Measuring Disparities in Patient Safety

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Slide 1

Measuring Disparities in Patient Safety

Ernest Moy
Ernest.moy@ahrq.hhs.gov
301-427-1329
https://www.ahrq.gov/qual/qrdr11.htm
http://statesnapshots.ahrq.gov

Images: The covers of the 2011 National Healthcare Quality and Disparities reports are shown.

Slide 2

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.

Slide 3

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.

Slide 4

QIO: Prophylactic Antibiotics Started

• All groups improving.
• In all years, Hispanics and AI/ANs had lower rates than Whites.

Image: A line graph shows improvement from ~75-80% to ~95% for all groups (White, Black, Hispanic, AI/AN, and Asian) between 2005 and 2009. 2008 Achievable Benchmark = 96%.

Slide 5

QIO: Prophylactic Antibiotics Discontinued

• All groups improving.
• In all years, Hispanics and Asians had lower rates than Whites.

Image: A line graph shows improvement from ~65-75% to 91-94% for all groups (White, Black, Hispanic, AI/AN, and Asian) between 2005 and 2009. 2008 Achievable Benchmark = 95%.

Slide 6

HCUP: Postoperative Sepsis, Adults

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

Image: A line graph shows sepsis rates for all groups (White, Black, Hispanic, and Asian) between 15 and 20 for 2008 and 2009. 2008 Achievable Benchmark = 8.7.

Slide 7

HCUP: Catheter-Related Bloodstream Infection, Adults

• In both years, Blacks had higher rates than Whites.

Image: A line graph shows blood infection rates for all groups (White, Black, Hispanic, and Asian) for 2008 and 2009. The rates for Whites, Hispanics, and Asians are between 2 and 3; the rate for Blacks is around 4 and rose between 2008 and 2009. 2008 Achievable Benchmark = 1.5.

Slide 8

HCUP: Catheter-Related BSI, Neonates, 2009

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

Image: A bar graph compares infection rates for White, Black, and Hispanic neonates under Private Insurance and Medicaid:

Private Insurance:

• White - 48.
• Black - 55.
• Hispanic - 69.

Medicaid:

• White - 55.
• Black - 64.
• Hispanic - 70.

2008 Achievable Benchmark = 17.

Slide 9

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.

Image: A bar graph compares sepsis rates for Whites, Blacks, and Hispanics for unspecified States. Most rates are below 25, but some "Hispanic" bars show rates in the 30s and one "Black" bar shows a rate of 70. 2008 Achievable Benchmark = 8.7.

Slide 10

MPSMS: Composites, 2002-2007

• Blacks had higher rates than Whites of:
  • HAIs (adjusted OR = 1.34).
  • ADEs (adjusted OR = 1.29).

Image: A bar graph compares rates for Whites and Blacks for Healthcare-Associated Infections and Adverse Drug Events:

Healthcare-Associated Infections:

• White – 1.8.
• Black – 2.6.

Adverse Drug Events:

• White – 8.3.
• Black – 11.2.

Slide 11

MPSMS: Composites, 2002-2007

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

Image: A bar graph compares rates for "Low" (0.3%) "Middle" (4.8%), and "High" (30.9%) numbers of Black patients with Healthcare-Associated Infections and Adverse Drug Events:

Healthcare-Associated Infections:

• Low – 1.7.
• Middle – 1.9.
• Black – 2.

Adverse Drug Events:

• Low – 8.2.
• Middle – 8.4.
• Black – 9.1.

Slide 12

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.