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Greene AC, Wong WG, Perez Holguin RA, Patel A, Pameijer CR, Shen C. The Association of Guideline-Concordant Sentinel Lymph Node Biopsy for Melanoma at Minority-Serving Hospitals. Ann Surg Oncol 2023; 30:3634-3645. [PMID: 36935433 DOI: 10.1245/s10434-023-13341-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/19/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Minority-serving hospitals (MSHs) have been associated with lower guideline adherence and worse outcomes for various cancers. However, the relationship among MSH status, concordance with sentinel lymph node biopsy (SLNB) guidelines, and overall survival (OS) for patients with cutaneous melanoma is not well studied. METHODS The National Cancer Database was queried for patients diagnosed with T1a*, T2, and T3 melanoma between 2012 and 2017. MSHs were defined as the top decile of institutions ranked by the proportion of minorities treated for melanoma. Based on National Comprehensive Cancer Network guidelines, guideline-concordant care (GCC) was defined as not undergoing SLNB if thickness was < 0.76 mm without ulceration, mitosis ≥ 1/mm2, or lymphovascular invasion (T1a*), and performing SLNB for patients with intermediate thickness melanomas between 1.0 and 4.0 mm (T2/T3). Multivariable logistic regressions examined associations with GCC. The Kaplan-Meier method and log-rank tests were used to evaluate OS between MSH and non-MSH facilities. RESULTS Overall, 5.9% (N = 2182/36,934) of the overall cohort and 37.8% of minorities (n = 199/527) were managed at MSHs. GCC rates were 89.5% (n = 33,065/36,934) in the overall cohort and 85.4% (n = 450/527) in the minority subgroup. Patients in the overall cohort (odds ratio [OR] 0.85; p = 0.02) and the minority subgroup (OR 0.55; p = 0.02) were less likely to obtain GCC if they received their care at MSHs compared with non-MSHs. Minority patients receiving care at MSHs had a decreased survival compared with those treated at non-MSHs (p = 0.002). CONCLUSIONS Adherence to SLNB guidelines for melanoma was lower at MSHs. Continued focus is needed on equity in melanoma care for minority patients in the United States.
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Affiliation(s)
- Alicia C Greene
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - William G Wong
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Rolfy A Perez Holguin
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Akshilkumar Patel
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Colette R Pameijer
- Division of Surgical Oncology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Chan Shen
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA. .,Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
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The role of pay-for-performance in reducing healthcare disparities: A narrative literature review. Prev Med 2022; 164:107274. [PMID: 36156282 DOI: 10.1016/j.ypmed.2022.107274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/27/2022] [Accepted: 09/18/2022] [Indexed: 11/21/2022]
Abstract
As American healthcare shifts to value-based payment, Pay-for-Performance (P4P) has become an important and controversial topic. One of the main controversies pertains to its potential to narrow or widen existing healthcare disparities depending on how the program is designed and implemented. It is thus imperative to understand which design features are most likely to reduce disparities. We conducted a systematic literature review from 2004 to 2021 of P4P's impact on disparities. Given the interdisciplinary nature of P4P research, multiple search strategies were combined, and many study designs were eligible for analysis. The literature was then qualitatively analyzed, with themes and major findings developed using Grounded Theory. Six major design features emerged as most promising in leveraging P4P to reduce disparities: 1) Risk/Case-Mix Adjustment; 2) Stratified Performance Measures/Stratification; 3) Disparity Reduction Metrics; 4) Exception Reporting; 5) Pay-for-Improvement; and 6) Population-Specific Metrics. Each design feature has its own mechanism, strengths, and weaknesses. We identify and define these features' direct and indirect effects on healthcare disparities. The interaction of each design feature with one another, with P4P as a whole, and within the larger reimbursement system can have considerable effects on disparities. Promising strategies exist to leverage P4P to narrow disparities for clinically and socially complex patients. The six design features discussed in this review help P4P programs address structural disadvantages faced by such patients and their providers. In regard to health equity, these design features can transform P4P from being part of the problem to being part of the solution.
