Frontiers of Health Services Management - Spring 2014 - (Page 8)
Examples include establishing a
relationship with a primary care
provider, obtaining affordable
prescription medications, receiving
age-appropriate preventive screenings,
and accessing hospital care when
needed. Having appropriate access to
care is a critical first step to achieving
health equity. Without access to care,
the other dimensions (care delivery
and health outcomes) cannot be
addressed. Disparities in access to
care are widely documented and are
a particular concern in Texas, which,
as mentioned earlier, leads the nation
in the percentage of its population
without health insurance coverage,
according to Mendes (2013). Note that
insurance coverage does not equate
to access, particularly in areas where
a significant number of providers
are unwilling to accept government
programs such as Medicare and
Medicaid.
2. Care delivery. The care delivery
dimension represents the care
provided to a patient once the
healthcare system has been
accessed. It can represent the
quality of clinical care provided by a
hospital or physician and a patient's
experience with the care provided.
Care delivery measures have long
been part of quality improvement
efforts for healthcare systems and
include indicators such as The
Joint Commission Core Measure
performance and Press Ganey patient
satisfaction scores. Often, care delivery
indicators are focused on adherence to
evidence-based processes of care.
3. Health outcomes. The health outcomes
dimension represents the clinical
outcomes of care provided to
patients. Typically, outcome measures
focus on clinical indicators and
biometric markers. At the patient
level, examples include hemoglobin
A1c scores for diabetic patients
and blood pressure measurements
for hypertensive patients, and
population-wide, metrics include
morbidity and mortality rates.
When reviewing these three dimensions, consider the visual orientation of
the Health Equity Triangle and the spatial
relationship of its three dimensions. The
access to care (on the left) and the care
delivery (on the right) dimensions point
down toward the health outcomes dimension, at the tip of the inverted triangle.
This positioning represents a relationship:
Access to care and care delivery disparities
must be addressed if we hope to effectively
improve equity in health outcomes. This
relationship does not preclude a healthcare
organization from working on any dimension independently, but it does illustrate the
interrelatedness of the three dimensions in
the effort to produce true health equity.
Health Equity Measurement and Analysis
With this conceptual framework in place,
the OHE was well positioned to address its
next core function: developing a measurement methodology to quantify health equity
performance for Baylor while identifying
the presence or absence of health disparities within the three equity dimensions. In
2007, leaders from the OHE were selected
to participate in the Disparities Leadership
Program (DLP), a year-long executive education program developed by the Disparities Solutions Center at Massachusetts General Hospital. DLP was designed to support
leaders from hospitals and other healthcare
organizations who were developing cuttingedge quality improvement strategies for
identifying and addressing disparities. As
8 * f ro ntier s o f h ea lth s e rvic e s m a na g e me nt 30 :3
Table of Contents for the Digital Edition of Frontiers of Health Services Management - Spring 2014
Frontiers of Health Services Management - Spring 2014
Contents
Editorial
Baylor Health Care System’s Journey to Provide Equitable Care
In Pursuit of High-Value Healthcare: The Case for Improving Quality and Acheiving Equity in a Time of Healthcare Transformation
Ending Healthcare Disparities: An Urgent Priority and a Growing Possibility
Expanding the Evidence Base for Health Equity
A Historical Perspective on Disparities as Context for Our Work Ahead
Frontiers of Health Services Management - Spring 2014
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