Chartbook on Health Care for Blacks

National Quality Strategy Priorities

• Patient Safety.
• Person- and Family-Centered Care.
• Care Coordination.
• Effective Treatment.
• Healthy Living.
• Care Affordability.

Quality Measures

QUALITY: Through 2013, most measures of health care quality for Blacks improved

Key: n = number of measures.

Improving = Quality is going in a positive direction at an average annual rate greater than 1% per year.
No Change = Quality is not changing or is changing at an average annual rate less than 1% per year.
Worsening = Quality is going in a negative direction at an average annual rate greater than 1% per year.

• Quality of care for Blacks:
  • Improved for 59% (106 of 179) of the measures.
  • Worsened for 9% (16 of 179) of the measures.
  • Did not change for 32% (57 of 179) of the measures.
• Among the NQS priorities, quality of care for Blacks:
  • Improved for 74% (17 of 23) of Patient Safety measures and did not change for 22% (5 of 23).
  • Improved for 72% (13 of 18) of Person-Centered Care measures and did not change for 28% (5 of 18).
  • Improved for 63% (12 of 19) of Care Coordination measures and did not change for 21% (4 of 19).
  • Improved for 57% (27 of 47) of Effective Treatment measures and did not change for 32% (15 of 47).
  • Improved for 58% (37 of 64) of Healthy Living measures and did not change for 36% (23 of 64).
• There are insufficient numbers of reliable measures of Care Affordability to summarize in this way.

Quality Disparities

QUALITY DISPARITIES: Blacks received poorer quality of care across many NQS priorities

Key: n = number of measures.
Note: For most measures, data from 2013 are shown. 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 received better quality of 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 received about the same quality of care. Differences are not statistically significant or are smaller than 10%.
• Worse = Population received worse quality of care than reference group. Differences are statistically significant, equal to or larger than 10%, and favor the reference group.

• Groups With Disparities:
  • Blacks received worse care for about 70% of Care Coordination measures.
  • Blacks received worse care for nearly 50% of Person-Centered Care measures.
  • Blacks received worse care for about 40% of measures of Patient Safety and Effective Treatment and almost one-third of Healthy Living measures.

Disparity Trends

QUALITY DISPARITIES: Through 2013, some disparities were getting smaller but most were not improving across a broad spectrum of quality measures

Key: n = number of measures.
Note: For the majority of measures, trend data are available from 2001-2002 to 2013.

For each measure with Black-White disparities in the baseline year, 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 2013, most Black-White disparities in quality of care in the baseline year showed no significant change over time (blue), neither getting smaller nor larger.
  • When changes in disparities occurred, measures of disparities were more likely to show improvement (green) than decline (black).

New Quality Disparities

QUALITY DISPARITIES: Several new Black-White disparities developed

• Three new Black-White disparities not present at baseline developed.
• Person Centered Care:
  • Family caregivers who did not want more information about what to expect while the patient was dying.
• Healthy Living:
  • Breast cancer diagnosed at advanced stage per 100,000 women age 40 and over.
  • Home health care patients who get better at getting in and out of bed.

Quality Disparities by State

QUALITY DISPARITIES: Overall quality and quality among Blacks varied widely across States and often did not match

Source: Agency for Healthcare Research and Quality, 2014 State Snapshots.
Note: An overall quality score is computed for each State based on the number of quality measures that are above, at, or below the average across all States; States are ranked and quartiles are shown in the top map. A quality score for Blacks is computed in a similar manner but only using data for Blacks. Go to State Snapshots at http://nhqrnet.ahrq.gov/inhqrdr/state/select for more detailed methods.

• Geographic Disparities:
  • There was significant variation in overall quality among States. States in the New England, Middle Atlantic, West North Central, and Mountain census divisions tended to have higher overall quality (blue and green) while States in the South census region tended to have lower quality (yellow and red).
  • There was also significant variation among States in quality for Blacks. Blacks tended to receive higher quality care in States in the South Atlantic and East South Central census divisions (blue and green) and lower quality care in States in the New England, Middle Atlantic, and West South Central census divisions (yellow and red).
  • The variation in State performance on overall quality and among specific priority populations may point to differential strategies for improvement. States with high overall quality but poor quality for Blacks might target this population for support; States with low overall quality and high quality for Blacks might seek to improve care for everyone.
  • The State Snapshots tool (http://nhqrnet.ahrq.gov/inhqrdr/state/select), part of the QDR Web site, focuses on variation across States and helps State health leaders, researchers, and consumers understand the status of health care in individual States and the District of Columbia. It is based on more than 100 QDR measures for which State estimates are possible.

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