AHA Disparities Toolkit - How To Use The Data

Eliminating racial and ethnic disparities in health care is a central issue in overall efforts to improve quality of care. Information on racial and ethnic characteristics of the U.S. population is needed to target quality improvement efforts, identify the nature and extent of health disparities, and monitor progress. Measurement, reporting, and benchmarking are critical to improving care. In addition, federal and certain state statutes and laws require reporting data by race and ethnicity to monitor discriminatory practices. Enforcement of laws that prohibit discrimination on the basis of race, color, national origin, and disability rely on data collection to monitor compliance. Ultimately, hospitals and other health care organizations need to be responsive to the communities they serve. A first step toward accomplishing this goal is understanding who the community is and working collaboratively to address problems and concerns.

The health system serves three critical functions (Eliminating Health Disparities: Measurement and Data Needs, National Research Council, 2004):

1. Ensuring the health of the population. This is the ability to provide consistent and reliable epidemiological data on the incidence and prevalence of various health conditions and related risk factors among different racial and ethnic populations.
2. Ensuring equitable access to care. Access to care is a prerequisite for entering and staying in the health care system. Available racial and ethnic data have been used to document important differences in access between racial and ethnic groups. More accurate data can also be used to document differences in access within racial groups (e.g., Puerto Rican, Mexican, Somali, Jamaican, etc.).
3. Ensuring quality of care. Language and cultural barriers can have a negative impact on quality of care. For example, African Americans were nearly twice as likely as whites to report being treated with disrespect during recent health care visits; Hispanics, regardless of language skills, were more likely than other patients to report having difficulty communicating with and understanding their doctors (Collins, Tenney, and Hughes, The Commonwealth Fund, 2002; Doty and Ives, The Commonwealth Fund, 2002). These findings underscore the importance of ensuring culturally competent care to patients by health care providers.

There are a number of disparity monitoring initiatives conducted by the federal government. Eliminating health care disparities is one of the primary goals of Healthy People 2010, a long-term national agenda aimed at improving health in the United States. Beginning in 1999, Congress also required the Agency for Healthcare Research and Quality to develop an annual National Healthcare Disparities Report (PDF) to track the extent of disparities in health care and monitor whether progress has been made toward eliminating them.

It is important to maintain a national focus on this issue to present national data to assess our progress in eliminating disparities in care. However, health care organizations need to also monitor the care they deliver within their own "backyards." Many experts have called for health care organizations to stratify their quality reports by race and ethnicity in order to undertake targeted interventions. Health care organizations should be able to stratify race, ethnicity, and language data by service quality indicators (patient satisfaction, wait times, etc.) as well as by technical quality indicators (clinical measures).

For example, the Robert Wood Johnson national initiative to reduce disparities in cardiac care, Expecting Success: Excellence in Cardiac Care, focuses on improving cardiac care to minority populations in a hospital learning collaborative. A major emphasis of this initiative focuses on reporting cardiac care quality measures by race, ethnicity, and primary language.

In addition, Finding Answers: Disparities Research for Change, a national program of the Robert Wood Johnson Foundation, suggest promising strategies for reducing racial and ethnic disparities in care for depression, diabetes, and cardiovascular disease.

Linking to Clinical Quality Measures

As part of the Hospital Quality Alliance, over 4,000 hospitals are voluntarily reporting inpatient quality of care measures to CMS for a number of conditions. Read this document (PDF) on the specific quality measures.

Linking to Patient Satisfaction Measures and Making Appropriate Resource Allocation Decisions

The American College of Physicians position paper on Racial and Ethnic Disparities in Health Care (2004) calls for an ongoing dialogue between hospitals and other health care organizations and surrounding communities to help integrate cultural beliefs and perspectives into health care practices and health promotion activities. Accurate information about race, ethnicity, and primary language can be used to ensure adequate interpreter services, provide relevant patient information materials, and understand dietary practices. Pressing problems in the communities, such as disparities in care, can be addressed more effectively if health care providers and practitioners build the trust of the community by documenting their accomplishments.

Complying with Civil Rights Laws

Routine monitoring of access, use of services, and outcomes of care by race, ethnicity, and primary language helps ensure compliance with civil rights laws. Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990, and related statutes and their implementing regulations require that patients from different racial and ethnic groups and patients with disabilities have equal opportunity to access quality care.