Chartbook for Hispanic Health Care

2014 QDR Chartbooks

• 2014 QDR supported by a series of related chartbooks that:
  • Present information on individual measures.
  • Are updated annually.
  • Are posted on the Web.
• Order and topics of chartbooks:
  • Access to care.
  • Priorities of the National Quality Strategy.
  • Access and quality of care for priority populations.

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Six Chartbooks Organized Around Priorities of the National Quality Strategy

1. Making care safer by reducing harm caused in the delivery of care.
2. Ensuring that each person and family is engaged as partners in their care.
3. Promoting effective communication and coordination of care.
4. Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease.
5. Working with communities to promote wide use of best practices to enable healthy living.
6. Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models.

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Other Chartbooks Organized Around AHRQ's Priority Populations

• AHRQ's priority populations, specified in the Healthcare Research and Quality Act of 1999 (Public Law 106-129):
  • Racial and ethnic minority groups.
  • Low-income groups.
  • Women.
  • Children (under age 18).
  • Older adults (age 65 and over).
  • Residents of rural areas.
  • Individuals with special health care needs, including:
    • Individuals with disabilities.
    • Individuals who need chronic care or end-of-life care.

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Access to Health Care

Access Disparities

ACCESS DISPARITIES: In 2012, disparities were observed across a broad spectrum of access measures

Key: AI/AN = American Indian or Alaska Native; n = number of measures.
Note: Poor indicates family income less than the Federal poverty level; High Income indicates family income four times the Federal poverty level or greater. Numbers of measures differ across groups because of sample size limitations. Measures that achieve an overall performance level of 95% or better are not reported in the QDR and are not included in these analyses. Because disparities are typically eliminated when overall performance reaches 95%, our analyses may overstate the percentage of measures exhibiting disparities.

The relative difference between a selected group and its reference group is used to assess disparities.

• Better = Population had better access to care than reference group. Differences are statistically significant, are equal to or larger than 10%, and favor the selected group.
• Same = Population and reference group had about the same access to care. Differences are not statistically significant or are smaller than 10%.
• Worse = Population had worse access to care than reference group. Differences are statistically significant, are equal to or larger than 10%, and favor the reference group.

Example: Compared with Whites, Hispanics had worse access to care on 14 of the 21 access measures, similar access on 4 measures, and better access on 3 measures.

• Groups With Disparities:
  • People in poor households experienced the largest number of disparities, followed by Hispanics and Blacks.
  • In 2012, people in poor households had worse access to care than people in high-income households on all access measures (green).
  • Blacks had worse access to care than Whites for about half of access measures.
  • Hispanics had worse access to care than Whites for two-thirds of access measures.
  • Asians and American Indians and Alaska Natives had worse access to care than Whites for about one-third of access measures.

Trends in Access Disparities

ACCESS DISPARITIES: Through 2012, across a broad spectrum of access measures, some disparities were reduced but most did not improve

Key: AI/AN = American Indian or Alaska Native; n = number of measures.
Note: Poor indicates family income less than the Federal poverty level; High Income indicates family income four times the Federal poverty level or greater. Numbers of measures differ across groups because of sample size limitations. For the vast majority of measures, trend data are available from 2001-2002 to 2012.

For each measure, average annual percentage changes were calculated for select populations and reference groups. Measures are aligned so that positive rates indicate improvement in access to care. Differences in rates between groups were used to assess trends in disparities.

• Worsening = Disparities are getting larger. Differences in rates between groups are statistically significant and reference group rates exceed population rates by at least 1% per year.
• No Change = Disparities are not changing. Differences in rates between groups are not statistically significant or differ by less than 1% per year.
• Improving = Disparities are getting smaller. Differences in rates between groups are statistically significant and population rates exceed reference group rates by at least 1% per year.

• Disparity Trends:
  • Through 2012, most disparities in access to care related to race, ethnicity, or income showed no significant change (blue), neither getting smaller nor larger.
  • In four of the five comparisons shown above, the number of disparities that were improving (black) exceeded the number of disparities that were getting worse (green).

Uninsurance

Adults ages 18-64 who were uninsured at the time of interview, by race/ethnicity, January 2010-June 2014

Key: Q = quarter.
Source:  Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 2010 -2014, Family Core Component.
Note: For this measure, lower rates are better. Data only available for 2014 quarters 1 and 2.