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Do Medicare Accountable Care Organizations Reduce Disparities After Spinal Fracture? J Surg Res 2019; 246:123-130. [PMID: 31569034 DOI: 10.1016/j.jss.2019.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/19/2019] [Accepted: 09/05/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND National changes in health care disparities within the setting of trauma care have not been examined within Accountable Care Organizations (ACOs) or non-ACOs. We sought to examine the impact of ACOs on post-treatment outcomes (in-hospital mortality, 90-day complications, and readmissions), as well as surgical intervention among whites and nonwhites treated for spinal fractures. MATERIALS AND METHODS We identified all beneficiaries treated for spinal fractures between 2009 and 2014 using national Medicare fee for service claims data. Claims were used to identify sociodemographic and clinical criteria, receipt of surgery and in-hospital mortality, 90-day complications, and readmissions. Multivariable logistic regression analysis accounting for all confounders was used to determine the effect of race/ethnicity on outcomes. Nonwhites were compared with whites treated in non-ACOs between 2009 and 2011 as the referent. RESULTS We identified 245,704 patients who were treated for spinal fractures. Two percent of the cohort received care in an ACO, whereas 7% were nonwhite. We found that disparities in the use of surgical fixation for spinal fractures were present in non-ACOs over the period 2009-2014 but did not exist in the context of care provided through ACOs (odds ratio [OR] 0.75; 95% confidence interval [CI] 0.44, 1.28). A disparity in the development of complications existed for nonwhites in non-ACOs (OR 1.09; 95% CI 1.01, 1.17) that was not encountered among nonwhites receiving care in ACOs (OR 1.32; 95% CI 0.90, 1.95). An existing disparity in readmission rates for nonwhites in ACOs over 2009-2011 (OR 1.34; 95% CI 1.01, 1.80) was eliminated in the period 2012-2014 (OR 0.85; 95% CI 0.65, 1.09). CONCLUSIONS Our work reinforces the idea that ACOs could improve health care disparities among nonwhites. There is also the potential that as ACOs become more familiar with care integration and streamlined delivery of services, further improvements in disparities could be realized.
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Cole AP, Nguyen DD, Meirkhanov A, Golshan M, Melnitchouk N, Lipsitz SR, Kilbridge KL, Kibel AS, Cooper Z, Weissman J, Trinh QD. Association of Care at Minority-Serving vs Non-Minority-Serving Hospitals With Use of Palliative Care Among Racial/Ethnic Minorities With Metastatic Cancer in the United States. JAMA Netw Open 2019; 2:e187633. [PMID: 30707230 PMCID: PMC6484582 DOI: 10.1001/jamanetworkopen.2018.7633] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE It is not known whether racial/ethnic differences in receipt of palliative care are attributable to different treatment of minorities or lower utilization of palliative care at the relatively small number of hospitals that treat a large portion of minority patients. OBJECTIVE To assess the association of receipt of palliative care among patients with metastatic cancer with receipt of treatment at minority-serving hospitals (MSHs) vs non-MSHs. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used Participant Use Files of the National Cancer Database, a prospectively maintained, hospital-based cancer registry consisting of all patients treated at more than 1500 US hospitals, to collect data from individuals older than 40 years with metastatic prostate, lung, colon, and breast cancer, diagnosed from January 1, 2004, to December 31, 2015. Data were accessed in October 2017, and the analysis was performed in July 2018. EXPOSURES Hospitals in the top decile in terms of the proportion of black and Hispanic patients for each cancer type were defined as MSHs. MAIN OUTCOMES AND MEASURES A multilevel logistic regression model that estimated the odds of palliative care was fit, adjusting for year of diagnosis, sex, race/ethnicity, insurance, income, educational level, and cancer type, with an interaction term between cancer type and MSH status and a hospital-level random intercept to account for unmeasured hospital characteristics. RESULTS A total of 601 680 individuals (mean [SD] age, 67.4 [11.4] years; 95% CI, 67.2-67.6 years; 314 279 [52.2%] male; 475 039 [78.9%] white) were studied. In total, 130 813 patients (21.7%) received palliative care, ranging from 102 019 (25.4%) with lung cancer to 9966 (11.1%) with colon cancer. In total, 16 435 black individuals (20.0%) and 3551 Hispanic individuals (15.9%) received palliative care vs 106 603 non-Hispanic white individuals (22.5%) (P < .001). The MSH patients were less likely than the non-MSH patients to receive palliative care, regardless of race/ethnicity (12 692 [18.0%] vs 118 121 [22.3%]; P = .002). In an adjusted analysis, treatment at an MSH had a statistically significant association with lower odds of receiving palliative care (odds ratio, 0.67; 95% CI, 0.53-0.84). CONCLUSIONS AND RELEVANCE Although the factors associated with minority patients' receipt of palliative care are complex, in this study, treatment at MSHs was associated with significantly lower odds of receiving any palliative care in an adjusted analysis, but black and Hispanic race/ethnicity was not. These findings suggest that the site of care is associated with race/ethnicity-based differences in palliative care.
