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Quality, Disparities - Coggle Diagram
Quality
Framework for Measuring Medical Quality
Structure
Characteristics of providers
tools/resources available
ex. board certification; use of info tech
Process
Actions/services performed by providers
evidence based medicine
ex. testing diabetics blood sugar
Outcome
Change in a patient's health due to medical care
ex. actual vs expected mortality rate for hospital
OVERALL: care about health outcome; process have appeal if all things were followed; structure makes it easier to provide care
Four Underlying Reasons for Inadequate Quality of Medical Care:
Growing complexity of medicine
Increase in chronic conditions among patients
Little financial incentive for hospitals to invest time and money to improve quality
Failure to exploit revolution of info tech
Current healthcare policies
Financial incentive for quality not presennt
readmission results inn extra payments
NOW: hospitals with high re admission rates are penalized
How is it hard for MDs and hospitals to improve quality?
without financial incentives it is hard
high skilled physicians have less complications than low skilled
multiple chronic conditions hard to treat
HOW CAN QUALITY BE IMPROVED?
Policy #1: Health care IT to the Rescue
2009 Stimulus law provided incentives
carrots: MD who adopted EMR system in 2011/2012 received extra payments of $44,000
stick: those who didn't adopt an EMR system by 2015 had payments reduced
Physician burnout?? - physicans spend 90 minutes per day. using EMR system
Policy 2: publicize information on quality of health plans, physicians, hospitals, and hope patients shun low quality providers
Policy 3:ACA has changed way physicians are paid to reward high quality care and penalize low quality
pay for performance
bundled payments
Accountable Care organizations- insurer shares costs of savings with health system
pay for performance hospitals will loose up to 8% of its payment from medicare; readmission rates drop
Example: improving quality over time; solution to eliminate bloodstream infections is checklist- lowered infection by 64%
Current State: Review the good and bad news regarding quality of medical care
Life expectancy at birth increased
Questionable medical quality
adverse events in hospital admissions resulting in death around 10% of the time
over 50% due to preventable medical error -> around 100k preventable deaths
Examples of adverse hospital events
bed sores
post operation hemorrhage and hematoma
sepsis
deep vein thrombosis
RAND Study
only 55% of patients receive recommended study
Medical Evidence base is expanding
medical data is expected to double every 73 days
Disparities
What is health disparities?
preventable differences inn burden of disease, injury, violence, or opportunities to achieve optimal health
What is health equity?
individuals achieving highest level of health through elimination of disparities
Racial life expectancy. disparities persist among pandemics such as cholera, influenza, AIDS, and COVID
differences in life expectancy by income are huge
differences in insurance coverage
What disparities are present in the health system?
Racial disparities still present
Black and hispanic patients more likely to be diagnosed with Stage III cancer
Black and white patients likely to receive a certain medication, but diff dosages
health professionals display bias -> may lead to worse health outcomes
stigmatizing language for POC
Why are learning disparities important?
Black men treated by black physicianns more likely to get preventtative services
Black white gap infant mortality reduced by 50% with black physician
Possible policies to address health disparities
Divest from racial health inequities: treat patients same regardless of payments
Diversify health care workforce
make mastering health effects of structural racism professional medical commpetency
Mandate and measure equitable outcomes
Protect and serve