Overview
Quality health care means delivering services in ways that are safe, timely, patient centered, effective, efficient, and equitable. Unfortunately, our health care system often distributes services inefficiently and unevenly across populations, and some Americans receive worse care than others in the United States. Variations in health care and health status among racial and ethnic and socioeconomic groups continue to challenge the nation.
The nature and size of quality disparities for vulnerable populations also vary across geographic areas, such that some States have larger gaps than others, as can be seen in State Snapshots. Even areas with smaller disparities between populations may warrant quality improvement efforts if the overall population is experiencing lower quality care.
The combination of unique population demographics and health care environments coupled with access to policy and program levers makes States an appropriate initiator of action to reduce health care disparities. States also have new opportunities and incentives to address health disparities in light of the Patient Protection and Affordable Care Act (ACA).
As States increasingly pursue activities to improve the health status and quality of care for vulnerable populations, such as racial and ethnic groups, AHRQ is developing and facilitating access to tools that can aid States in their efforts. Below are seven categories of resources useful to quality improvement and disparities reduction available to States:
Contents
- Raising Awareness
- Collecting Data
- Analyzing Data
- Reporting Data
- Identifying Best Practices
- Focusing on Specific Vulnerable Populations
Raising Awareness
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| Source | Resource | Description |
|---|---|---|
| AHRQ | National Healthcare Quality and Disparities Report | Summarizes health care quality and access among various racial, ethnic, and income groups and other priority populations, such as residents of rural areas and people with disabilities. Also reports trends in health care quality, including effectiveness of care, patient safety, timeliness of care, patient centeredness, and efficiency of care. |
| CDC | Health Disparities and Inequalities Report-United States (2013) | Consolidates the most recent national data available on disparities in mortality, morbidity, behavioral risk factors, health care access, preventive health services, and social determinants of critical health problems in the US across selected indicators |
| HHS | Healthy People 2030 | Provides science-based, 10-year national objectives for improving the health of all Americans |
| HHS | HHS Disparities Action Plan to Reduce Racial and Ethnic Health Disparities: Implementation Progress Report 2011-2014 | Outlines goals and actions HHS will take to reduce health disparities among racial and ethnic minorities |
| NAM | Unequal Treatment (2002) | Assesses the extent of disparities in the types and quality of health services received by U.S. racial and ethnic minorities and non-minorities, explores contributing factors, and recommends policies and practices to eliminate these inequities |
| CDC | Native Hawaiian/Pacific Islander (NHPI) National Health Interview Survey (NHIS) | The NHPI NHIS was an unprecedented opportunity to collect rich and accurate information from a large NHPI sample about the health of Native Hawaiian/Pacific Islanders in all 50 states. |
| HHS | Healthy People 2020 Health Disparities Widget | Healthy People 2020 has created a widget that displays disparities data related to the Healthy People 2020 objectives for the Leading Health Indicators (LHIs). |
| CMS | Mapping Medicare Disparities | Addressing Disparities and Improving Quality |
| NAM | Vital Signs: Core Metrics for Health and Health Care Progress | A multi-stakeholder consensus based product describing a concise list of measures that provide a snapshot of health and healthcare. |
| HRSA | Health Equity Report 2019-2020 | HRSA’s report provides data on health inequities experienced by patients who are treated in HRSA-funded health centers. |
| HHS | Think Culture Health | Culture Health is a website that features information, continuing education opportunities, resources, and more for health and health care professionals to learn about culturally and linguistically appropriate services, or CLAS. |
| Surgeon General | Smoking Cessation: A Report of the Surgeon General | Report on the benefits of smoking cessation at any age including premature death, risk of adverse health outcome and financial burden. The report also highlights the considerable disparities that exist in the prevalence of smoking as well as key indicators of smoking cessation. |
| HHS | The Role of Law and Policy in Assisting Families to Reach Healthy People’s Maternal, Infant, and Child Health Breastfeeding Goals in the United States | This report presents evidence-based policy solutions that community and tribal leaders, government officials, public health professionals, health care providers, lawyers, and social service providers can use in their communities to help meet breastfeeding goals. |
| SAMHSA | Double Jeopardy: COVID-19 and Behavioral Health Disparities for Black and Latino Communities in the U.S. | Provides information on how the inequities in health care that communities of color experience has been magnified by COVID19. Disparities in access to behavioral health care has magnified disparities. |
