did not collect information on Asians and NHOPIs separately but in aggregate as Asian and Pacific Islander. This source did not collect information for >1 race.

Key: NHOPI=Native Hawaiian or Other Pacific Islander; AI/AN=American Indian or Alaska Native.

Table 2.1a. Racial and Ethnic Differences in Effectiveness of Care (continued)

Core Report MeasureRacial DifferenceiEthnic Differenceii
BlackAsianNHOPIAI/AN>1 RaceHispanic
Nursing Home, Home Health, and Hospice Care
Long-stay nursing home residents with physical restraintsiii 
High-risk, long-stay nursing home residents with pressure soresiii= 
Short-stay nursing home residents with pressure soresiii= 
Adult home health care patients whose ability to walk or move around improvediv======
Adult home health care patients who were admitted to the hospitaliv=

i Compared with Whites.
ii Compared with non-Hispanic Whites.
iii Source: CMS Minimum Data Set, 2006. This source categorizes race/ethnicity information as a single item: non-Hispanic White, non-Hispanic Black, Hispanic, Asian and Pacific Islander. Contrasts compare each group with non-Hispanic Whites.
iv Source: CMS Outcome and Assessment Information Set, 2006.

Key: NHOPI = Native Hawaiian or Other Pacific Islander; AI/AN = American Indian or Alaska Native.

Key Used in Quality of Health Care Tables:
=Group and comparison group receive about same quality of health care or have similar outcomes.
Group receives better quality of health care than the comparison group or has better outcomes.
Group receives poorer quality of health care than the comparison group or has worse outcomes.
Blank cell: Reliable estimate for group could not be made.

Table 2.1b. Socioeconomic Differences in Effectiveness of Care

Core Report MeasureIncome DifferenceiEducational DifferenceiiInsurance Differenceiii
<100%100-199%200-399%<HSHS GradUninsured
Cancer
Adults age 50 and over who report having ever received a sigmoidoscopy, colonoscopy, or proctoscopy or who report fecal occult blood test within the last 2 yeariv
Colorectal cancer deaths per 100,000 population per yearv    
Diabetes
Composite: Adults with diabetes who had hemoglobin A1c measurement, dilated eye exam, and foot exam in the calender yearvi=
Heart Disease
Adults with obesity who ever received advice to exercise morevi
Adult current smokers who received advice to quit smokingvi=====
Maternal and Child Health
Pregnant women who first received prenatal care in first trimestervii    
Infant deaths per 1,000 live births, birth weight <1,500 gramsvii    
Children 19-35 months who received all recommended vaccinesviii   
Children 2-17 with advice about healthy eatingvi  
Children ages 3-6 who ever had their vision checkedvi===  

i Compared with persons with family incomes 400% of Federal poverty thresholds or above.
ii Compared with persons with any college education.
iii Compared with persons under 65 with any private health insurance.
iv Source: National Health Interview Survey, 2006.
v Source: National Vital Statistics System-Mortality, 20055. This source did not collect information on Asians and NHOPIs separately but in aggregate as Asian and Pacific Islander. This source did not collect information for >1 race.
vi Source: Medical Expenditure Panel Survey, 2005.
vii Source: National Vital Statistics System-Natality, 2005. This source did not collect information for >1 race.
viii Source: National Immunization Survey, 2006.

Key: HS = high school.

Table 2.1b. Socioeconomic Differences in Effectiveness of Care (continued)

Core Report MeasureIncome DifferenceiEducational DifferenceiiInsurance Differenceiii
<100%100-199%200-399%<HSHS GradUninsured
Mental Health and Substance Abuse
Adults with a major depressive episode in the last 12 months who received treatment for the depression in the last 12 monthsiv===== 
Suicide deaths per 100,000 populationv    
People age 12 and over who needed treatment for illicit drug use who received such treatmentiv==== 
Respiratory Diseases
Adults age 65 and over who ever received pneumococcal vaccinationvi=== 

i Compared with persons with family incomes 400% of Federal poverty thresholds or above.
ii Compared with persons with any college education.
iii Compared with persons under 65 with any private health insurance.
iv Source: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health, 2006.
v Source: National Vital Statistics System-Mortality, 2006. This source did not collect information on Asians and NHOPIs separately but in aggregate as Asian and Pacific Islander. This source did not collect information for >1 race.
vi Source: National Health Interview Survey, 2006.

Key: HS = high school.

