The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #56156

Susan Fossett Brittman, MPH and Weihong Fan, MS. Special Studies Program, Center for Healthcare Quality, 3175 Lenox Park Blvd, Suite 309, Memphis, TN 38115, 901-682-0381 x2694, tnpro.sbrittman@sdps.org

Introduction: In Healthy People 2010, the Department of Health and Human Services (DHHS) established health objectives for the next decade. One of those objectives is to eliminate health disparities. Within DHHS, the Centers for Medicare and Medicaid Services (CMS) developed a system for reporting the performance of 24 evidence-based, quality of care indicators. The indicators measure the effectiveness in the delivery of services in preventing or treating the following clinical conditions: breast cancer, diabetes, acute myocardial infarction, heart failure, pneumonia, and stroke. They further identified five underserved Medicare beneficiary groups; African American, Asian/Pacific Islander, Hispanic, American Indian/North American Native and Medicare beneficiaries who are also enrolled in Medicaid (dually enrolled) and documented the disparities among these groups compared to the general Medicare population. Methods: Medicare beneficiaries were selected from all states using systematic random sampling methodology. Baseline data were collected during 1997-1999 from inpatient medical records, Medicare claims for outpatient services, and beneficiary surveys. Follow-up data were collected during 1999-2001. Identification of the underserved populations used one of the following three methods: the race code in the Medicare enrollment data base (African American, Asian/Pacific Islander, American Indian/North American Native), the “state buy-in” code in the enrollment database (Dually enrolled), and a combination of race code and modification of the Passel-Work surname list (Hispanic). Other methods to identify the underserved population groups were explored, however, those methods did not produce comparable measures of specificity. Efforts to assess disparity at the national level are measured in two ways. An improvement in the indicator rate for the underserved populations is assessed initially. Secondly, a reduction in disparity is measured by comparing the rate for the underserved beneficiaries to the rate of the overall population. Results: At baseline, almost three-fourths of the quality indicators for the underserved populations exhibited a disparity in the care received by members of these groups relative to the average Medicare beneficiary with the greatest disparities seen in the outpatient setting. At re-measurement, the same trend was true with a few noted reductions in disparity. During both time periods, the greatest disparities were seen among the Hispanic and Dually Enrolled populations. Overall, healthcare delivered to underserved population groups improved over time.

Learning Objectives:

• Track national and state-level changes in the quality of medical care indicators for Medicare beneficiaries
• Describe the need for a system for monitoring healthcare disparities
• Evaluate the effectiveness of the reducing disparities effort in the Medicare community

Keywords: Health Care Quality,

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.