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Collecting Data
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| Source | Resource | Description |
|---|---|---|
| Commonwealth Fund | Racial, Ethnic, and Primary Language Data Collection in the Health Care System: An Assessment of Federal Policies and Practices (2001) | Provides the first comprehensive analysis of the policies and statutes governing the collection of health care data by race, ethnicity, and primary language |
| AHA | AHA Disparities Toolkit | Provides hospitals, health systems, clinics, and health plans information and resources for systematically collecting race, ethnicity, and primary language data from patients |
| NAM | Race, Ethnicity, and Language Data: Standardization for Healthcare Quality Improvement (2009) | Recommends collection of more granular ethnicity and language data according to national standards |
| CHCS | The National Health Plan Collaborative Toolkit | Provides resources, lessons, best practices, and case studies to help health plans join the effort to reduce disparities |
| CDC | National Center for Health Statistics: Health, United States | Health, United States is an annual report on trends in health statistics developed by the National Center for Health Statistics. |
| HHS | The Office of Minority Health | The Office of Minority Health is dedicated to improving the health of racial and ethnic minority populations through the development of health policies and programs that will help eliminate health disparities in the Department of Health and Human Services. |
| AHRQ | Medical Expenditure Panel Survey (MEPS) | The Medical Expenditure Panel Survey (MEPS) is a set of large-scale surveys of families and individuals, their medical providers, and employers across the United States. |
| AHRQ | Healthcare Cost and Utilization Project (HCUP) | HCUP is the Nation’s most comprehensive source of hospital care data, including information on in-patient stays, ambulatory surgery and services visits, and emergency department encounters. |
| NAM | Vital Signs: Core Metrics for Health and Health Care Progress | Provides a streamlined set of 15 standardized measures that could provide consistent benchmarks for health progress across the nation and improve system performance in the highest priority areas |
| CMS | Addressing Disparities and Improving Quality | Compendium of Resources for Standardized Collection of Demographic and Language Data Collection |
| AHRQ | Quality improvement for CAHPS data | Quality improvement for CAHPS data |
| AHRQ | Quality improvement using SOPS data | Quality improvement using SOPS data |
| CDC | United States Cancer Statistics | The United States Cancer Statistics are combined cancer registry data from CDC’s National Program of Cancer Registries (NPCR) and the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) Program. Together, these data provide the latest cancer information on the entire U.S. population. |
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Analyzing Data
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| Source | Resource | Description |
|---|---|---|
| AHRQ | NHQDR Data Tools | Provides national and State health care quality information and data, including benchmarks and trends |
| AHRQ | HCUPnet: Instant Access to Hospital Statistics | HCUPnet is a free, on-line query system based on data from the Healthcare Cost and Utilization Project (HCUP) |
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Reporting Data
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| Source | Resource | Description |
|---|---|---|
| AHRQ | Talking Quality | Provides guidance on how to communicate health care quality information in understandable and useful ways |
| NAM | Future Directions for the National Healthcare Quality and Disparities Reports (2010) | Provides recommendations on how the NHQDR can be improved to make them more influential in promoting change in the health care system |
| AHRQ | State Documentation of Racial and Ethnic Health Disparities to Inform Strategic Action (2011) | Summarizes how leading States analyze race/ethnicity data in strategic plans and reports aimed at reducing racial and ethnic disparities in health status and health care |
| AHRQ | State Uses of Hospital Discharge Databases to Reduce Racial and Ethnic Disparities (2010) | Summarizes how leading States that participate in the Healthcare Cost and Utilization Project (HCUP) and their clients use hospital discharge data on patient race/ethnicity to inform State health care disparities reduction activities |
| Massachusetts General Hospital | Creating Equity Reports: A guide for Hospitals (2008) | Provides a framework for equity reporting and shares lessons learned from experiences creating and using such reports |
| CMS | Mapping Medicare Disparities (MMD) Tool | The CMS Office of Minority Health has designed an interactive map, the Mapping Medicare Disparities Tool, to identify areas of disparities between subgroups of Medicare beneficiaries (e.g., racial and ethnic groups) in health outcomes, utilization, and spending. It is an excellent starting point to understand and investigate geographic and racial and ethnic differences in health outcomes. This information may be used to inform policy decisions and to target populations and geographies for potential interventions. |