• Trends: All ethnic groups displayed a decrease from 2013 Q4 to 2014 Q2:
  • White: 14.0% to 11.1%.
  • Black: 24.6% to 15.9%.
  • Hispanic: 40.3% to 33.2%.
• Groups With Disparities: Hispanic adults ages 18-64 were significantly more likely than Whites to be uninsured from January 2010 to June 2014. The percentage peaked in the second quarter of 2010 at 44.9%, then significantly decreased to 33.2% for the second quarter of 2014.

Usual Source of Care

Age-sex adjusted percentage of people of all ages with a usual place to go for medical care, by race/ethnicity, 2013 and January-June 2014

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 1997-2013 and January-June 2014, Combined Sample Adult and Sample Child Core Component.
Note: Data only available for  2014 quarters 1 and 2.

• Groups With Disparities:
  • From January to June 2014, after adjustment for age and sex, the percentage of people with a usual place to go for medical care was 82.2% for Hispanics, 89.3% for Whites, and 86.5% for Blacks.
  • In both years, Hispanics were less likely to have a usual place to go for medical care compared with Blacks and Whites.

Difficulty Getting Care When Wanted: Adults

Adults who needed care right away for an illness, injury, or condition in the last 12 months who sometimes or never got care as soon as wanted, by race/ethnicity and by insurance (ages 18-64) among Hispanics, 2002-2012

Left Graph:

Right Graph:

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2012.

• Trends: From 2002 to 2012, the percentage of adults who needed care right away who sometimes or never got care as soon as wanted did not change overall or for any ethnic group.
• Groups With Disparities:
  • From 2010 to 2012, Hispanics were less likely than Whites to receive care as soon as wanted.
  • In all years, uninsured Hispanic adults were less likely than privately insured Hispanic adults to receive needed care right away for an illness, injury, or condition in the last 12 months.

Difficulty Getting Care When Wanted: Children

Children who needed care right away for an illness, injury, or condition in the last 12 months who sometimes or never got care as soon as wanted, by race/ethnicity and language spoken at home, 2002-2012

Left Graph:

Right Graph:

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2012.
Note: For 2010, data for Other did not meet the criteria for statistical reliability.

• Trends: From 2007 to 2012, Hispanic children were less likely than non-Hispanic White children to get care as soon as wanted.
• Groups With Disparities:
  • In 2012, the percentage of children who needed care right away who sometimes or never got care as soon as wanted was 9.3% for those who spoke a language other than English and 3.0% for those who spoke English.
  • In all years, English-speaking children were less likely than children speaking other languages to have problems receiving care as soon as wanted.

HRSA-Supported Health Center Population

Characteristics of HRSA-supported health center population versus U.S. population, 2013

Key: AI/AN = American Indian or Alaska Native; NHOPI = Native Hawaiian or Other Pacific Islander; FPL = Federal poverty level.
Source: Health Resources and Services Administration, Bureau of Primary Health Care, Uniform Data System, 2013. http://bphc.hrsa.gov/uds/datasnapshot.aspx?year=2013.
Note: Racial groups include Hispanics and non-Hispanics. Health center population only includes data from 1,202 program grantees.

• Groups With Disparities:
  • In 2013, 71.9% of the health center population was at or below the Federal poverty level compared with 15% of the U.S. population. The health center population also had higher percentages of uninsurance (34.9%) and Medicaid enrollment (41.5%) than the U.S. population (15.4% and 16.4%, respectively).
  • In 2013, slightly more than one-third (34.8%) of the health center population was Hispanic, which was twice as much as the percentage in the U.S. population (17.1%). The percentage of Blacks at the health centers was nearly one-quarter (23.8%), nearly twice as much as the percentage in the U.S. population (12.2%).

AHRQ Health Care Innovations in Access to Health Care

Salud Mobile Outreach Program

• Location: Primarily in rural areas of northern Colorado.
• Population: Mexican immigrants, many of whom are poor, uninsured, and monolingual with limited education.
• Intervention: Reduce health disparities by providing medical and dental care, referrals, and patient education.
• Outcomes: Enhanced access to needed medical care and education in a population who had no other way to access such services.

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