Healthcare Quality and Disparities in Women: Highlights From the 2011 National Healthcare Quality and Disparities Reports
Women's Health Updates from AHRQAgency for Healthcare Research and Quality (AHRQ) sent this bulletin at 10/15/2012 07:27 AM EDT
The following new items have been posted:
Healthcare Quality and Disparities in Women
Highlights From the 2011 National Healthcare Quality and Disparities Reports
Fact SheetQuality and disparities measures in health care for women are integrated throughout the National Healthcare Quality and Disparities Reports. This fact sheet highlights the measures in a single document. It is intended to serve as an “index” so readers can focus on women's health measures of interest and then refer to the primary reports for detailed information.
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ContentsIntroduction to the NHQR and NHDR
Effectiveness of Health Care
For More Information
Introduction to the NHQR and NHDRSince 2003, the Agency for Healthcare Research and Quality (AHRQ) has annually reported on progress and opportunities for improving health care quality and reducing health care disparities. As mandated by the U.S. Congress, the National Healthcare Quality Report (NHQR) focuses on “national trends in the quality of health care provided to the American people” while the National Healthcare Disparities Report (NHDR) focuses on “prevailing disparities in health care delivery as it relates to racial factors and socioeconomic factors in priority populations.” Priority populations include racial and ethnic minorities, low-income groups, women, children, older adults, residents of rural areas and inner cities, and individuals with disabilities and special health care needs.
Women's HealthQuality and disparities measures in health care for women are integrated throughout both reports. This document extracts and highlights the measures in a single document. It is organized around the same framework as the larger NHQR and NHDR but collapses some components to provide a broader view. The reports describe health along eight components, shown in the box. The components of effectiveness are organized around eight clinical areas. Naturally, some measures will cross components. For example, receipt of discharge instructions for heart failure is related to effectiveness of heart disease care as well as care coordination. For the purposes of this document, measures with clinical context are presented with the effectiveness measures. Other measure sets describe health care delivery and systems issues and are discussed together.
This document is intended to serve as an “index” so readers can focus on women's health measures of interest and then refer to the primary reports for detailed information. New analyses of other measures are not included but are planned for future publication.
Effectiveness of Health CareReaders are referred to the two reports for a description of methods, definitions, and criteria. However, when groups were compared (for example, women versus men), two criteria were applied to determine whether the difference between two groups was meaningful. The difference between the two groups must have been statistically significant (p <0 .05=".05" 10="10" and="and" at="at" been="been" between="between" difference="difference" groups="groups" have="have" least="least" must="must" p="p" relative="relative" the="the" two="two">
Colorectal CancerColorectal cancer is the third most common cancer in adults. Cancers can be diagnosed at different stages of development. Cancers diagnosed early before spread has occurred are generally more amenable to treatment and cure; cancers diagnosed late with extensive spread often have poor prognoses.
Breast and Cervical CancerThe reports include measures related to screening and treatment. They reflect the recent recommendation of the U.S. Preventive Services Task Force for mammograms every 2 years for women ages 50-74.
Chronic Kidney DiseaseEarly referral to a nephrologist is important for patients with progressive chronic kidney disease approaching kidney failure. Patients who begin nephrology care more than a year before kidney failure are less likely to begin dialysis with a catheter, experience infections related to vascular access, or die during the months after dialysis initiation.
DiabetesDiabetes is the most common cause of kidney failure. Keeping blood sugar levels under control can prevent or slow the progression of kidney disease due to diabetes. While some cases of kidney failure due to diabetes cannot be avoided, other cases reflect inadequate control of blood sugar or delayed detection and treatment of early kidney disease due to diabetes. Diabetes can also lead to lower extremity amputation.
Heart DiseaseAccording to the National Center for Health Statistics, women's death rate from heart disease in 2008 was nearly eight times the death rate from breast cancer. That year, females had higher rates of inpatient heart attack mortality than males. Several benchmarks related to heart disease that represent the top 10% of reporting States have implications for women's health:
HIV and AIDSRecommended services for HIV include two or more CD4 cell counts, highly active antiretroviral therapy, two or more medical visits in an HIV care setting, and Pneumocystis pneumonia prophylaxis for patients with CD4 cell count below 200. Although care delivery for males and females may be similar, outcomes can vary by gender.
