New help to keep healthcare equal

NQF releases disparity-sensitivity document

No one likes to think that their care differs based on some external element of the patient — the way they look or talk, their perceived class. But study after study shows that we aren’t as blind to difference as we’d like to think. But how can you make sure that the work you do in quality takes account of potential disparities?

The National Quality Forum (NQF) published a paper in November that should help to “weave disparities assessment into our measurement efforts,” says Helen Burstin, MD, MPH, senior vice president for performance measures at the NQF. Until now, measuring for disparities was an “afterthought,” says Burstin. “The hope is that if there are clinical areas with known disparities, then we won’t be content looking at the overall rate without diving deeper to see the differences across populations.”

NQF reviewed more than 500 measures to determine just which were disparities-sensitive. The team involved looked at issues of prevalence, quality gap, and if it could be linked to an endorsed measure related to cultural competency or preferred practice.

Eventually, with adequate sample sizes, stratified reporting of these measures might be encouraged or required, although the report notes that many people worry that reporting such results will lead to organizations “cherry picking” patients that will improve their scores and not accepting those that might hurt them. The goal is to improve any disparities of care quickly so that’s not an issue.

Among the measures listed as disparity sensitive are those related to esophagectomy for cancer, fibronolytic therapy within 30 minutes of hospitalization for heart attack patients, children who receive family centered care, and relative resource use for people with diabetes and those with cardiovascular conditions. There are 80 measures included.

The complete list of measures and the entire report is available at http://www.qualityforum.org/projects/Healthcare_Disparities_and_Cultural_Competency.aspx#t=2&s=&p=3|.

Burstin says that quality managers should consider the list of disparities-sensitive measures and consider if they should be stratifying data. “It should be an interesting exercise for quality managers,” she says. It may also point to some populations at risk “who may need some targeted outreach. It also may provide important insights on disparities and cultural competency that could inform staff training and community engagement.”

NQF will build this assessment of disparities-sensitivity into the prospective assessment of all measures, she says. “We will also need to consider how to best build these demographics into the emerging electronic data platform so that the information can be collected from patients once and use across the healthcare system to assess disparities.”