Improving the Quality of Health Care given Medicare Disadvantaged Populations

1. Improving the Quality of Health Care given Medicare Disadvantaged Populations Edwin Huff, Ph.D., Science Officer, HCFA, Boston Office of Clinical Standards & Quality, with graphical assistance from Mary Anne Burgoyne. American Public Health Association, Medical Care Section, Boston, MA

2. DPAT Members: John Hebb, Chris Gibbons, Diane Merriman, Edwin Huff, Emily Townsend, Steve Preston, Louise Roumagoux, Frank Campbell, Pat Rawlings, Marie Wagner-Clarke DASPRO Members: Irwin Goldzweig, Dawn Fitzgerald, Christina Blanchard-Horan, Jennifer Nestor, Judith M. Hammond, Weihong Fan, Barbara Ockerson Presented on behalf of HCFA’s DPAT and DASPRO Teams: American Public Health Association, Medical Care Section, Boston, MA

3. Presentation Goals: • Provide an overview of HCFA’s current Initiative with PROs to Reduce Disparities. • Describe preliminary national and state baseline measures of Disparity. • Share lessons learned to date, and enable follow on contact concerning current state projects and plans for future national work. American Public Health Association, Medical Care Section, Boston, MA

4. PRO 6th Scope of Work • Who are PROs? Peer Review Organizations (established by TEFRA 82) are under contract to HCFA in all states and US territories to ensure that medical care given Medicare beneficiaries meets professionally recognized standards of quality. American Public Health Association, Medical Care Section, Boston, MA

5. Goals and Evaluation Expectations of PRO Disparity Reduction Projects: • Pre - Post reduction of disparity for a targeted state specific disadvantaged group relative to their in-state non-disadvantaged reference group; and • Generation of knowledge associated with causes of disparity and interventions to reduce them. American Public Health Association, Medical Care Section, Boston, MA

6. Indications of National* Disparities in AMI Quality Indicators. * Measures are not weighted, and represent only aggregated state results. American Public Health Association, Medical Care Section, Boston, MA

7. Indications of National* Disparities in Community Acquired Pneumonia. * Measures are not weighted, and represent only aggregated state results. American Public Health Association, Medical Care Section, Boston, MA

8. Indications of National* Disparities in Stroke (Atrial Fibrillation). * Measures are not weighted, and represent only aggregated state results. American Public Health Association, Medical Care Section, Boston, MA

9. Indications of National* Disparities in Use of ACEI in CHF. * Measures are not weighted, and represent only aggregated state results. American Public Health Association, Medical Care Section, Boston, MA

10. National Indications* of Disparity in Diabetes Care: Annual HbA1c Glucose Monitoring. * Measures are population based, and represent national results. American Public Health Association, Medical Care Section, Boston, MA

11. National Indications of Disparity in Diabetes Care: Biennial Eye Exam American Public Health Association, Medical Care Section, Boston, MA

12. National Indications of Disparity in Diabetes Care: Biennial Lipid Profile American Public Health Association, Medical Care Section, Boston, MA

13. National Indications of Disparity in Biennial Mammography Rates. American Public Health Association, Medical Care Section, Boston, MA

14. Indications of National Disparity in Flu Immunization Rates. American Public Health Association, Medical Care Section, Boston, MA

15. Indications of National Disparities in PPV Immunization Rates. American Public Health Association, Medical Care Section, Boston, MA

16. State Indications of Disparity in Annual HbA1c Glucose Monitoring across Dual Eligibles & White Non-Dual Eligibles. American Public Health Association, Medical Care Section, Boston, MA

17. State Indications of Disparity in Annual HbA1c Glucose Monitoring across African Americans & White Non-Dual Eligibles. American Public Health Association, Medical Care Section, Boston, MA

18. Clinical Condition: Breast Cancer - 18 Diabetes - 18 Flu Immunization - 14 AMI - 1 CAP - 1 Disadvantaged Population: African Americans - 27 Dual Eligibles - 19 Hispanics - 3 American Natives - 2 Asian/Pacific Islanders - 1 PRO Project Topics and Populations: American Public Health Association, Medical Care Section, Boston, MA

19. Initial Lessons Learned: • Evidence of Disparity is constrained by what is measured, and how it is measured: • For example, Disparities in Procedural access can’t be seen if it’s not measured; • Immunization disparity is hard to “see” with small statewide samples , i.e., BRFSS, and inpatient hospitalization topics. • Project Designs may need to be different for Knowledge Generation vs. Improving Performance Measures. American Public Health Association, Medical Care Section, Boston, MA

20. Follow - Up Contact & Collaboration: • To contact the DPAT or DASPRO: • John Hebb at JHebb@HCFA.GOV or • Irwin Goldzweig at 901-682-0381 x224. • To contact a PRO go to: • WWW.HCFA.GOV and look up PROs for specific state listings with email addresses, and phone numbers. American Public Health Association, Medical Care Section, Boston, MA