Cara James
Putting patients first: Today's disparities research leading to health equity tomorrow
Centers for Medicare and Medicaid Services|Office of Minority Health
centers medicare medicaid services cms collaborated wide variety stakeholders support work three areas path equity increasing understanding awareness disparities causes developing disseminating solutions implementing sustainable actions increase understanding awareness disparities cms sponsored issue goal contributing conversation health disparities emphasizing value continuing research area studies included issue underscore importance identifying groups people benefit equally health system identifying root causes differences value information analysis provide important topic hope create discussion reduce health disparities sponsoring issue latest series things cms done improve health equity nationwide improve understanding disparities causes fostered demographic data collection implementation data standards analyzed reported health disparities annual reports health care quality medicare advantage analytic reports launched mapping medicare disparities tool interactive webbased tool allows user quickly calculate range health outcome measures population interest county state national levels agency also launched cms equity plan improving quality medicare focuses six priority areas increasing ability health care workforce meet needs vulnerable populations improving physical accessibility health care facilities improving communication language access individuals limited english proficiency persons disabilities also implemented coverage care c2c initiative help individuals understand coverage use connect primary care preventive services right released first ever cms rural health strategy developed number resources help stakeholders build organizational response health disparities provided health equity technical assistance organizations seeking help identify address health disparities finally worked across agency ensure programs looking ways incorporate focus health equity quality improvement organization program seeks part improve health quality community level medicare beneficiaries partnership patients initiative publicprivate partnership aims improve quality safety affordability health care models accountable health communities model 5year model tests whether systematically identifying addressing healthrelated social needs medicare medicaid beneficiaries food insecurity inadequate unstable housing screening referral community navigation services impact health care costs reduce health care utilization also finalized payment code providers spend additional time visit patients need including persons disability cognitive impairment efforts great start know learn cms office minority health omh pleased support special issue health services research issue evaluates several areas interest cms chronic disease quality care patient experience satisfaction health coverage authors conducted innovative research examine multitude influences impact health disparities promote innovation quality improvement programs targeted interventions support vulnerable populations taken together move us little closer toward goals achieving health equity special issue begins three manuscripts examine chronic disease health equity lens first manuscript durfey et al 2019 uses area deprivation index adi measures explore chronic disease management among medicare advantage enrollees authors suggest adi limitations measure social determinant health also suggest may help medicare assess individual risk target interventions enrollees live found area deprivation predictor chronic disease management relationship differ race ethnicity association remained statistically significant controlling individuallevel risk factors top 10 percent disadvantaged neighborhoods significant association blood pressure control adjustment authors suggest may indicate need prioritization resources segment population another aspect place living food swamp focus next manuscript phillips rodriguez 2019 note term relatively new public health literature food swamps places large numbers unhealthy energydense food offerings inundate swamp relatively existing healthy food offerings note contrast food desert defined paucity healthy options authors combine multiple data sources complete crosssectional analysis 784 counties across 15 states study found positive association food swamp score allcause hospitalizations stronger association rural counties urban counties karliner et al 2019 combined data san francisco mammography registry facility survey california cancer registry explore followup times population vulnerability defined raceethnicity educational attainment english proficiency systembased processes association cancer stage diagnosis mammography facilities found population vulnerability highest facilities longer followup times facilities also fewer radiologists longer biopsy appointment wait times less direct patient communication however even within facilities whites better outcomes nonwhite counterparts longer followup time facility also associated higher adjusted odds ratio advancedstage cancer diagnosis body work chronic disease raises many questions health equity researchers policy makers health equity methodology interventions first begin use area deprivation index factor assess risk capture variation within adi segmentsand much variation study durfey colleagues found relationship remained significant whites blacks however work necessary determine whether finding generalizable health outcomes beyond chronic disease management second strong associations food environment health done health care arena help patients disadvantaged things outside control foods available room partnerships federal state local institutions improve situation authors also highlight need consider place evaluating programs including cms medicare diabetes prevention program expanded model third karliner et als work demonstrates variation quality care across facilities time critical facing possible diagnosis cancer research tell us effective interventions focus systems level combine individuallevel approach empower patients advocate within systems room quality measurement followup time biopsy consequence racial ethnic disparities site care inequality care public health interventions improve equity next set manuscripts examine quality care relates health equity provide springboard begin new discussions population health first one authors examine underexplored aspect quality careone occurs patients even step clinic doors leech irbyshasanmi mitchell 2019 conducted pilot field experiment explore influence linguistic name cues pediatric provider offices reports availability wellchild visits findings included auditors giving linguistic name cues black patients less likely told office accepting new patients likely experience withholding behaviors misattributions public insurance compared control group work lloren colleagues 2019 offered innovation