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APHA Scientific Session and Event Listing

Recorded presentation

Marcia J. Wilson, MBA and Bruce Siegel, MD, MPH. Department of Health Policy, The George Washington University, 2021 K Street, NW, #800, Washington, DC 20006, 202-530-2316, mjwilson@gwu.edu

Research Objective: The Institute of Medicine's report Crossing the Quality Chasm: A New Health System for the 21st Century recognizes equity as one of the six domains of quality health care. Yet, disparities in health care are well documented and pervasive throughout the delivery system. The Expecting Success program is a hospital collaborative designed to reduce disparities in healthcare for minority Americans with cardiovascular disease using quality improvement (QI) initiatives. Study Design: Through a national competitive process, 10 institutions with large African American and/or Latino populations were selected to work over 29 months to improve the quality of cardiac care. The hospitals will implement rapid-cycle change QI techniques to foster use of evidence based clinical practices. Twenty-three performance measures are collected monthly by patients' race, ethnicity and primary language. These measures include the current Hospital Quality Alliance metrics for heart failure (HF) and acute myocardial infarction (AMI), as well as newer “measures of ideal care” assessing whether patients received all recommended therapies. Population Studied: The ten selected hospitals serve rural, suburban, and urban markets. The hospitals include six not-for-profit hospitals, one for-profit, and three publicly owned. Three are community hospitals, three are teaching hospitals, and four are academic medical centers. Principal Findings: While hospitals collect data on patients' race and ethnicity, initial findings indicate that few hospitals implement formal quality improvement initiatives specifically designed to reduce ethnic or racial disparities in care. Preliminary program data indicate that there are no significant disparities in care for some measures, but significant opportunities to improve quality of cardiovascular care for all patients may exist. In other measures, there are apparent differences in care between racial and ethnic groups within individual hospitals. Conclusions: In some cases, the elimination of observed national disparities may require overall improvement in care at hospitals with large minority populations. In other instances, we may need to address real differences in the care rendered to specific populations at given institutions. Implications for Policy, Delivery, or Practice: The ability of a diverse set of hospitals to demonstrate the use of QI strategies and standardized data collection to eliminate measured disparities could greatly influence national performance improvement activities. The successful use of QI and data collection techniques by a diverse set of hospitals will also raise questions as to whether disparities reduction activities should be included in reforms of public data reporting, accreditation, and regulatory systems.

Learning Objectives: AT the conclusion of the session, the participants in this session will be able to

• Recognize the difference between disparities in care within an institution versus disparities in care among institutions.
• Describe select quality improvement strategies initiated to reduce disparities in cardiac care.
• Articulate the relationship between quality improvement initiatives and reducing disparities in care.

Related Web page: www.expectingsuccess.org

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation