Measurement challenges in developing the national healthcare quality report and the national healthcare disparities report.

OBJECTIVES: The objective of this study was to describe 2 measurement challenges faced in the development of the National Healthcare Quality Report (NHQR) and the National Healthcare Disparities Report (NHDR): the use of federal data on race and ethnicity and the selection of measures of socioeconomic status (SES). METHODS: Over 30 federal and nonfederal data systems were examined to identify measures of race, ethnicity, and SES and to evaluate the characteristics and relative quality of the data. RESULTS: The availability and quality of data on race, ethnicity, and SES vary by factors such as the type of data (population or establishment based-survey, administrative/claims data, or vital statistics), the source of information (self, proxy, other, or some combination), and the transition to new federal standards. No single measure of SES could be identified, so a mix of measures is presented, including income, education, and expected source of payment (ESOP). Income relative to federal poverty level was used as the preferred SES measure from person-based surveys. Selected analyses linking hospital discharge data to annual median household income from US census data were presented for data derived from administrative data systems. Educational attainment was the variable used for examining SES using data from the Vital Statistics System. CONCLUSIONS: The first NHQR and NHDR maximized the presentation of data by accommodating the variation among data systems while at the same time imposing some standardization in the coding and classification of data on race, ethnicity, and SES.

Heart disease and prevention: race and age differences in heart disease prevention, treatment, and mortality.

OBJECTIVE: The objective of this study was to analyze race and age differences in the distribution of health promotion and cardiovascular screening tests, and the prevalence of serious heart disease and cardiovascular mortality in the United States. DATA SOURCES/STUDY POPULATION: Data are from 7 federal datasets represented in the first National Healthcare Quality Report and the National Healthcare Disparities Report, and include surveys, administrative and vital statistics data systems. The study analyzes blacks and whites. MEASURES: Counseling on diet and nutrition, exercise, and tobacco during an outpatient visit indicate the availability of health promotion services, and screening for high blood pressure and cholesterol represent preventive services. Hospitalizations for heart-related conditions and use of certain cardiac procedures identify serious heart disease. Deaths from coronary artery disease and stroke are the heart-related mortality measures. PRINCIPAL FINDINGS: Counseling and education services tend to occur more on outpatient visits by individuals aged 45 to 64 years than in younger age groups. Screening rates among individuals aged 45 to 64 years of approximately 90% for hypertension and 80% for high cholesterol suggest progress in early detection of cardiac risk factors. However, blacks aged 45 to 64 years are 5.6 times more likely than their white counterparts to be hospitalized for hypertension, approximately one third less likely to receive a cardiac procedure, and almost twice as likely to die of coronary heart disease. CONCLUSIONS: Although findings indicate few racial differences in health promotion services in ambulatory care or screening for cardiac risk factors, the prevalence of serious cardiovascular disease, use of cardiac procedures, and heart-related mortality suggest continuing racial disparities in heart disease.

Preparing the national healthcare disparities report: gaps in data for assessing racial, ethnic, and socioeconomic disparities in health care.

BACKGROUND: Efforts to quantify, monitor, understand, and reduce disparities in health care are critically dependent on the collection of high-quality data that support such analyses. In producing the first National Healthcare Disparities Report (NHDR), a number of gaps in data were encountered that limited the ability to assess racial, ethnic, and socioeconomic disparities in health care. OBJECTIVES: The objectives of this study were to identify and quantify gaps in data related to disparities in health care and discuss efforts to fill these gaps in future NHDRs. FINDINGS: : Data on specific racial, ethnic, and socioeconomic groups were often not collected or collected in formats that differed from federal standards. When collected, data were often insufficient to generate reliable estimates for specific racial, ethnic, and socioeconomic groups. These effects were magnified when attempting to assess disparities within many of the agency's priority populations such as women, children, the elderly, low-income populations, and rural residents. Future NHDRs begin to fill some of these gaps in data, but some gaps will likely persist and new gaps will likely arise as the availability of data for specific populations vary from year to year. CONCLUSIONS: Gaps in data limit the ability to address racial, ethnic, and socioeconomic disparities in health care. Although many federal efforts are underway to improve data collection, some groups and populations pose unique challenges for data collection that will be difficult to overcome.

Characteristics of emergency departments serving high volumes of safety-net patients: United States, 2000.

OBJECTIVE: This report describes hospital, community, and patient factors associated with emergency departments (EDs) whose case loads are driven by "safety-net" populations. The study also explores the relationship between safety-net burden and receipt of Medicaid Disproportionate Share Hospital (DSH) Program funds. METHODS: Linked data were analyzed from the 2000 National Hospital Ambulatory Medical Care Survey (NHAMCS), Area Resource File, and reports of Medicaid DSH payments to hospitals. NHAMCS ED visit data were aggregated to the hospital ED level (n = 376). Hospital sampling weights were used to produce national estimates of hospital EDs. Hospitals were classified into high vs. low safety-net burden based on the percent of ED visits where the expected source of payment was Medicaid or uninsured (self-pay or no charge). High- and low-burden EDs were compared along five domains: hospital characteristics; community factors; patient mix; diagnosis mix using Billings' profiling algorithm; and condition severity, visit content, and outcome. RESULTS: Approximately one-third (36.1 percent) of U.S. EDs were classified as high safety-net burden provides. Hospitals located in the South were more likely to have a high ED safety-net burden (61.3%). High-burden EDs saw a higher percentage of cases that were either nonurgent or emergent, but primary care treatable. EDs high in uninsured burden were not necessarily high in Medicaid burden. Fewer than half of high-burden EDs received DSH payments. CONCLUSIONS: High safety-net burden is not necessarily offset by public funding. The vast majority of EDs that serve high proportions of uninsured patients do not receive such compensation.