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Affiliation(s)
- Alexander P. Cole
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - David-Dan Nguyen
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Akezhan Meirkhanov
- Nazarbayev Intellectual School of Physics and Mathematics, Almaty, Kazakhstan
| | - Mehra Golshan
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nelya Melnitchouk
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stuart R. Lipsitz
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kerry L. Kilbridge
- Lank Center for Genitourinary Malignancies, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Adam S. Kibel
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joel Weissman
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Garnick DW, Horgan CM, Acevedo A, Lee MT, Panas L, Ritter GA, Campbell K, Bean-Mortinson J. Influencing quality of outpatient SUD care: Implementation of alerts and incentives in Washington State. J Subst Abuse Treat 2017; 82:93-101. [PMID: 29021122 PMCID: PMC5653287 DOI: 10.1016/j.jsat.2017.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/08/2017] [Accepted: 09/12/2017] [Indexed: 12/18/2022]
Abstract
Financial incentives for quality improvement and feedback on specific clients are two approaches to improving the quality of treatment for individuals with substance use disorders. We examined the impacts of these interventions in Washington State by randomizing outpatient substance use treatment agencies into intervention and control groups. From October 2013 through December 2015, agencies could earn financial incentives for meeting performance goals incorporating both achievement relative to a benchmark and improvement from agencies' own baselines. Weekly feedback was e-mailed to agencies in the alert or alert plus incentives arms. Difference-in difference regressions controlling for client and agency characteristics showed that none of the interventions significantly affected client engagement after outpatient admissions, overall or for sub-groups based on race/ethnicity, age, rural residence, or agency baseline performance. Treatment agencies offered insights related to several themes: delivery system context (e.g., agency time and resources needed during transition to a managed behavioral healthcare system), implementation (e.g., data lag), agency issues (e.g., staff turnover), and client factors (e.g., motivation). Interventions took place during a time of Medicaid expansion and planning for statewide integration of mental health and substance use disorder treatment into a managed care model, which may have resulted in agencies not responding to the interventions. Moreover, incentives and alerts at the agency-level may not be effective when factors are at play beyond the agency's control.
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Affiliation(s)
- Deborah W Garnick
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, United States.
| | - Constance M Horgan
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, United States
| | - Andrea Acevedo
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, United States; Department of Community Health, Tufts University, United States
| | - Margaret T Lee
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, United States
| | - Lee Panas
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, United States
| | - Grant A Ritter
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, United States
| | - Kevin Campbell
- The Division of Behavioral Health and Recovery, Washington State Behavioral Health Administration, United States
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Card AJ. Moving Beyond the WHO Definition of Health: A New Perspective for an Aging World and the Emerging Era of Value-Based Care. WORLD MEDICAL & HEALTH POLICY 2017. [DOI: 10.1002/wmh3.221] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Chin MH. Creating the Business Case for Achieving Health Equity. J Gen Intern Med 2016; 31:792-6. [PMID: 26883523 PMCID: PMC4907942 DOI: 10.1007/s11606-016-3604-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/30/2015] [Accepted: 01/25/2016] [Indexed: 11/25/2022]
Abstract
Health care organizations have increasingly acknowledged the presence of health care disparities across race/ethnicity and socioeconomic status, but significantly fewer have made health equity for diverse patients a true priority. Lack of financial incentives is a major barrier to achieving health equity. To create a business case for equity, governmental and private payors can: 1) Require health care organizations to report clinical performance data stratified by race, ethnicity, and socioeconomic status. 2) Incentivize preventive care and primary care. Implement more aggressive shared savings plans, update physician relative value unit fee schedules, and encourage partnerships across clinical and non-clinical sectors. 3) Incentivize the reduction of health disparities with equity accountability measures in payment programs. 4) Align equity accountability measures across public and private payors. 5) Assist safety-net organizations. Provide adequate Medicaid reimbursement, risk-adjust clinical performance scores for sociodemographic characteristics of patients, provide support for quality improvement efforts, and calibrate cuts to Disproportionate Share Hospital (DSH) payments to the pace of health insurance expansion. 6) Conduct demonstration projects to test payment and delivery system reform interventions to reduce disparities. Commitment to social justice is essential to achieve health equity, but insufficient without a strong business case that makes interventions financially feasible.
