Reducing Health Disparities Among Hispanic Elders: From Report to Support

Slide Presentation from the AHRQ 2008 Annual Conference

On September 10, 2008, Ernest Moy, M.D., made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (3.6 MB).

Slide 1

Reducing Health Disparities Among Hispanic Elders: From Report to Support

Ernest Moy
Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services
Ernest.Moy@ahrq.hhs.gov

Slide 2

National Reports ≠ Better Health Care

Screen shot of the 2007 National Disparities Health Report (NHDR) with an arrow stating "How?" pointing to photos of health care providers giving care.

Slide 3

From NHDR to Action

Slide depicts an arrow pointing from left to right; inside are the words:

• Know—Plan—Do—Better Health Care.
• See it happen—Help it happen—Make it happen—Better Health Care.
• Screening—Diagnosis—Treatment—Better Health Care.
• Nation—State—Community—Better Health Care.
• AHRQ—Learning Network—Community Teams—Better Health Care.
• National Report—Community Chartbooks—Real Data—Better Health Care.

Slide 4

Steps from NHDR to Action

• National Healthcare Disparities Reports:
  1. Need action?
  2. Whom to focus on?
• Learning Network Planning Team:
  3. Where to focus?
• Learning Network Community Teams:
  4. What should each team focus on?
  5. Where in the community should each team focus?

Slide 5

Need action? Disparities are prevalent

Bar graph shows the following approximate percentages by ethnic group:

• Black vs. White: Better 18%, Same 40%, Worse 42%.
• Asian vs. White: Better 38%, Same 38%, Worse 24%.
• American Indians/Alaska Natives (AI/AN) vs. White: Better 17%, Same 60%, Worse 23%.
• Hispanic vs. Non-Hispanic White: Better 10%, Same 30%, Worse 60%.

Slide 6

Need action? Disparities are not improving

Bar graph shows the following approximate percentages by ethnic group:

• Black vs. White: Improving 36%, Same 32%, Worsening 32%.
• Asian vs. White: Improving 40%, Same 34%, Worsening 26%.
• AI/AN vs. White: Improving 40%, Same 34%, Worsening 26%.
• Hispanic vs. Non-Hispanic White: Improving 40%, Same 30%, Worsening 30%.

Slide 7

Whom to focus on? Hispanic disparities getting worse

• Adult vaccination.
• Asthma.
• Diabetes.
• Mental health care.
• Tuberculosis.
• Timeliness of care.
• Patient-provider communication.

Slide 8

Where to focus? Disparities vary across States

Bar graph shows performance by states (unnamed), ranging from about -14 in the worst up to nearly 30 in the state, with the average about 15.

Slide 9

Where to focus? Much variation within States

Maps of Texas and California depict diabetes long-term complications rate (Prevention Quality Indicators [PQI] 3) across each state, with risk-adjusted rates ranging from 0.00 up to 109.19 per 100,000 population in Texas and up to 80.33 in California.

Slide 10

New York, NY (metropolitan statistical area [MSA]) Disparities Between Hispanic and White Medicare Beneficiaries for Receipt of Cancer Screenings and Secondary Prevention of Diabetes Complications

Bar graphs depict the following percentages:

• Prostate-specific antigen (PSA) screening:
  • White Low socioeconomic status (SES): 44%.
  • Hispanic Low SES: 23%.
  • White High SES: 47%.
  • Hispanic High SES.28%
• Any Colorectal Cancer Screening:
  • White Low SES: 14%.
  • Hispanic Low SES: 8%.
  • White High SES: 18%.
  • Hispanic High SES: 11%.
• Eye Exam:
  • White Low SES: 65%.
  • Hispanic Low SES: 58%.
  • White High SES: 65%.
  • Hispanic High SES: 56%.
• Physiologic Measures:
  • White Low SES: 86%.
  • Hispanic Low SES: 65%.
  • White High SES: 90%.
  • Hispanic High SES: 76%.

Slide 11

Diabetes Risk Factors and Diabetes Services by Race: Chicago vs. U.S.

• Chicago MSA Diabetes Risk Factors:
  • Obesity: White 22%, Hispanic 28%.
  • No Exercise: White 17%, Hispanic 32%.
  • Diabetes: White 5%, Hispanic 8%.
• Chicago MSA Diabetes Services:
  • No Physio Test: White 13%, Hispanic 21%.
  • No Eye Exam: White 38%, Hispanic 49%.
  • No Self-Care: White 47%, Hispanic 49%.
• U.S. Diabetes Risk Factors:
  • Obesity: White 24%, Hispanic 27%.
  • No Exercise: White 21%, Hispanic 35%.
  • Diabetes: White 7%, Hispanic 8%.
• U.S. Diabetes Services:
  • No Physio Test: White 11%, Hispanic 16%.
  • No Eye Exam: White 35%, Hispanic 42%.
  • No Self-Care: White 46%, Hispanic 51%.

Slide 12

What to focus on? Houston may focus on diabetic elders with no eye exam

• Miami: White 24%, Hispanic 36%.
• Lower Rio Grande Valley (LRGV): White 40%, Hispanic 37%.
• San Diego (SD): White 33%, Hispanic 40%.
• Los Angeles (LA): White 35%, Hispanic 41%.
• New York (NY): White 35%, Hispanic 41%.
• San Antonio (SA): White 26%, Hispanic 43%.
• Chicago: White 37%, Hispanic 50%.
• Houston: White 37%, Hispanic 54%.
• Rest of United States: White 36%, Hispanic 47%.

Slide 13

Where to focus? Houston may focus on specific census tracts

Map depicts Houston census tracts with varying frequencies of eye exams.

Slide 14

Disparities in Diabetes Risk Factors and Diabetes Services: City Map

Map of United States shows cities; legend beneath says "Pick from City Map" and links under that say "Go to State Map," "Go to Tables," and "Methods."

Slide 15

Conclusions

• National Reports ≠ Better Health Care.
• Reports can support planning for action.
  • Make case for action.
  • Identify populations in need.
• Report methods can support targeting action.
  • Which communities.
  • Which services.
  • What specific part of a community.
• Community teams do the improvement.