Measuring Disparities in Patient Safety Ernest Moy [email protected] 301-427-1329 .

Measuring Disparities in Patient Safety

Ernest [email protected]

301-427-1329www.ahrq.gov/qual/qrdr11.htmhttp://statesnapshots.ahrq.gov

National Healthcare Reports

Annual reports to Congress from Secretary since 2003 mandated by 1999 Healthcare Research and Quality Act

Unified team, Interagency Work Group, framework, data, methods, quality measures

Quality Report Disparities Report

Snapshot & trends in quality of health care in America

Snapshot & trends in disparities in health care

Effectiveness, safety, timeliness, patient centeredness, care coordination, efficiency, health system infrastructure, access

Differences across race, ethnicity, & socioeconomic status

Variation across states Variation across populations

QRDR Patient Safety Data

QIO Surgical Infection Prophylaxis– ‘Voluntary’ reporting by hospitals– ~1 million surgical cases per year

HCUP SID Disparities Analytic File– All-payer hospital discharge abstract data – Sample from 36 HCUP-SID ‘good race data’

States = >15 million records Medicare Patient Safety Monitoring System

– Structured inpatient chart abstraction– Sample from charts requested by CMS =

~25,000 charts per year

QIO: Prophylactic Antibiotics Started

All groups improving

In all years, Hispanics and AI/ANs had lower rates than Whites

2005 2006 2007 2008 200950

60

70

80

90

100

White Black HispanicAI/AN Asian

2008 Achievable Benchmark = 96%

QIO: Prophylactic Antibiotics Discontinued

All groups improving

In all years, Hispanics and Asians had lower rates than Whites

2005 2006 2007 2008 200950

60

70

80

90

100

White Black HispanicAI/AN Asian

2008 Achievable Benchmark = 95%

HCUP: Postoperative Sepsis, Adults

In both years, Blacks and Hispanics had higher rates than Whites

2008 20090

5

10

15

20

25

White Black Hispanic Asian

2008 Achievable Benchmark = 8.7

HCUP: Catheter-Related Bloodstream Infection, Adults

In both years, Blacks had higher rates than Whites

2008 20090

1

2

3

4

5

White Black Hispanic Asian

2008 Achievable Benchmark = 1.5

HCUP: Catheter-Related BSI, Neonates, 2009

Among both neonates with private health insurance and with Medicaid, Blacks and Hispanics had higher rates than Whites

Private insurance Medicaid0

20

40

60

80

100

White Black Hispanic

2008 Achievable Benchmark = 17

HCUP: Postoperative Sepsis, Adults, 2009

In most States, Blacks and Hispanics had higher rates than Whites, but this is often not statistically significant at the State level.

0

25

50

75

White Black Hispanic

2008 Achievable Benchmark = 8.7

MPSMS: Composites, 2002-2007

Blacks had higher rates than Whites of– HAIs (adjusted

OR = 1.34)– ADEs

(adjusted OR = 1.29)

Healthcare-Associated Infections

Adverse Drug Events0

2

4

6

8

10

12

White Black

MPSMS: Composites, 2002-2007

Patients in hospitals with higher % of patients who are black had higher rates of HAIs and ADEs

Healthcare-Associated Infections

Adverse Drug Events0

2

4

6

8

10

12

Low Black % (0.3%) Middle Black % (4.8%)High Black % (30.9%)

Conclusions

Disparities in patient safety are common, especially related to – Healthcare-associated infections– Adverse drug events.

Process measures improve; outcomes and disparities often do not.

Disparities are attributable to variation– Within and between payer groups– Within and between States– Within and between hospitals.