State Documentation of Racial and Ethnic Health Disparities to Inform Strategic Action

On September 21, 2011, Carrie Hanlon made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (2.6 MB). Plugin Software Help.

Slide 1

State Documentation of Racial and Ethnic Health Disparities to Inform Strategic Action

AHRQ 2011 Annual Conference

September 21, 2011

Slide 2

Federal and National Activity Setting the Stage for State Action

• Understanding the problem:
  • AHRQ National Healthcare Quality Report & National Healthcare Disparities Report.
  • Centers for Disease Control and Prevention (CDC) Health Disparities and Inequalities Report—United States, 2011.
• Offering guidance on what to do:
  • Institute of Medicine (IOM):
    • Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (2003).
    • Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement (2009).
  • Office of Minority Health: National Partnership for Action to End Health Disparities' National Plan for Action.
• Federal Health Reform (Patient Protection & Affordable Care):
  • Directs states to collect information and data regarding disparities.
  • Permanently reauthorizes the Indian Health Care Improvement Act.
  • Includes provisions about workforce diversity, cultural competence.

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Why States Need to Play a Role in Reducing Disparities

• State responsibility for enhanced data collection under federal health reform.
• Provider incentives for data collection under Meaningful Use.
• Growing interest in costs of disparities and improving health system efficiency.
• Lean budgets may require states to target areas or populations with greatest disparities.
• Medicaid programs have incentive to act given disproportionate representation by minorities.

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AHRQ Resources

• 2010 National Healthcare Disparities Report:
  • http://www.ahrq.gov/research/findings/nhqrdr/nhdr10/index.html
  • Identifies gaps where some populations receive worse care than others and tracks changes in gaps over time.
• AHRQ State Snapshots:
  • http://statesnapshots.ahrq.gov/snaps10/index.jsp?menuId=1&state=.
  • Focus on Disparities section.
  • Demographic data on state population.
  • New Section: State Resources for Addressing Disparities in Health Care Quality http://statesnapshots.ahrq.gov/snaps10/SnapsController?menuId=99&action=resources&state=.

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State Documentation of Racial and Ethnic Health Disparities to Inform Strategic Action:

2011 Report Findings

Carrie Hanlon
National Academy for State Health Policy
chanlon@nashp.org

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State Roles in Reducing Disparities

• Purchase health care services.
• Define benefits.
• Regulate professionals and facilities.
• Collect and report data.
• Set standards and measure performance.
• Inform consumers.
• Educate and train healthcare professionals.
• Convene stakeholders.

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Report Methodology

• Environmental scan for documents:
  • Published in 2007 or later.
  • Data-driven.
  • Addressing disparities in health care.
  • With evidence of state use of the information.
• E-mail follow up to confirm scan findings.
• Identified 8 leading states to feature:
  • CO, CT, GA, MD, NJ, NM, RI, UT.
• Phone conversations.

Slide 8

General Findings from Featured States

• 3 types of state documents:
  • Data report, action plan, combination of both.
• 2 states use a report card (GA, NM).
• Behavioral Risk Factor Surveillance System (BRFSS) and vital records most common data sources.
• 4 states provide county-level data (CO, GA, NJ, MD).
• Relative rates are more common than absolute rates.

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General Findings (cont'd)

• Only slight variation in races/ethnicities included.
• Common Measures:
  • Condition or risk factor prevalence/incidence (all).
  • Access/utilization (all).
  • Mortality (all).
  • Socioeconomic Status (CO, CT, GA, RI, UT).
  • Cost (CT, GA, MD).
• Common topics: heart disease/stroke, HIV/STDs, diabetes, cancer, and maternal, prenatal and child health care.

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Use & Impact of State Documents

• Incorporate into grant applications.
• Conduct stakeholder outreach.
• Inform public health projects and the provision of grants to address disparities described in reports.
• Publish or plan new documents.
• Strengthen internal state government processes.

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Lessons from Featured States

• States use data documents to identify and address disparities.
• Data sources, units of analysis, and rates vary, yet reports share many commonalities.
• Additional data on disparities are necessary.
• States have different organizational approaches to documenting and addressing disparities.

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Lessons (cont'd)

• State reports include a focus on making data actionable.
• States need additional funding sources in order to focus on reducing disparities.
• State Offices of Minority Health are important leaders, but cannot act alone to achieve health equity.

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Related Healthcare Cost & Utilization Project (HCUP) Documents

• Issue Briefs:
  • Reducing Racial and Ethnic Disparities through Health Care Reform: State Experience (2011).
  • Assessing the Costs of Racial and Ethnic Health Disparities: State Experience (2011).
• State Uses of Hospital Discharge Databases to Reduce Racial and Ethnic Disparities (2010).
• Environmental scan findings.
• All available at:
  • http://www.hcup-us.ahrq.gov/reports/r_e_disparities.jsp.