quantifying hospitalspecific health outcome disparities publicly reported use patients hospitals work builds models already used cms payforperformance programs using dual eligibility racial identity african american indicators social risk authors developed tested metric intended used target quality improvement efforts address health equity across populations medicare administrative claims data master beneficiary summary file mbsf combined enabling authors examine patterns readmission acute myocardial infarction heart failure pneumonia among seniors ages 65 older authors demonstrated hospitalspecific disparity metric feasible effective highlighting relative differences outcomes within hospitals manuscript addressing health outcomes youth cook et al 2019 took close look prescription patterns fda issued 2004 fda black box warning antidepressant use among youth indicating increased risk suicidal thinking feeling behavior among young patients although issues around black box warnings discussed literature length authors approached health equity perspective identify gaps practices among racial ethnic minorities compared whites found although warning impact prescribing patterns resulted lower prescribing habits postwarning provider patientlevel influences played significant part variance overall prescribing patterns disparities prescribing patterns warning providers continuing prescribe drugs minority patients higher rates whites reduction disparity masked potential dangers black latino youth continuing adherence prescribed antidepressant use face black box warning best next steps address barriers great quality care equitable system access care leech et als work suggests work necessary front line staff ensure equitable access care particularly important early childhood years lloren et al offer potential metric assess quality care disparities hospitals examining withinhospital betweenhospital metrics finally cook et al suggest may opportunity policies area individual outreach patientcaregiver education rather relying strictly provider communication together manuscripts suggest potential points intervention future health equity work put patients first need understand patient experience satisfaction care next three articles explore equity issues area keen eye innovation data analysis interpretation elliott et al 2019 approached health equity exploring withingroup variation language preference relates inpatient care quality satisfaction using data 20142015 hospital consumer assessment healthcare providers systems hcahps survey found nonenglishpreferring patients reported poorer scores inpatient care experience englishpreferring counterparts measures considered including communication doctors communication nurses responsiveness hospital staff communication medication discharge information care coordination study found significant difference scores care coordination nonenglishpreferring patients often attended hospitals lower overall average patient experience scores research shown place matters comes health elliott et al 2019 responded place health literature considering patient experience across geographic regions using data 20152016 medicare consumer assessment healthcare providers systems mcahps survey 2010 census data authors attempted disentangle poverty vs racial segregation relationship health disparities found counties higherthanaverage patient experience scores also home reduced blackwhite disparities patient experience scores racial makeup county mattered well higher levels segregation associated overall level health care access poverty segregation significantly associated getting care quickly unexpected given literature poverty health using data 20142015 nationwide adult medicaid consumer assessment healthcare providers systems cahps survey martino et al 2019 explored differences patient experience across racial ethnic groups geographic areas four composite measures focus manuscript getting needed care getting care quickly doctor communication customer service authors found compared whites american indians alaska natives aian asians pacific islanders api beneficiaries reported worse experiences blacks reported better experiences additionally found beneficiaries large urban areas reported worse experiences others particularly regard access care considerable segment health equity literature focuses betweengroup variationbut learn also consider withingroup variation understanding distinctions health equity issues approach solutions enhanced elliotts studies reinforce need training cultural competency linguistically appropriate services linguistic support health literacy well eye toward geographic variation patient experience health equity issues extend far beyond walls health care facilitieswe also need look outside health care system order better understand patient populations barriers care may relevant health equity access quality care often thought rural vs urban issue martino et als work demonstrates focus access urban areas may fruitful investment well authors pose three theories contribute result first transportation urban areas may insufficient eliminate barriers care second lowerperforming health care providers accessible third utilization management techniques disproportionately disadvantage medicaid beneficiaries improved scores among blacks study may point issues raised leech irbyshasanmi mitchells study exploring role language preference finally research shown united states population health driven large part access care whether health care coverage comes private public providers important consider impact coverage health wellbeing final two manuscripts explore issues first using data 20082014 medical expenditure panel survey winkelman segel davis 2019 examined costs utilization access health across racial ethnic groups determine differences medicaid enrollment made found compared respondents remained uninsured gained medicaid reported increases total health care costs significant decrease outofpocket costs also saw evidence increase prescription drug use reports usual source care decrease foregone care significant improvements severe psychological distress lastly examined data health equity lens comparing outcomes race ethnicity revealed significant differences race ethnicity prescription drug costs total prescription drug fills marton colleagues 2019 using data american community survey acs examined coverage disparities across income race ethnicity marital status age gender enough precision consider local state geographic variation results showed predicted impact full aca implementation including medicaid expansion probability coverage high 226 percentage points predicted impact coverage aca implemented without medicaid expansion high 95 percentage points overall impact greater lowest income minority populations younger populations women rural communities cms omh know cannot achieve health equity alonebut together learn studies gain better understanding health disparities us move forward work eliminate disparities