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State Documentation of Racial and Ethnic Health Disparities to Inform Strategic Action, July 2011

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Federal and National Activity Setting the Stage for State Action

• Understanding the problem:
• AHRQ National Healthcare Quality Report & National Healthcare Disparities Report
• CDC Health Disparities and Inequalities Report - United States, 2011
• Offering guidance on what to do:
• Institute of Medicine (IOM):
• Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (2003)
• Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement (2009)
• Office of Minority Health: National Partnership for Action to End Health Disparities' National Plan for Action
• Federal Health Reform (Patient Protection & Affordable Care)
• Directs states to collect information and data regarding disparities
• Permanently reauthorizes the Indian Health Care Improvement Act
• Includes provisions about workforce diversity, cultural competence

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Why States Need to Play a Role in Reducing Disparities

• State responsibility for enhanced data collection under federal health reform
• Provider incentives for data collection under Meaningful Use
• Growing interest in costs of disparities and improving health system efficiency
• Lean budgets may require states to target areas or populations with greatest disparities
• Medicaid programs have incentive to act given disproportionate representation by minorities

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Overview of Findings from New HCUP Report:

State Documentation of Racial and Ethnic Health Disparities to Inform Strategic Action

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State Roles in Reducing Disparities

• Purchase healthcare services
• Define benefits
• Regulate professionals and facilities
• Collect and report data
• Set standards and measure performance
• Inform consumers
• Educate and train healthcare professionals
• Convene stakeholders

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Report Background & Methodology

• Builds on 2010 HCUP Report:
• State Uses of Hospital Discharge Databases to Reduce Racial and Ethnic Disparities.
• Environmental scan for documents:
• Published in 2007 or later;
• Data-driven;
• Addressing healthcare disparities; and
• With evidence of state use of the information

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Methodology (cont'd)

• Email follow up to confirm scan findings
• Identified 8 leading states to feature: CO, CT, GA, MD, NJ, NM, RI, UT
• Phone conversations
• "Noteworthy" activity cited in 8 additional states
• 50-state scan findings will soon be available on HCUP website

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Highlighted States in New HCUP Report

Map of United States features 8 states in the HCUP report - CT, CO, GA, MD, NJ, NM, RI, and UT. Eight noteworthy states are AZ, CA, MA, MI, MN, NC, OH, and VA are those that were referenced by leading states as inspiring their work or they have unique practices or documents that are noted in the report but not described in as much detail as the featured states.

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Featured States' Documents

State	Document Title(s)
CO	2008-2010 Office of Health Disparities Strategic Plan Racial and Ethnic Health Disparities in Colorado 2009 Colorado Health Disparities Strategic Plan 2008: Interagency Health Disparities Leadership Council
CT	The 2009 Connecticut Health Disparities Report
GA	Health Disparities Report 2008: A County-Level Look at Health Outcomes for Minorities in Georgia
MD	Maryland Chartbook of Minority Health and Minority Health Disparities Data Maryland Plan to Eliminate Minority Health Disparities Plan of Action 2010-2014
NJ	Strategic Plans to Eliminate Health Disparities in New Jersey March 2007, December 2007 Update, and Update and Addendum
NM	Racial and Ethnic Health Disparities Report Card
RI	Minority Health Plan for Action Heart Disease and Stroke Prevention Rhode Island State Plan 2009 Reducing the Burden of Asthma in Rhode Island: Asthma State Plan, 2009-2014
UT	Health Status by Race and Ethnicity: 2010 Action Plan to Eliminate Racial/Ethnic Health Disparities in the State of Utah

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General Findings

• 3 types of state documents:
• Data report
• Action plan
• Combination of both
• 2 states use a report card (GA, NM)
• BRFSS and vital records used by all states
• 5 states use hospital discharge data (CT, GA, MD, NJ, RI)
• 4 states provide county-level data (CO, GA, NJ, MD)
• Relative rates are more common than absolute rates

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General Findings (cont'd)

• Only slight variation in races/ethnicities included
• Measures:
• Condition or risk factor prevalence/incidence (all)
• Access/utilization (all)
• Mortality (all)
• Socioeconomic Status (CO, CT, GA, RI, UT)
• Cost (CT, GA, MD)
• Common topics: heart disease/stroke, HIV/STDs, diabetes, cancer, and maternal, prenatal and child healthcare

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Use and Impact of State Documents

• Incorporate into national or federal grant applications
• Conduct outreach to stakeholders
• Inform public health projects and the provision of grants to address disparities described in reports
• Publish or plan new documents
• Strengthen internal state government processes

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Lessons from Featured States

• States use data documents to identify and address disparities.
• Data sources, units of analysis, and rates vary, yet reports share many commonalities.
• Additional data on disparities are necessary.
• States have different organizational approaches to documenting and addressing disparities.

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Lessons (cont'd)

• Partnerships are critical.
• State reports include a focus on making data actionable.
• States need additional funding sources in order to focus on reducing disparities.
• State Offices of Minority Health are important leaders, but cannot act alone to achieve health equity.

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RESOURCES FOR MORE INFORMATION

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Related HCUP Reports

• State Documentation of Racial and Ethnic Health Disparities to Inform Strategic Action, Report (2011)
• Assessing the Costs of Racial and Ethnic Health Disparities: State Experience, Issue Brief (2011)
• State Uses of Hospital Discharge Databases to Reduce Racial and Ethnic Disparities, Report (2010)
• All available at
• http//www.hcup-us.ahrq.gov/reports/r_e_disparities.jsp

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Other AHRQ Resources

• 2010 National Healthcare Disparities Report
• http://archive.ahrq.gov/research/findings/nhqrdr/nhdr10/
• Identifies gaps where some populations receive worse care than others and tracks changes in gaps over time
• AHRQ State Snapshots
• http://statesnapshots.ahrq.gov/snaps10/index.jsp?menuId=1&state=
• Focus on Disparities section
• Demographic data on state population
• NEW SECTION: State Resources for Addressing Disparities in Health Care Quality http://statesnapshots.ahrq.gov/snaps10/SnapsController?menuId=99&action=resources&state=

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Additional Resources

• Institute of Medicine:
• Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (2003) (http://www.nap.edu/openbook.php?isbn=030908265X)
• Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement (2009) (http://www.nap.edu/catalog/12696.html)
• CDC Health Disparities and Inequalities Report, United States, 2011
• http://www.cdc.gov/minorityhealth/CHDIReport.html

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Health Care Reform

• U.S. DHHS. "Health Disparities and the Affordable Care Act" http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=10
• D.P.Andrulis et al., Patient Protection and Affordable Care Act of 2010: Advancing Health Equity for Racially and Ethnically Diverse Populations. (Washington, DC: Joint Center for Political and Economic Studies, July 2010) http://jointcenter.org/sites/default/files/Patient%20Protection%20and%20Affordable%20Care%20Act.pdf