Cardiovascular Business - January/February 2009 - (Page Cover3)

The › By ralPH BriNDis, MD, MPH, FaCC ACC C0RNeR Data Collection and Measurement Are Key to Reducing Disparities in Healthcare n 2002, the Institute of Medicine (IOM) released a report that found racial and ethnic minorities received lower quality of care that persisted even when clinical factors—such as disease stage, severity, comorbidities and age—were taken into account. Treatment for cardiovascular disease was no exception. The IOM report alerted policymakers, physicians and researchers to a significant problem within the U.S. healthcare system, and research that followed further explored present-day disparities. For example, a recent Health Affairs report found that minority patients tend to have primary-care physicians with less clinical training; see specialists with poorer clinical outcomes; and seek care at lower-performing hospitals than white patients. However, when minority and white patients seek care at the same hospital, they receive the same standard of care, the report found. Several studies have found disparities within the cardiovascular field specifically. Research by Medtronic found that rates of cardioverter defibrillator implants are lower among ethnic minorities, a bias that could not be attributed to earlier treatment disparities. In addition, a 1999 study in the New England Journal of Medicine found that race affected how physicians handled chest pain, independent of other variables. With minority health disparities becoming increasingly transparent, states are taking action. Almost two dozen state legislatures and governors have addressed health disparities by considering and/or passing major healthcare reform legislation, according to a report in the March/April 2008 issue of Health Affairs. The legislation under consideration would significantly alter the manner in which these states approach access to care issues and regulation of their health system. Access to care is especially crucial in efforts to reduce disparities in healthcare, given that racial and ethnic minorities tend to have a higher percentage of uninsured than other groups1. The Massachusetts health insurance law is an example of a state taking action to address disparities. The law subsidizes premiums for lower-income state residents while requiring employers with more than 10 employees to provide insurance to workers or pay into a state insurance pool. In addition, the law I creates a Health Care Quality and Cost Council, which will collect and analyze health data with a particular focus on racial and ethnic disparities. The American College of Cardiology (ACC) is addressing healthcare disparities through its health system reform initiative, Quality First. Quality First supports universal access to basic care, which would jump-start efforts to im- Dr. Brindis is the prove disparities and provide patients with the senior advisor for cardiovascular disease highest value care they deserve. In addition, for Northern California the initiative supports increased transparency Kaiser and a clinical and a renewed focus on measurable health professor of medicine at the University outcomes to provide accountability. of California, san This focus should be supported through the Francisco. He is also consistent use of cardiovascular standards, vice president of the american College of clinical practice guidelines, implementation of Cardiology. ACC’s appropriate use criteria and embracing clinical decision-making tools embedded in electronic health records (EHRs). Also critical in our desire to eliminate disparities of care is the routine practice of robust data collection comprised of key performance metrics analyzing domains of healthcare delivery surrounding not only patient outcomes but also structural and process measures of care. If you do not “measure it,” you cannot “manage it.” This is particularly true in not only understanding the true prevalence of disparities but also in assessing the implementation of mechanisms to eliminate them. The ACC has invested millions in developing the largest national cardiovascular data registry and is actively working with lawmakers, payers and other stakeholders to use these registries to facilitate participation in quality reporting initiatives, ensure compliance with guidelines and appropriate use criteria, and provide muchneeded feedback on quality of care to physicians and practices. With a new Congress and new presidential administration, we have an opportunity to make a real difference when it comes to reducing disparities and ensuring all patients receive the highest quality of care at the most effective cost. 1 Mead, Holly, et al. “racial and ethnic Disparities in U.s. Health Care: a Chartbook.” March 2008. The Commonwealth Fund. CardiovascularBusiness.com Cardiovascular Business 33 http://www.CardiovascularBusiness.com

Table of Contents Feed for the Digital Edition of Cardiovascular Business - January/February 2009

Cardiovascular Business - January/February 2009 Contents First Word Electrophysiology Roundtable Forum: A Candid Conversation about Profits, Procedures and Patients Heart Failure Care Gets Boost from Technology Emerging Technologies in Peripheral Vascular Interventions Stent vs. Graft: Choosing the Best Path for the Diabetic Patient with Multivessel Disease Cardiology Groups and Hospitals Strive to ‘Connect’ Seamlessly CT Beyond 64 Slices Clinical Study Digest: Kidney Disease & PCI; Women and Valve Disease Compact Echo Systems Come Up Big in Cardiac Care News & Views Reader Resources The ACC Corner

Cardiovascular Business - January/February 2009

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