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Affiliation(s)
- Marshall H Chin
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA.
- Robert Wood Johnson Foundation Reducing Health Care Disparities Through Payment and Delivery System Reform Program Office, University of Chicago, Chicago, IL, USA.
- MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL, USA.
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Cary MP, Merwin EI, Oliver MN, Williams IC. Inpatient Rehabilitation Outcomes in a National Sample of Medicare Beneficiaries With Hip Fracture. J Appl Gerontol 2016; 35:62-83. [PMID: 25037153 PMCID: PMC4537688 DOI: 10.1177/0733464814541325] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 06/01/2014] [Indexed: 12/30/2022] Open
Abstract
Effects of patient characteristics on rehabilitation outcomes (functional status at discharge, discharged home) were assessed in a retrospective study of Medicare beneficiaries admitted to Medicare-certified inpatient rehabilitation facilities (IRFs) following hospitalization for hip fracture in 2009 (N = 34,984). Hierarchical regression analysis showed significantly higher functional status at discharge (p < .0001) for patients with these characteristics: White or Asian, younger, female, lived alone, higher functional status at admission, fewer comorbidities, no tier comorbidities, and longer IRF length of stay (LOS). Likelihood of discharged home was higher for patients with these characteristics: Hispanic (1.49 [1.32, 1.68]), Asian (1.35 [1.04, 1.74]), or Black (1.28 [1.12, 1.47]); younger (0.96 [0.96, 0.96]); female (1.14 [1.08, 1.20]); lived with others (2.12 [2.01, 2.23]); higher functional status at admission (1.06 [1.06, 1.06]); fewer comorbidities, no tier comorbidities; and longer LOS (1.61 [1.56, 1.67]). Functional status at admission, tier comorbidities, and race/ethnicity contributed the most to variance in functional status at discharge. Living with others contributed the most to variance in discharged home.
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Katz A, Enns JE, Chateau D, Lix L, Jutte D, Edwards J, Brownell M, Metge C, Nickel N, Taylor C, Burland E. Does a pay-for-performance program for primary care physicians alleviate health inequity in childhood vaccination rates? Int J Equity Health 2015; 14:114. [PMID: 26616228 PMCID: PMC4663722 DOI: 10.1186/s12939-015-0231-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/02/2015] [Indexed: 12/02/2022] Open
Abstract
Introduction Childhood vaccination rates in Manitoba populations with low socioeconomic status (SES) fall significantly below the provincial average. This study examined the impact of a pay-for-performance (P4P) program called the Physician Integrated Network (PIN) on health inequity in childhood vaccination rates. Methods The study used administrative data housed at the Manitoba Centre for Health Policy. We included all children born in Manitoba between 2003 and 2010 who were patients at PIN clinics receiving P4P funding matched with controls at non-participating clinics. We examined the rate of completion of the childhood primary vaccination series by age 2 across income quintiles (Q1–Q5). We estimated the distribution of income using the Gini coefficient, and calculated concentration indices for vaccination to determine whether the P4P program altered SES-related differences in vaccination completion. We compared these measures between study cohorts before and after implementation of the P4P program, and over the course of the P4P program in each cohort. Results The PIN cohort included 6,185 children. Rates of vaccination completion at baseline were between 0.53 (Q1) and 0.69 (Q5). Inequality in income distribution was present at baseline and at study end in PIN and control cohorts. SES-related inequity in vaccination completion worsened in non-PIN clinics (difference in concentration index 0.037; 95 % CI 0.013, 0.060), but remained constant in P4P-funded clinics (difference in concentration index 0.006; 95 % CI 0.008, 0.021). Conclusions The P4P program had a limited impact on vaccination rates and did not address health inequity.
