U.S. study outlines efforts to boost equal care

The AMA Foundation aids an effort to reduce diabetes care disparities.

By Andis Robeznieks — Posted March 14, 2005

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The gap between the best possible health care and actual care remains large, and disparities in health care delivered to racial and ethnic minorities remain "pervasive," new government studies conclude.

But improvements are possible, and in some cases they are already under way, said two reports that the U.S. Agency for Healthcare Research and Quality published in February.

The National Healthcare Quality Report examined the effectiveness, safety, timeliness and "patient centeredness" of treatment that people receive for cancer, diabetes, heart disease and six other areas. The National Healthcare Disparities Report then compared how these quality measures stacked up among racial, ethnic and economic minority groups.

Both reports contained a mixture of good and bad news but maintained an optimistic tone by highlighting proven ways that physicians and others in health care have closed quality and disparity gaps.

For example, diabetes is one area being addressed. The quality report noted that there was a 34% decrease in the hospital admission rate for uncontrolled diabetes between 1994 and 2001. The disparities report, however, noted that blacks, Hispanics and American Indians were more likely to die from diabetes and its complications than whites in 2001. It also noted that these groups were less likely to receive the five recommended tests and services for diabetes: A1c and lipid management, eye and foot exams and influenza immunization.

In Michigan, the American Medical Association Foundation's Train-the-Trainer program on health literacy was part of a collaborative effort that sought to eliminate disparities by improving outreach to people who have the disease. Members of MPRO, Michigan's quality improvement organization, attended the educational program in October 2003 that was funded with grants from the AMA Foundation, Michigan State Medical Society and others.

The end result was that the rate of lipid profile testing among diabetic African-American senior citizens in Wayne County increased, narrowing by 60.1% the quality gap between blacks and whites getting this test.

"We educated our colleagues about health literacy and pointed out that, if patients don't get educated, you cannot improve their health care," said AMA Foundation Board President Krishna Sawhney, MD. "Our colleagues took this to heart, MPRO helped, and the result is quite obvious."

Dr. Sawhney, a vascular surgeon for the Detroit area's Henry Ford Health System, gave credit to local political leaders and health care organizations for the project's success.

"Good things are possible if there is teamwork," Dr. Sawhney said. "The AMA and AMA Foundation can only deliver the message, and that message has to be taken up by our colleagues."

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Quality improvements

The 2004 National Healthcare Quality Report published by the U.S. Agency for Healthcare Research and Quality highlights the good and bad news on the quality front. Here are some of the findings:

Good news

  • Colorectal cancer death rates have fallen by an average 2% a year since 1984.
  • The percentage of nursing home patients reporting moderate to severe pain saw a relative decrease of 37% between 2002 and 2003.

Bad news

  • One-third of diabetic patients did not receive the annual foot exam that should be part of their care.
  • More than 75% of adults with high cholesterol are not taking any medication to treat their condition.

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Quality care

After studying 38 quality measures and 31 access measures, the 2004 National Healthcare Disparities Report concluded that there is a disparity in the preventive, acute and chronic care that racial, ethnic and economic minorities receive. But the report also highlighted some improvements in these areas.

Room for improvement

  • African-Americans received lower quality care in about 66% of the areas measured. They had less access to care for about 40% of the access measures.
  • Hispanics received lower quality care than non-Hispanic whites in half the quality measures. They had less access to care for about 90% of the access measures.
  • Poor people received lower quality of care for about 60% of quality measures. They had less access to care that those with higher incomes for about 80% of the measures.

Improvements under way

  • The nation's 3,600 federally funded health centers helped reduce disparities for 13.2 million people in vulnerable populations.
  • "No significant differences" were found in measles-mumps-rubella immunization rates among black and white children in 2002.

Source: U.S. Agency for Healthcare Research and Quality

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External links

"2004 National Healthcare Quality Report," U.S. Agency for Healthcare Research and Quality (link)

"2004 National Healthcare Disparities Report," U.S. Agency for Healthcare Research and Quality (link)

MPRO, Michigan health care quality improvement organization (link)

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