Measuring Equitable Care to Support Quality Improvement

Transcription

1 Measuring Equitable Care to Support Quality Improvement Berny Gould RN, MNA Sr. Director, Quality, Hospital Oversight, and Equitable Care Prepared by: Sharon Takeda Platt, PhD Center for Healthcare Analytics Hospitals, Quality and Care Delivery Excellence 28 th Annual National Forum on Quality Improvement in Health Care December 5, 2016 Health Disparities Vision Statement Adopted by the Kaiser Permanente Partnership Group and endorsed by the Kaiser Foundation Health Plan/Hospitals Boards of Directors in 2007 Kaiser Permanente will: Be a leader in eliminating disparities in health and health care Provide equitable care to our members Target resources to areas of need in the communities we serve Identify and implement strategies and policies that support equity in health nationwide, including universal coverage Page 2 1

2 Collection of Race and Ethnicity Data Percent of Total Programwide Membership with Race/Ethnicity Data Entered in Kaiser Permanente HealthConnect Combined Race Format Categories Black or African American Hispanic or Latino Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native White Ethnicity 268 granular ethnicities Page 3 How do we estimate race/ethnicity? We use the RAND Corporation s Bayesian Improved Surname & Geocoding (BISG) methodology to estimate race/ethnicity (RE) for members without reported race or ethnicity data in the electronic health record Geocoding infers RE by linking the member s address to the racial/ethnic proportions for census block groups Surname analysis infers RE from surnames, based on the U.S. Census Bureau s national tabulation of more than 150,000 surnames, along with each surname s self-reported RE distribution For each member, an imputed racial/ethnic probability distribution is generated for these categories: Black or African American only 1 Hispanic or Latino 2 White only 1 Asian or Pacific Islander only 1 American Indian or Alaska Native only 1 Multiracial 3 1 Non-Hispanic 2 Regardless of any other racial/ethnic identity 3 Two or more racial/ethnic identities, non-hispanic Page 4 2

3 GEMS Datamart Geographically Enriched Member Sociodemographics Member Demographics Population Demographics (indexed by census block groups & tracts) Members Birth date Sex Marital status Race Ethnicity Primary spoken language Primary written language Need for an interpreter Country of origin Product line Primary medical office building Where Our Members Live Total population Population by age Median age Population by race/ethnicity Households by income level Median household income Population by educational attainment Unemployment rate Estimated proportion of people living at or below x% of the Federal Poverty Level Estimated proportion of adults with health insurance Page 5 Race/Ethnicity of Membership Kaiser Permanente Page 6 3

4 Primary Spoken Language & Need for an Interpreter Kaiser Permanente Spanish is the primary spoken language of 7% of members More than half of those members (58%) need an interpreter Spanish is the primary spoken language of 81% of the 525,000 members who need an interpreter Page 7 Quarterly Equitable Care Reports with 24 HEDIS Measures For the Seven Kaiser Permanente Regions and Programwide Quarterly reports provide trend charts for HEDIS measures stratified by race/ethnicity, age and gender, and tables with rates, denominators, and disparities (expressed as difference in rates and numbers needed to reach the reference group s rate and the HEDIS national 90 th percentile) In various reports, quality measures are stratified by race/ethnicity, product line, medical center, facility, and granular Asian or Pacific Islander ethnicities Prevention and Screening Breast Cancer Screening Cervical Cancer Screening Colorectal Cancer Screening Childhood Immunization Status Immunizations for Adolescents Human Papillomavirus Vaccine for Female Adolescents Behavioral Health Antidepressant Medication Management: Effective Acute Phase Treatment Effective Continuation Phase Treatment Cardiovascular Conditions Persistence of Beta-Blocker Treatment After a Heart Attack Controlling High Blood Pressure Statin Therapy for Patients with Cardiovascular Disease: Received Statin Therapy Statin Adherence 80% Medication Management Annual Monitoring for Patients on Persistent Medications: ACE or ARB Digoxin Diuretics Diabetes Comprehensive Diabetes Care: HbA1c Testing HbA1c < 9.0% HbA1c < 8.0% Retinal Eye Exam Medical Attention for Nephropathy BP < 140/90 Statin Therapy for Patients with Diabetes: Received Statin Therapy Statin Adherence 80% Respiratory Conditions Asthma Medication Ratio Page 8 4

5 Example of a chart from a quarterly equitable care report Page 9 Example of a chart from Hawaii Region s quarterly report Page 10 5

6 How far have we come in reducing disparities? Colorectal Cancer Screening From 2009 to 2016, the colorectal cancer screening rate for Hispanic/Latino members improved 19% (2009 Q4: 65.7%, 2016 Q1: 78.1%) The Hispanic/Latino White disparity in screening rates was reduced from a high of 5.9 points to 2.9 points, a decrease of 50% Kaiser Permanente membership growth is reflected in the growing number of Hispanic/Latino members in the colorectal cancer screening denominator, from 308,000 in 2009 to 422,000 in 2016 (an increase of more than 35%) Controlling High Blood Pressure 1 From 2009 to 2016, the percentage of Black/African American members with controlled hypertension improved 20% (2009 Q4: 70.2%, 2016 Q1: 84.0%) The Black/African American White disparity in control rates was reduced from a high of 8.6 points to 3.4 points, a decrease of 60% 1 From Q3, the BP threshold for adequate control is 140/90; starting with 2014 Q4, the threshold is based on age and diagnosis: BP < 140/90 for members age and members age with a diagnosis of diabetes; BP < 150/90 for members age without a diagnosis of diabetes Page 11 Page 12 6

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