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From page 215... ... 7 Data Collection and Monitoring The preceding chapters illustrate the complexity and variety of factors -- including healthcare financing arrangements, institutional and organizational characteristics of healthcare settings, aspects of the clinical encounter, and the attitudes, perceptions, and beliefs of healthcare providers and their patients -- that influence healthcare disparities. The complexity of these factors, coupled with the fact that disparities in care are not always apparent to patients or providers in clinical encounters, increases the need for data to better understand the extent of disparities and the circumstances under which disparities are likely to occur. Read the entire page →
From page 216... ... 216 UNEQUAL TREATMENT and monitoring therefore provides critically needed information for civil rights enforcement. Further, collecting and analyzing patterns of care by patient race, ethnicity, and other demographic data can help health plans to monitor plan performance. Read the entire page →
From page 217... ... 217 DATA COLLECTION AND MONITORING OBSTACLES TO RACIAL/ETHNIC DATA COLLECTION The need for data on patients' race and ethnicity and quality of care must be balanced against other significant considerations. Foremost, patient privacy must be protected. Read the entire page →
From page 218... ... 218 UNEQUAL TREATMENT ernment should collect any information about race or ethnicity. Ward Connerly, for example, the California businessman who led efforts to repeal affirmative action in that state, is spearheading a ballot initiative to prevent the state from collecting any information about race or ethnicity, except for a few limited circumstances (Jordan, 2001) Read the entire page →
From page 219... ... 219 DATA COLLECTION AND MONITORING proportion of individuals define themselves using two or more racial and ethnic categories, making simple classification difficult. Finally, efforts to address disparities in care must acknowledge the significant heterogeneity within each of the federally defined racial and ethnic groups (whites, African Americans, Native Americans, Asian Americans, Pacific Islanders, and Hispanics) Read the entire page →
From page 220... ... 220 UNEQUAL TREATMENT agency policies, practices, and data collection vehicles related to race, ethnicity, and primary language in healthcare settings. This analysis included an assessment of the extent to which federal policies mandate or encourage collection and reporting of race, ethnicity, and primary language data and an assessment of how current law is understood, interpreted, and implemented by federal officials. Read the entire page →
From page 221... ... 221 DATA COLLECTION AND MONITORING SHIRE and NHeLP draw four principle conclusions regarding the federal role in racial, ethnic, and primary language data collection. First, the collection of such data is legal and authorized under Title VI of the Civil Rights Act of 1964. Read the entire page →
From page 222... ... 222 UNEQUAL TREATMENT consensus, as data requirements and methods for collection and reporting vary across federal agencies, and no single HHS blueprint exists to provide a framework and rationale for the department's activities. Further, no department-wide mandate exists for racial, ethnic and primary language data collection and reporting, leaving only a patchwork of efforts across agencies to promote data collection and reporting (Perot and Youdelman, 2001) Read the entire page →
From page 223... ... 223 DATA COLLECTION AND MONITORING extracted from the Medicare Enrollee Database, which is based on Social Security Administration (SSA) information. Read the entire page →
From page 224... ... 224 UNEQUAL TREATMENT series of federal surveys of medical care costs, was initiated by the AHRQ in 1996 for the purpose of assessing the types, frequency of use, and costs of healthcare services used in the United States. MEPS data yield information on health services expenditures and how they are paid for, as well as the extent of health insurance coverage among the U.S. Read the entire page →
From page 225... ... 225 DATA COLLECTION AND MONITORING Public and privately funded healthcare plans can take advantage of survey instruments developed as part of broader quality improvement initiatives, such as the Health Plan Employer Data and Information Set (HEDIS) Read the entire page →
From page 226... ... 226 UNEQUAL TREATMENT provided by the California Department of Health Services, The California Endowment, the National Cancer Institute (NCI) , California Children and Families Commission, the U.S. Read the entire page →
From page 227... ... 227 DATA COLLECTION AND MONITORING tional Vital Statistics report system to evaluate the health of geographically defined populations. The second 12 indicators include measures of managed care plans to provide consumers and purchasers with information about plan performance. Read the entire page →
From page 228... ... 228 UNEQUAL TREATMENT TABLE 7-1 "Health Accountability 36" Report Card Indicators Unit of Analysis Source Indicators Geographically Healthy 1. Total age-adjusted death rate Defined People 2. Read the entire page →
From page 229... ... 229 DATA COLLECTION AND MONITORING tial measures of discrimination in healthcare settings, note that such measures must not only address structural differences in receipt of care (e.g., the proportion of women receiving prenatal care in the first trimester, as suggested by Smith [1998] Read the entire page →
From page 230... ... 230 UNEQUAL TREATMENT tors, and may not reflect whether patients are receiving care appropriate to their needs. Nonetheless, such perceptions form an important component of a multi-pronged assessment profile, particularly if measures can assess the degree of patient participation in treatment decisions and understanding of their diagnosis and course of treatment. Read the entire page →
From page 231... ... 231 DATA COLLECTION AND MONITORING cial or ethnic discrimination. In this strategy, individuals are trained to present the same needs and background information to targeted healthcare facilities, but vary only in race or ethnicity (see Chapter on "Racial Attitudes and Discrimination") Read the entire page →
From page 232... ... 232 UNEQUAL TREATMENT variables, however, had a limited effect on plan performance, as most plans changed by less than 5% in performance measures. Romano (2000) Read the entire page →
From page 233... ... 233 DATA COLLECTION AND MONITORING patient care data by race, ethnicity, and where possible, primary language. Accreditation bodies, such as JACHO and NCQA, should require the inclusion of data on patient race, ethnicity, and highest level of education attained (in case of children, highest level of education attained by mother) Read the entire page →
From page 234... ... 234 UNEQUAL TREATMENT mance measurement, such as NCQA's HEDIS indicators. The collec tion of data on patients' primary language should be encouraged. Read the entire page →

From page 215...

... 7 Data Collection and Monitoring The preceding chapters illustrate the complexity and variety of factors -- including healthcare financing arrangements, institutional and organizational characteristics of healthcare settings, aspects of the clinical encounter, and the attitudes, perceptions, and beliefs of healthcare providers and their patients -- that influence healthcare disparities. The complexity of these factors, coupled with the fact that disparities in care are not always apparent to patients or providers in clinical encounters, increases the need for data to better understand the extent of disparities and the circumstances under which disparities are likely to occur.