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Measuring Disparities in Patient Safety

Measuring Disparities in Patient Safety. Ernest Moy Ernest.moy@ahrq.hhs.gov 301-427-1329 www.ahrq.gov/qual/qrdr11.htm http://statesnapshots.ahrq.gov. National Healthcare Reports. QRDR Patient Safety Data. QIO Surgical Infection Prophylaxis ‘Voluntary’ reporting by hospitals

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Measuring Disparities in Patient Safety

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  1. Measuring Disparities in Patient Safety Ernest Moy Ernest.moy@ahrq.hhs.gov 301-427-1329 www.ahrq.gov/qual/qrdr11.htm http://statesnapshots.ahrq.gov

  2. National Healthcare Reports

  3. QRDR Patient Safety Data • QIO Surgical Infection Prophylaxis • ‘Voluntary’ reporting by hospitals • ~1 million surgical cases per year • HCUP SID Disparities Analytic File • All-payer hospital discharge abstract data • Sample from 36 HCUP-SID ‘good race data’ States = >15 million records • Medicare Patient Safety Monitoring System • Structured inpatient chart abstraction • Sample from charts requested by CMS = ~25,000 charts per year

  4. QIO: Prophylactic Antibiotics Started • All groups improving • In all years, Hispanics and AI/ANs had lower rates than Whites 2008 Achievable Benchmark = 96%

  5. QIO: Prophylactic Antibiotics Discontinued • All groups improving • In all years, Hispanics and Asians had lower rates than Whites 2008 Achievable Benchmark = 95%

  6. HCUP: Postoperative Sepsis, Adults • In both years, Blacks and Hispanics had higher rates than Whites

  7. HCUP: Catheter-Related Bloodstream Infection, Adults • In both years, Blacks had higher rates than Whites 2008 Achievable Benchmark = 1.5

  8. HCUP: Catheter-Related BSI, Neonates, 2009 • Among both neonates with private health insurance and with Medicaid, Blacks and Hispanics had higher rates than Whites 2008 Achievable Benchmark = 17

  9. HCUP: Postoperative Sepsis, Adults, 2009 • In most States, Blacks and Hispanics had higher rates than Whites, but this is often not statistically significant at the State level. 2008 Achievable Benchmark = 8.7

  10. MPSMS: Composites, 2002-2007 • Blacks had higher rates than Whites of • HAIs (adjusted OR = 1.34) • ADEs (adjusted OR = 1.29)

  11. MPSMS: Composites, 2002-2007 • Patients in hospitals with higher % of patients who are black had higher rates of HAIs and ADEs

  12. Conclusions • Disparities in patient safety are common, especially related to • Healthcare-associated infections • Adverse drug events. • Process measures improve; outcomes and disparities often do not. • Disparities are attributable to variation • Within and between payer groups • Within and between States • Within and between hospitals.

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