196278 Application of publicly available nationally collected data for regional hospital quality improvement and disparity reduction initiatives

Monday, November 9, 2009: 12:30 PM

David Barton Smith, PhD , Department of Health Management and Policy, Drexel University, Philadephia, PA
Dennis Paul Andrulis, PhD, MPH , Director, Center for Health Equality Associate Dean of Research, Drexel University School of Public Health, Philadelphia, PA
Mary Ellen Cook , Center for Health Equality, Drexel University School of Public Health, Philadelphia, PA
Nicole A. Vaughn, PhD , Dept. of Health Management and Policy, Drexel University School of Public Health, Philadelphia, PA
Nadia J. Siddiqui, MPH , Center for Health Equality, School of Public Health, Drexel University, Philadelphia, PA
The study compared the nation as a whole and fourteen regions selected for participation in the RWJF Aligning Forces for Quality initiative (Cincinnati, Cleveland, Detroit, Humboldt County, Kansas City, Maine, Memphis, Minnesota, Seattle, Willamette Valley, Western Michigan, Western New York, Wisconsin, and York County, PA). We compiled regional statistical profiles from a systematic review of all major public data sources (AHRQ, CMS, AHA, AHRQ, NCHS, HRSA, JCAHO and US Census Bureau). The CMS MEDPAR was used to develop racial comparisons of hospital outcomes (medical and surgical death rates, incidents rates of safety problems).We used the CMS/JCHO HospitalCompare consensus process indicators (AMI, Heart Failure, Pneumonia, and Surgical Infection Prevention) and computed “structural disparity” indicators by region weighting a summary process indicator for each hospital in a region by the proportion of white and black discharges in the region as identified in the MEDPAR. The principal findings were: (1) While there were substantial variations between AF4Q regions on demographic, disease and health care measures, on the average these areas had somewhat lower poverty rates, more health care resources, lower age adjusted death rates and less racial disparities in death rates than the nation as a whole. (2) The degree of racial segregation in terms of hospital use by blacks and whites varied but was relatively low. The Overall Index of Dissimilarity was .333, and the most segregated regions were Wisconsin (.637), Minnesota (.543) and Detroit (.540). (3) There was no difference in the HospitalCompare process summary measure adjusted for where blacks and whites received care in the 14 regions (black/white ratio .99). (4) While black medical admission death rates were lower than whites (.70), surgical death rates were higher (1.21) as were incidents of safety problems (1.39).

We conclude that: (1) The moderate degree of segregation among hospital providers and the lack of variation between hospitals on HospitalCompare indicators contributed to the lack of regional racial disparity on these measures of hospital quality. (2) While there were significant differences between blacks and whites on the MEDPAR indicators, the low incidence rates make it impossible to compare the performance of individual hospitals and the complex factors contributing to these differences don't lend themselves easily to corrective action. (3) Hospitals are in the early stages of developing the internal capacity to analyze performance by race and ethnicity and the HospitalCompare process and MEDPAR outcome indicators have limited usefulness in comparing individual hospital performance.

Learning Objectives:
Assess the ability of existing nationally available datasets to assist regional initiatives for improving the quality of hospital care and reducing disparities.

Keywords: Quality Improvement, Social Inequalities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Ph.D Health Services Research University of Michigan, author of five books and more than thirty peer reviewed articles related to this topic. The research presented in this paper resulted from a grant from the Robert Wood Johnson Foundation
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.