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Affiliation(s)
- Alan Katz
- Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada. .,Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB, R3E 0W3, Canada.
| | - Jennifer Emily Enns
- Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada. .,Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB, R3E 0W3, Canada.
| | - Dan Chateau
- Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada. .,Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB, R3E 0W3, Canada.
| | - Lisa Lix
- Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada. .,Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB, R3E 0W3, Canada.
| | - Doug Jutte
- Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada. .,School of Public Health, University of California, 50 University Hall, #7360, Berkeley, CA, 94720-7360, USA.
| | - Jeanette Edwards
- Winnipeg Regional Health Authority, Primary Health Care and Chronic Disease, 496 Hargrave St, Winnipeg, MB, R3A 0X7, Canada.
| | - Marni Brownell
- Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada. .,Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB, R3E 0W3, Canada.
| | - Colleen Metge
- Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada. .,Winnipeg Regional Health Authority, 200-1155 Concordia Ave, Winnipeg, MB, R2K 2M9, Canada.
| | - Nathan Nickel
- Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada. .,Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB, R3E 0W3, Canada.
| | - Carole Taylor
- Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada.
| | - Elaine Burland
- Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada.
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Gaskin DJ, Zare H, Haider AH, LaVeist TA. The Quality of Surgical and Pneumonia Care in Minority-Serving and Racially Integrated Hospitals. Health Serv Res 2015; 51:910-36. [PMID: 26418717 DOI: 10.1111/1475-6773.12394] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To explore the association between quality of care for surgical and pneumonia patients and the racial/ethnic composition of hospitals' patients. DATA SOURCE Our primary data were surgical and pneumonia processes of care indicators from the 2012 Medicare Hospital Compare Data. We merged this data with information from the 2011 American Hospital Association Annual Survey of Hospitals. We computed the racial and ethnic composition of hospital patients using 2008 data from the Healthcare Costs and Utilization Project. STUDY DESIGN The sample included 1,198 acute care general hospitals from 11 states: AZ, CA, FL, IA, MA, MD, NC, NJ, NY, WA, and WI. We compared quality across minority-serving, racially integrated, and majority-white hospitals using unconditional quantile regression models controlling for hospital and market characteristics. PRINCIPAL FINDINGS We found quality differences between the lowest performing minority-serving, racially integrated, and majority-white hospitals. As we moved from 10th to 90th quantile, the quality differences between hospitals by patients' racial composition disappeared. In other words, the best minority-serving and racially integrated hospitals performed as well as the best majority hospitals. CONCLUSIONS Efforts to improve quality of care for patients in minority-serving and racially integrated hospitals should focus on the lowest performers.
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Affiliation(s)
- Darrell J Gaskin
- Department of Health Policy and Management, Hopkins Center of Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Hossein Zare
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Faculty Appointments & Services, University of Maryland University College (UMUC), Adelphi, MD
| | - Adil H Haider
- Center for Surgery and Public Health, Brigham and Women's Hospitals, Boston, MA
| | - Thomas A LaVeist
- Department of Health Policy and Management, Hopkins Center of Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Shippee TP, Henning-Smith C, Rhee TG, Held RN, Kane RL. Racial Differences in Minnesota Nursing Home Residents' Quality of Life: The Importance of Looking Beyond Individual Predictors. J Aging Health 2015; 28:199-224. [PMID: 26112065 DOI: 10.1177/0898264315589576] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The aim of this study is to investigate racial differences in nursing home (NH) residents' quality of life (QOL) at the resident and facility levels. METHOD We used hierarchical linear modeling to identify significant resident- and facility-level predictors for racial differences in six resident-reported QOL domains. Data came from the following: (a) resident-reported QOL (n = 10,929), (b) the Minimum Data Set, and (c) facility-level characteristics from the Minnesota Department of Human Services (n = 376). RESULTS White residents reported higher QOL in five of six domains, but in full models, individual-level racial differences remained only for food enjoyment. On the facility level, higher percentage of White residents was associated with better scores in three domains, even after adjusting for all characteristics. DISCUSSION Racial differences in QOL exist on individual and aggregate levels. Individual differences are mainly explained by health status. The finding that facility racial composition predicts QOL more than individual race underscores the importance of examining NH structural characteristics and practices.
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Affiliation(s)
| | | | | | - Robert N Held
- Minnesota Department of Human Services, Minneapolis, USA
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Mueller M, Purnell TS, Mensah GA, Cooper LA. Reducing racial and ethnic disparities in hypertension prevention and control: what will it take to translate research into practice and policy? Am J Hypertens 2015; 28:699-716. [PMID: 25498998 DOI: 10.1093/ajh/hpu233] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 10/30/2014] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Despite available, effective therapies, racial and ethnic disparities in care and outcomes of hypertension persist. Several interventions have been tested to reduce disparities; however, their translation into practice and policy is hampered by knowledge gaps and limited collaboration among stakeholders. METHODS We characterized factors influencing disparities in blood pressure (BP) control by levels of an ecological model. We then conducted a literature search using PubMed, Scopus, and CINAHL databases to identify interventions targeted toward reducing disparities in BP control, categorized them by the levels of the model at which they were primarily targeted, and summarized the evidence regarding their effectiveness. RESULTS We identified 39 interventions and several state and national policy initiatives targeted toward reducing racial and ethnic disparities in BP control, 5 of which are ongoing. Most had patient populations that were majority African-American. Of completed interventions, 27 demonstrated some improvement in BP control or related process measures, and 7 did not; of the 6 studies examining disparities, 3 reduced, 2 increased, and 1 had no effect on disparities. CONCLUSIONS Several effective interventions exist to improve BP in racial and ethnic minorities; however, evidence that they reduce disparities is limited, and many groups are understudied. To strengthen the evidence and translate it into practice and policy, we recommend rigorous evaluation of pragmatic, sustainable, multilevel interventions; institutional support for training implementation researchers and creating broad partnerships among payers, patients, providers, researchers, policymakers, and community-based organizations; and balance and alignment in the priorities and incentives of each stakeholder group.
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Affiliation(s)
- Michael Mueller
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, Maryland, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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Bogdan-Lovis E, Fleck L, Barry HC. It's NOT FAIR! Or is it? The promise and the tyranny of evidence-based performance assessment. THEORETICAL MEDICINE AND BIOETHICS 2012; 33:293-311. [PMID: 22825592 DOI: 10.1007/s11017-012-9228-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Evidence-based medicine (EBM), by its ability to decrease irrational variations in health care, was expected to improve healthcare quality and outcomes. The utility of EBM principles evolved from individual clinical decision-making to wider foundational clinical practice guideline applications, cost containment measures, and clinical quality performance measures. At this evolutionary juncture one can ask the following questions. Given the time-limited exigencies of daily clinical practice, is it tenable for clinicians to follow guidelines? Whose or what interests are served by applying performance assessments? Does such application improve medical care quality? What happens when the best interests of vested parties conflict? Mindful of the constellation of socially and clinically relevant variables influencing health outcomes, is it fair to apply evidence-based performance assessment tools to judge the merits of clinical decision-making? Finally, is it fair and just to incentivize clinicians in ways that might sway clinical judgment? To address these questions, we consider various clinical applications of performance assessment strategies, examining what performance measures purport to measure, how they are measured and whether such applications demonstrably improve quality. With attention to the merits and frailties associated with such applications, we devise and defend criteria that distinguish between justice-sustaining and justice-threatening performance-based clinical protocols.
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Affiliation(s)
- Elizabeth Bogdan-Lovis
- Center for Ethics and Humanities in the Life Sciences, Michigan State University, East Fee Hall, 965 Fee Road, Room C222, East Lansing, MI 48824, USA.
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