Achieving Health Equity Closing The Gaps InHealth Care Di.docx
An Introduction to CVD Racial Disparities
1. An Introduction to Racial Disparities in the
Treatment of Cardiovascular Disease
Polishing our Lens of Research and Care
Dr. Anthony Shackelford DHA, CCP, CCT
Assistant Professor
Cardiovascular Perfusion Program
Medical University of South Carolina
2. Purpose
To help increase awareness within the
perfusion community of racial disparities in
the treatment of cardiovascular disease. by
providing:
a general overview of what health care
disparities are and are not
the processes and programs in place to reduce
and eliminate health care disparities
examples of evidence specific to the treatment
of heart disease in the context of racial
disparities
2
3. What are going to cover?
General overview of what health care
disparities are and are not
The processes and programs in place to
reduce and eliminate health care disparities
Examples of evidence specific to the
treatment of heart disease in the context of
racial disparities
Applicability to Perfusion
3
4. Disclaimer
I have no contractual or financial
affiliations with any of the
manufactures of any of the devices
mentioned in this presentation
4
6. Death Rate due to Heart Disease by
Race/Ethnicity, 2005
329.8
Deaths per 100,000
population:
262.2
228.3
192.4
173.2 170.3
141.1
129.1
115.9
91.9
White, Hispanic African-
Asian andAmerican White, NoHispanic African-
Asian andAmerican
Non- American Pacific Indian/ n- American Pacific Indian/
Hispanic Islander Alaska Hispanic Islander Alaska
Native Native
Men Women
NOTES: Rates are age-adjusted.
DATA: Centers for Disease Control and Prevention, National Center for Health Statistics, National
Vital Statistics System.
SOURCE: Health US, 2007, Table 36.
7. Starting Point: Health Status
Determined by a variation
of social and behavioral risk
factors among people of:
different race/ethnicity
socioeconomic status (SES)
gender
+/- effect on mortality
Blacks and American Indians >
Whites
Asian and Pacific Islanders <
Whites.
7
8. What are Health Disparities?
Racial or ethnic differences in the quality of
health care that is not due to:
access-related factors
clinical needs
preferences
appropriateness of intervention
8
10. Literature “skim” of Racial
Disparities in the Treatment of
Cardiovascular Disease
10
11. Trends of CVD mortality by race and
ethnicity
Findings: CHD mortality rates of black
men and women have declined
the rate has been slower than white men and
women since the mid 1980’s
11
12. 17,000 patients for differences with respect to
noninvasive procedures and invasive procedures
(e.g. CABG, CC, PTCA)
Findings:
Black men and women < white men and women
to undergo costly cardiovascular procedures
Hispanics < whites to have received CC / PTCA
(Am J Public Health. 2000;90:1128–1134) 12
13. 3,015 patients over a two year period
Statistically significant difference in the utilization rates
comparing Caucasians to African-Americans for CABG
Although not statistically significant, African-Americans
were less likely than Caucasians to receive a cardiac
catheterization and Percutaneous Transluminal Coronary
Angioplasty (PTCA).
No significant disparities for gender for the utilization of
invasive treatments for cardiovascular disease.
Journal of Cultural Diversity, 11(3), 80-87.
13
14. Found that DES use was influenced by demographic,
socioeconomic and hospital characteristics.
blacks and low-income groups were significantly less likely to receive a
DES than their counterparts and differences according to facility
procedural volumes
14
16. Why this is more important
to North Carolina?