| CMS | Hospital Compare | The Centers for Medicare & Medicaid Services (CMS) updated hospital performance data on the Hospital Compare website and on data.medicare.gov to empower patients, families, and stakeholders with important information they need to compare hospitals and make informed healthcare decisions. |
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Identifying Best Practices
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| Source | Resource | Description |
|---|---|---|
| AHRQ | Quality Diagnostic Tools for States | Consists of events and technical assistance opportunities that disseminate and encourage the use of AHRQ Quality Improvement tools to support State policymakers with their health care quality improvement efforts |
| AHRQ | Diabetes Care Quality Improvement: A Resource Guide for State Action | Helps States assess the quality of diabetes care and create quality improvement strategies |
| AHRQ | Asthma Care Quality Improvement: A Resource Guide for State Action | Helps States assess the quality of asthma care and create quality improvement strategies |
| NAM | Challenges and Successes in Reducing Health Disparities: Workshop Summary (2008) | Summarizes workshop designed to increase the visibility of disparities and to develop strategies to reduce disparities |
| NQF | Comprehensive Framework and Preferred Practices for Measuring and Reporting Cultural Competency (2009) | Outlines a comprehensive framework for measuring and reporting cultural competency and provides a detailed set of preferred practices for culturally competent care |
| Essential Hospitals | Assuring Healthcare Equity: A Healthcare Equity Blueprint (2008) | Offers strategies and practices that can be tailored to individual hospitals to address equity in providing quality care |
| Massachusetts General Hospital | Improving Quality and Achieving Equity: A Guide for Hospital Leaders | Serves as a health care quality improvement guide for CEOs, high-level managers in hospitals, and other leaders in the fields of safety, finance, and risk reduction in hospitals |
| Robert Wood Johnson Foundation | Expecting Success Toolkit: Excellence in Cardiac Care (2008) | Provides tips for hospitals on improving the quality of care and reducing disparities based on the experience of 10 participating hospitals |
| NAM | Medications for Opioid Use Disorder | Report on the effectiveness and benefits of the medications used to treat opioid use disorder and major barriers including access and stigma that hamper the use of medications. |
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Focusing on Specific Vulnerable Populations
Children and Adolescents
| Source | Resource | Description |
|---|---|---|
| AHRQ | Child Health Care Quality Toolbox: Measuring Quality in Children’s Health Programs | Provides concepts, tips, and tools for evaluating the quality of health care for children |
Low Income Groups
| Source | Resource | Description |
|---|---|---|
| CMS | Health Care Coverage Analyses of the 2000-2008 National Healthcare Quality and Disparities Report (2014) | For the first time, presents data on quality and racial and ethnic disparity measures by payer |
Older Americans
| Source | Resource | Description |
|---|---|---|
| CDC | Clinical Preventive Services for Older Adults | Offers examples of recent activities and interventions that have focused on increasing the use of clinical preventive services in diverse communities |
| CDC | Promoting Preventive Services for Adults 50-64 | Identifies a set of recommended preventive services, provides indicators and data with which to monitor progress, and promotes successful strategies to facilitate adoption and use |
Women
| Source | Resource | Description |
|---|---|---|
| AHRQ | Chartbook on Women’s Health Care, 2014 | Summarizes key findings from the National Healthcare Quality and Disparities Reports related to health care for women |
Persons with Disabilities
| Source | Resource | Description |
|---|---|---|
| AHRQ | Statistical Brief #312: Patient-Provider Communication by Race/Ethnicity and Disability Status: United States, 2007 (2011) | Examines patient-provider communication by race/ethnicity and disability status using data from the Household Component of the Medical Expenditure Panel Survey (MEPS-HC) |
| Assistant Secretary for Planning and Evaluation (ASPE) | Research Addressing the HHS Strategic Framework on Multiple Chronic Conditions | Identifies common combinations of multiple chronic conditions to help in targeting interventions for specific subgroups and examines promising data, methods, and topics for conducting disparities research within the multiple chronic conditions population |
Residents of Rural Areas
| Source | Resource | Description |
|---|---|---|
| AHRQ | Chartbook on Rural Healthcare, 2021 | Includes a summary of trends across measures of healthcare in rural areas from the NHQDR and figures illustrating select measures of healthcare in rural areas. |
Veterans
| Source | Resource | Description |
|---|---|---|
| AHRQ | Chartbook on Healthcare for Veterans, 2020 | Provides information regarding disparities in access to and quality of healthcare received by Veterans. |