Addressing Racial and Ethnic Disparities to Improve Quality: Focusing on Cardiac Care

1. Addressing Racial and Ethnic Disparities to Improve Quality: Focusing on Cardiac Care S. Ryan Greysen, M.D., M.A. Bruce Siegel, M.D., M.P.H.

2. Objectives Explain the distinction between differences and disparities Demonstrate differences that exist between patient populations Demonstrate evidence for the existence of disparities Explain how quality improvement can effect disparities Provide solutions to improve quality and reduce disparities

3. Differences vs. Disparities in Care

4. Social Factors and the Quality Gradient

5. Why Examine Disparities in Cardiovascular Care? Heart disease is the leading cause of death among minorities Scientific and medical literature extensively document disparities in cardiac care There is strong consensus for recommended treatments There are widely-accepted measures of quality of cardiac care

6. Source: Bradley, et al. JAMA,�2004, 292: 1563-1572.

7. Patients� race affects clinical decision-making 720 physicians were shown a recorded interview and given other data about a hypothetical patient and asked to recommend care. Men and whites were more likely to be referred for cardiac catheterization than women and blacks. Blacks were less likely to get referred for cardiac catheterization Black women were referred the least

8. Perception of disparities differs from reality

9. Education increases awareness

10. Disparities are a quality failure Qual?i?ty n. The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge

12. Evidence of Differences in Inpatient Care

13. Increasing Education and Awareness of Disparities Among Providers Acknowledge Disparities Don�t Make Assumptions Eliminate Fear

14. Overall Improvement