Key Used in Quality of Health Care Tables:
= Group and comparison group receive about same quality of health care or have similar outcomes.
Group receives better quality of health care than the comparison group or has better outcomes.
Group receives poorer quality of health care than the comparison group or has worse outcomes.
Blank cell: Reliable estimate for group could not be made.

Table 2.2a. Racial and Ethnic Differences in Patient Safety

Core Report MeasureRacial DifferenceiEthnic Differenceii
BlackAsianNHOPIAI/AN>1 RaceHispanic
Postoperative Complications
Composite: Adult surgery patients with postoperative complicationsiii     
Other Complications of Hospital Care
Composite: Bloodstream infections or mechanical complications per 1,000 central venous catheter placementsiii=     
Deaths per 1,000 discharges following complications of careiv  =
Complications of Medications
Adults age 65 and over who received potentially inappropriate prescription medicationsv==   

i Compared with Whites.
ii Compared with non-Hispanic Whites.
iii Source: Medicare Patient Safety Monitoring System, 2006.
iv Source: HCUP State Inpatient Databases disparities analysis file, 2005. This source categorizes race/ethnicity information as a single item: non-Hispanic White, non-Hispanic Black, Hispanic, Asian and Pacific Islander. These contrasts compare each group with non-Hispanic Whites.
v Source: Medical Expenditure Panel Survey, 2005. This source did not collect information on Asians and NHOPIs separately but in aggregate as Asian and Pacific Islander. This source did not collect information for >1 race.

Key: NHOPI = Native Hawaiian or Other Pacific Islander; AI/AN = American Indian or Alaska Native.

Key Used in Quality of Health Care Tables:
= Group and comparison group receive about same quality of health care or have similar outcomes.
Group receives better quality of health care than the comparison group or has better outcomes.
Group receives poorer quality of health care than the comparison group or has worse outcomes.
Blank cell: Reliable estimate for group could not be made.

Table 2.3a. Racial and Ethnic Differences in Timeliness and Patient Centeredness

Core Report MeasureRacial DifferenceiEthnic Differenceii
BlackAsianNHOPIAI/AN>1 RaceHispanic
Timeliness
Adults who sometimes or never got care for illness or injury as soon as wantediii  =
Emergency department visits in which patient left without being seeniv=    
Patient Centeredness
Composite: Adults who reported poor provider-patient communicationiii  =
Composite: Children whose parents reported poor provider-patient communicationiii=   =

i Compared with Whites.
ii Compared with non-Hispanic Whites.
iii Source: Medical Expenditure Panel Survey, 2005. This source did not collect information for >1 race.
iv Source: National Hospital Ambulatory Medical Care Survey - Emergency Department, 2005-2006. Missing rates preclude analysis by ethnicity.

Key: NHOPI=Native Hawaiian or Other Pacific Islander; AI/AN=American Indian or Alaska Native

Key Used in Quality of Health Care Tables:
= Group and comparison group receive about same quality of health care or have similar outcomes.
Group receives better quality of health care than the comparison group or has better outcomes.
Group receives poorer quality of health care than the comparison group or has worse outcomes.
Blank cell: Reliable estimate for group could not be made.

Table 2.3b. Socioeconomic Differences in Timeliness and Patient Centeredness

Core Report MeasureIncome DifferenceiEducational DifferenceiiInsurance Differenceiii
<100%100-199%200-399%<HSHS GradUninsured
Timeliness
Adults who sometimes or never got care for illness or injury as soon as wantediv=
Emergency department visits in which patient left without being seenv     
Patient Centeredness
Composite: Adults who reported poor provider-patient communicationiv
Composite: Children whose parents reported poor provider-patient communicationiv  =

i Compared with persons with family incomes 400% of Federal poverty thresholds or above.
ii Compared with persons with any college education.
iii Compared with persons under 65 with any private health insurance.
iv Source: Medical Expenditure Panel Survey, 2005. This source did not collect information for >1 race.
v Source: National Hospital Ambulatory Medical Care Survey - Emergency Department, 2005-2006. Missing rates preclude analysis by ethnicity.

Key: HS = high school.

Key Used in Quality of Health Care Tables:
= Group and comparison group receive about same quality of health care or have similar outcomes.
Group receives better quality of health care than the comparison group or has better outcomes.
Group receives poorer quality of health care than the comparison group or has worse outcomes.
Blank cell: Reliable estimate for group could not be made.
Current as of March 2009
Internet Citation: Chapter 2. Quality of Health Care (continued, 4): National Healthcare Disparities Report, 2008. March 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhdr08/Chap2d.html