Giving Disparities a Voice

Today's post was written by our excellent summer intern, Asantewaa Poku, who is headed off to graduate school at The Mailman School of Public Health at Columbia University.


The healthcare reform debate has brought to light a number of critical issues: driving down costs, covering the uninsured, creating competition, and improving quality. The crucial issue of healthcare disparities is getting lost in the haze of the debate.

The past and present unequal treatment of many vulnerable populations has translated into health disparities for groups lost in the current system. . In fact, these Americans might argue that perhaps what the system lacks most is a commitment to equality.

The Agency for Healthcare Research and Quality has defined disparities as those differences in experiences between one population group and another that manifest themselves in a variety of ways including poor communication between patients and caregivers, provider biases, poor health literacy, and most importantly poor health outcomes .

According to AHRQ, among non-elderly adults 17% of Hispanic and 16% percent of African Americans report they are only in fair or poor health compared to 10% of white Americans. A study by the National Center for Health Statistics found that African-American women have the highest death rates from heart disease, breast and lung cancer, stroke and pregnancy among women of all racial and ethnic backgrounds. The National Business Group on Health found that rates of heart disease mortality have decreased the most for whites and the least for African Americans, for whom mortality rates for heart disease are 50% higher than their white counterparts. Cardiovascular disease is the leading cause of death in the United States and has a direct cost of $296 billion. Real healthcare reform must address the human and financial costs of these disparities head on.

How do we give disparities a voice?

It is easy for stakeholders to lose sight of the issues created by disparities. Real healthcare reform must be patient-centered. By giving each patient a voice in their care we assure better healthcare for all.

In Unequal Treatment, the Institute of Medicine’s disparities report, the importance of patient-centered reform is stressed. Both patients and providers need to be educated and change ingrained behaviors. Patients must learn to take a more active role in clinical decision making, take responsibility for their treatment plan and self care. Providers must learn to become more aware of their unconscious biases and more understanding of the cultural diversity of their patients. By giving both participants tools that foster better communication and overall care we can begin to close the gap in healthcare outcomes for all populations.

By hardwiring the patient’s voice into the clinical suite, we assure that every patient is heard.

Increasing the Credibility of Quality Measurement

When we talk quality in healthcare, what are we really talking about? We’re talking about the quality of care received by the patient from their clinician. Not just the procedures done, the tests ordered or the drugs prescribed, but the quality of the information given to the patient and the clinician’s ability to engage and empower the patient to utilize that information to take better care of themselves.

Everyone should read Kristen Gerencher’s article in the WSJ online, Imagine Doctors, Patients Talking.

http://online.wsj.com/article/SB124916985105199263.html?mod=djemHL

She makes a number of good points, not the least of which is that when a doctor and patient build a therapeutic partnership based on “mutual honesty and transparency” the patient will often choose less expensive care options. This is because they trust the doctor to tell them, honestly, if they don’t really need the most expensive test or procedure. This trust will also facilitate the patient feeling accountable for complying with the doctor’s instructions on taking care of themselves. They want the doctor to trust them, too.

As a former state and federal prosecutor, credibility is an issue I’ve examined, and cross- examined, up close and personal. If we really want credible measurement of healthcare quality and efficiency we need to move beyond self reported clinical data. We need third party collected, patient reported data from as close in time to the clinical interaction as possible.

In a 2008 National Business group on Health report, Transparency: Large Employers’ Perspective, the NBGOH indicates that in a survey of 120 employers, 56% of whom had more than 20,000 employees, one of the key findings was that employers should “continue efforts to build credibility of quality and efficiency measurement”. Indeed they should.

How can this credibility be hard wired into the quality measurement system?

By having a third party collect it, directly from the patient, immediately after the clinical interaction. By collecting the data through easy to use and understand health information technology so that the patient is empowered to participate directly in measuring and improving the quality of their care. By utilizing technology to build “mutual honesty and transparency”, thereby strengthening the therapeutic partnership between the patient and caregiver.

If we want credibility, if we want patients to trust their caregivers, if we want the billions of dollars of funds coming into healthcare for HIT to lead to better outcomes – if we want to really understand what is happening when a patient sees their caregiver, so that we can continually improve the quality of that interaction– all we need to do is give the patient a voice.