How preventable hospitals can shed light on health equity. Healthiest Community Health News
At the start of the pandemic, Alice Pressman noticed an alarming trend among black patients at Sutter Health, the elder Northern California Health Systems where he is the Executive Director of the Center for Health Systems Research. Compared to white patients, black patients were almost three times More likely to be hospitalized with COVID-19.
to answer like this of inequality, developed by Pressman and other Sutter researchers data-based approach For Vaccination: Towards achieving holistic herd immunity, Efforts encourage physicians especially push For even higher vaccination rates in at-risk populations, such as people of color.
This approach focuses on equality rather than equality. And there’s a big difference between the two, Pressman says: Traditionally, research on equity in health care has focused on whether patient populations reflect a geographic population and whether different members of that population are given the same level of care. is going
“Equality is about what we do. It’s about the things we do. Equity is about the outcome or impact of the actions we serve,” says Pressman, who is a director of the Sutter Institute for He is also the Director of Scientific Research for Advancing Health Equity.
together with this year Ranking of best hospitals, US News & World Report developed measures With the aim of capturing how effectively hospitals contribute Racial health equality in their communities, which involves evaluation focused on hospitalization for conditions such as asthma, diabetes or high blood pressure. With adequate outpatient management, these types of “ambulatory care sensitive situations” often do not require hospitalization, so the investigation of such potentially preventable events across racial groups may provide a window into potential inequalities in preventive care. can offer.
Of course, hospitals are often not the only providers of preventive care, with outside physicians’ offices, clinics and community groups playing a vital role in keeping people healthy. Yet the Affordable Care Act pushed for tax-exempt hospitals proactive about community health, and hospital can be punished When patients are recently re-admitted for certain conditions, they have additional incentives to provide early quality care.
Beyond direct hospital care, potentially preventable hospitalization helps shed light on the physical and social conditions affecting health in the community.
“Geography really matters and access really matters. A lot of the racial and ethnic inequalities that we see in American health care are also tied to the communities people are living in,” said senior policy and research Vice President Dr. Eric Schneider says Health Care Focused Foundation Commonwealth Fund.
The best hospital assessment compares the rates of potentially preventable hospitalizations between black and non-Black Medicare beneficiaries in a given hospital service area, or HSA — a representation of the community served by a hospital. A set of zip codes to do. Using data from 2015 — the most recent year this type of data was available by race — HSA discharge rates for black beneficiaries with these conditions are compared with the average discharge rates for all beneficiaries nationwide. The HSA is then placed in one of the four categories on the basis of their performance. They are placed in one of three categories based on their performance over time.
About 400 HSAs were assessed at the community level, with a similar overall assessment compared to the national average. Overall, 229 HSAs representing 645 hospitals fell in the best available category for at least one of the three preventive care metrics. Yet in more than 70% of the HSAs analyzed, black beneficiaries were marginally significantly more likely than non-black beneficiaries to be hospitalized with these conditions.
Another US news analysis shows that many communities in the South – such as HSAs – are involved. Lumberton, North Carolina, And Demopolis, Alabama – performed well in providing equitable care, even as black people faced more potentially preventable hospitalizations than the entire nation. That’s likely because this type of measurement can capture systemic disparity along with the quality of care as a whole in an area – and reconciling those two things can be difficult.
“Low levels of performance in some states can actually make it look like they have more equitable care,” says Schneider. “It’s because everyone else is caring worse.”
often using two states opposite end NS health related Ranking, presents a fictional example of a white man in Schneider Mississippi who could get worse care than a black person in Massachusetts. In other words, small gaps in care between racial groups do not prevent a community from receiving worse care as a whole.
The opposite may also be true: in two West Coast communities, for example – Berkeley, California, And Portland, Oregon Data shows that black people saw lower rates of potentially preventable hospitalization than people nationwide. But compared to non-black patients in the area, they were still being hospitalized for these conditions.
Meanwhile, in the Midwest, black people were often worse off than their non-black counterparts in the same hospital service area and Americans served by hospitals elsewhere in the country.
The US News assessment of preventive care provides a starting point for understanding health parity in hospital communities.
Schneider notes that not every community has a sufficient minority population to draw accurate, quantitative conclusions about health disparities. For this reason, US News excluded hospital service areas with fewer than 1,000 Medicare beneficiaries from any racial comparison groups.
Pressman points out that achieving equity may need to focus on a smaller subset of the population, as with Sutter’s efforts to vaccinate racial minorities, who face greater risk from COVID-19. . And in that case, it might not be a bad thing if a hospital or clinic sees a disproportionate number of black patients walk through its doors: it could be a sign that black residents of that hospital are in that area. trust and choose to go there. Pay attention to other options, or that the hospital is doing something proactive to promote equity.
“Sometimes the work we do at Equity is just identifying places to take a deeper look,” Pressman says.
Schneider agrees that looking at equity measures such as disparity in preventable hospitalizations is a start. But they must be interpreted along with other factors affecting community health, he says.
“Many of the racial and ethnic inequalities that we see in American health care are also linked to the communities in which people are living, whether those communities are well resourced,” Schneider says. “It’s the concept of structural racism and the fact that where people live, work and play has a real impact on their overall health.”
It was not until the advent of Medicare in 1965, that Hospitals were forced to isolate. Today, safety net hospitals, which have fewer physical resources than private hospitals, often serve more racial minorities, Schneider says.
Schneider says, “We may have overcome some of the segregation tendencies that exist within hospitals, but we have a long way to go in terms of trying to isolate or at least differentiate hospitals with similar resources.” To do.” .
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