Measuring Disparities in Patient Safety Ernest Moy

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 Quality Report Disparities Report Snapshot & trends in quality of health care in America Snapshot & trends in disparities in health care Effectiveness, safety, timeliness, patient centeredness, care coordination, efficiency, health system infrastructure, access Differences across race, ethnicity, & socioeconomic status Variation across states Variation across populations

QRDR Patient Safety Data QIO Surgical Infection Prophylaxis QIO Surgical Infection Prophylaxis – ‘Voluntary’ reporting by hospitals – ~1 million surgical cases per year HCUP SID Disparities Analytic File 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 Medicare Patient Safety Monitoring System – Structured inpatient chart abstraction – Sample from charts requested by CMS = ~25,000 charts per year

QIO: Prophylactic Antibiotics Started All groups improving All groups improving In all years, Hispanics and AI/ANs had lower rates than Whites In all years, Hispanics and AI/ANs had lower rates than Whites 2008 Achievable Benchmark = 96%

QIO: Prophylactic Antibiotics Discontinued All groups improving All groups improving In all years, Hispanics and Asians had lower rates than Whites In all years, Hispanics and Asians had lower rates than Whites 2008 Achievable Benchmark = 95%

HCUP: Postoperative Sepsis, Adults In both years, Blacks and Hispanics had higher rates than Whites In both years, Blacks and Hispanics had higher rates than Whites

HCUP: Catheter-Related Bloodstream Infection, Adults In both years, Blacks had higher rates than Whites In both years, Blacks had higher rates than Whites 2008 Achievable Benchmark = 1.5

HCUP: Catheter-Related BSI, Neonates, 2009 Among both neonates with private health insurance and with Medicaid, Blacks and Hispanics had higher rates than Whites Among both neonates with private health insurance and with Medicaid, Blacks and Hispanics had higher rates than Whites 2008 Achievable Benchmark = 17

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. In most States, Blacks and Hispanics had higher rates than Whites, but this is often not statistically significant at the State level Achievable Benchmark = 8.7

MPSMS: Composites, Blacks had higher rates than Whites of Blacks had higher rates than Whites of – HAIs (adjusted OR = 1.34) – ADEs (adjusted OR = 1.29)

MPSMS: Composites, Patients in hospitals with higher % of patients who are black had higher rates of HAIs and ADEs Patients in hospitals with higher % of patients who are black had higher rates of HAIs and ADEs

Conclusions Disparities in patient safety are common, especially related to Disparities in patient safety are common, especially related to – Healthcare-associated infections – Adverse drug events. Process measures improve; outcomes and disparities often do not. Process measures improve; outcomes and disparities often do not. Disparities are attributable to variation Disparities are attributable to variation – Within and between payer groups – Within and between States – Within and between hospitals.