% of Population Black 1990 ->2000
United States
248,709,873 -> 281,421,906
29,980,996 (12.1%) ->34,658,190 (12.3%)
North Carolina
6,628,637 -> 8,049,313
1,456,323 (22.0%) -> 1,737,545 (21.6%)
South Carolina
3,486,703 -> 4,012,012
1,039,884 (29.8%) -> 1,185,216 (29.5%) 16
17. Federal Policy Actions Taken to
Eliminate & Reduce Disparities
The Healthcare Research and Quality Act of 1999
Directed Agency for Healthcare Research and Quality
(AHRQ) to develop 2 annual reports:
National Healthcare Quality Report (NHQR)
National Healthcare Disparity Report (NHDR)
Focus: a more comprehensive snapshot of the
performance of our health care system’s strengths
and areas for future improvement
17
18. Congress Charges
Institute of Medicine
Assess the extent of racial and ethnic differences in
healthcare
Evaluate potential sources of racial and ethnic
disparities
including the role of bias, discrimination, and stereotyping
At the individual (provider and patient), institutional, and
health system levels **
Provide recommendations regarding interventions
to eliminate healthcare disparities.
18
20. Sources of Disparities in Healthcare
Complex
Rooted in historic and
contemporary
inequities
Involve many
participants at several
levels
health systems
processes
health care professionals
patients
20
21. IOM’s Unequal Treatment
www.nap.edu
Recommendations
Increase awareness of existence of disparities
Address systems of care
Support race/ethnicity data collection, quality improvement, evidence-
based guidelines, multidisciplinary teams, community outreach
Improve workforce diversity
Facilitate interpretation services
Provider education
Health Disparities, Cultural Competence, Clinical Decisionmaking
Patient education (navigation, activation)
Research
Promising strategies, Barriers to eliminating disparities
22. Goal: Control the System
1. How care is delivered with
respect to the varying patient
demographics.
2. At minimum our healthcare
system and its processes
should not independently
contribute to lesser/negative
outcomes in care.
22
23. So how are we doing?
Results form the 2011
Health care quality and access are suboptimal, especially for minority and
low-income groups.
Quality is improving; access and disparities are not improving.
Progress is uneven with respect to eight national priorities:
Two are improving in quality:
(1) Palliative and End-of-Life Care and (2) Patient and FamilyEngagement.
Three are lagging: (3) Population Health, (4) Safety, and (5) Access.
Three require more data to assess:
(6) Care Coordination,
(7) Overuse, and
(8) Health System Infrastructure
All eight priority areas showed disparities related to race, ethnicity, and
socioeconomic status.
23
24. Federal Efforts to Address
Health Disparities
Federal Office of Minority Health
Efforts within HHS
Department of Health and Human Services (DHHS)
Interagency Working Group on Health Disparities
Health Disparities Collaboratives
Healthy People 2020
Data Collection
Legislation
Reimbursement rates to providers
Language access laws
Title VI of the Civil Rights Act of 1964
Medical malpractice
25. Potential Policy Levers for
Eliminating Health Disparities
Coverage
Piecemeal efforts vs. comprehensive efforts
Fragmentation of the health care system
Language access (who should pay?)
Reimbursement rates and other incentives
Provider training for cultural competence
Social policies (education, job training,
housing)
Health information technology
26. Examples of System-Level
Efforts to Eliminate Disparities
Insurance Companies
National Health Plan Collaborative (NHPC)
Pay-for-Performance (P4P)
Disease registries
Massachusetts General Hospital –
Disparities Solutions Center
Johns Hopkins Center for Health
Disparities
27. We are including the
Core Measures for Heart
Attack, Heart Failure and
Pneumonia.
28. Where Does Perfusion Fit In?
Provider education:
Increase awareness of existence of disparities
Health Disparities, Cultural Competence, Clinical Decision-
making
Improve workforce diversity
Support race/ethnicity data collection,
quality improvement,
evidence-based guidelines,
multidisciplinary teams
28
29. Take Home Messages
1. Disparities exist 5. A myriad of efforts
2. Regardless of how are underway to
they fair in the address disparities.
aggregate, all racial
groups have 6. Overall, we still have
problems. a long way to go to
3. Racial groups are eliminate
not monolithic. disparities.
4. Many factors aside
from race impact
health and health
care.
However one variation in the health care system that can be controlled and improved upon is how care is delivered with respect to the varying patient demographics. The minimum performance level of our healthcare system and its processes should be that the system does not independently contribute to lesser/negative outcomes in care.