Maternal and Child Health
Transgender Health IssuesThe 2011 NHDR included lesbian, gay, bisexual, and transgender (LGBT) populations. LGBT individuals experience differences in receipt of health care services and are sometimes denied services. Due to lack of data availability in Federal surveys, the 2011 NHDR includes an excerpt from the National Transgender Discrimination Survey Report. Key findings reported were:
Mental Health and Substance AbuseMental disorders are common in the United States and internationally. An estimated 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year.1 According to the World Health Organization, unipolar depression, predicted to be the second leading cause of global disability burden by 2020, is twice as common in women.
Respiratory DiseasesIn general, significant gender differences are not seen in respiratory disease measures, but women fare better on some measures and worse on others.
Lifestyle ModificationLifestyle can have a major impact on health. For example, obese women are more likely to develop gestational diabetes and have difficulties in labor than women at a healthy weight. In addition, smoking and obesity both contribute to or worsen heart disease, which is a leading cause of death in women. Health care providers can encourage behavior changes that can improve health and reduce the risk of disease.
Functional Status Preservation and RehabilitationA person's ability to function can decline with disease or age, but it is not always an inevitable consequence. Services to maximize function are delivered in a variety of settings, such as providers' offices, patients' homes, and long-term care facilities. Screening for possible risks can help women maintain optimal function.
Supportive and Palliative CareDisease cannot always be cured, and disability cannot always be reversed. For patients with long-term health conditions, managing symptoms and preventing complications are important goals.
Health Care Delivery and SystemsInformation about health care delivery and systems are presented in the chapters about Patient Safety, Timeliness, Patient Centeredness, Care Coordination, Efficiency, Health System Infrastructure, and Access to Care. A variety of measures described women's health within these components.
1 Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Arch Gen Psychiatr, 2005 Jun;62(6):617-27.
SummaryImproving quality and reducing disparities require measurement and reporting, but these are not the ultimate goals. The fundamental purpose of improvement in health care is to make all patients' and families' lives better. The NHQR and NHDR concentrate on tracking health care quality and disparities at the national level, but the statistics reported in the reports reflect the aggregated everyday experiences of patients and their providers across the Nation. It makes a difference in people's lives when breast cancer is diagnosed early with timely mammography; when a patient suffering from a heart attack is given the correct lifesaving treatment in a timely fashion; when medications are correctly administered; and when doctors listen to their patients and their families, show them respect, and answer their questions in a culturally and linguistically skilled manner.
AHRQ includes women in their priority populations, because women have unique health care needs or issues that require special focus. In addition to analyses in the NHQR and NHDR, AHRQ supports research on all aspects of health care provided to women, including enhancing the response of the health system to women's needs, understanding differences between the health care needs of women and men, understanding and eliminating disparities in health care, and providing evidence to inform women in their health care decisions.
For More InformationThe 2011 NHQR and NHDR are available online at http://www.ahrq.gov/qual/qrdr11.htm.
To learn more about the mission and activities of AHRQ's Division of Priority Populations, please visit the AHRQ Web site at www.ahrq.gov/populations. For information and/or questions about specific activities related to priority populations, you may contact us at: Prioritypops@ahrq.hhs.gov
Agency for Healthcare Research and Quality
Office of Extramural Research, Education, and Priority Populations (OEREP)
Division of Priority Populations
540 Gaither Road
Rockville, MD 20850
AHRQ Publication No. 12-0006-2-EF
Replaces AHRQ Publication No. 11-0005-1-EF
Current as of September 2012
Healthcare Quality and Disparities in Women: Highlights From the 2011 National Healthcare Quality and Disparities Reports. Fact Sheet. AHRQ Publication No. 12-0006-2-EF, September 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/nhqrdr11/nhqrwomen11.htm0>