Cultural Competence and Disparities: The National Quality Forums Role

1
Cultural Competence and DisparitiesThe National
Quality Forums Role
NQF NATIONAL QUALITY FORUM
Helen W. Wu, MSc, NQF Program Director National
Minority Health Month Foundation 2nd Annual
National Health Disparities Summit Washington,
DC April 26, 2005
2
Two Basic Concepts

• Quality healthcare is equitable healthcare
  inequality and quality cannot co-exist
• Disparities must be addressed across all domains
  of quality these are NOT separate issues
• In order to improve care for ethnically,
  racially, linguistically, and culturally diverse
  groups, we must be able to measure the quality of
  their care
• Standardized approaches to quality measurement
  are needed to create valid scorecards of
  provider/health plan performance for these
  populations

3
and How the Healthcare System Doesnt Get It

• Widespread disparities in quality documented
  throughout the healthcare system
• Notion that disparities are a separate issue
  from quality and that cultural competence
  improvements are too soft and intangible
• Performance measurement and reporting initiatives
  are everywhere today (e.g., CMS HospitalCompare)
• Lack of coordinated/standardized approaches to
  measuring, reporting, and improving quality with
  respect to diverse populations

4
What Is NQF and Where Does It Fit In Here?

• Voluntary Consensus Standard-setting organization
• Legally recognized Consensus Development Process
• Comports with Federal NTTAA
• Allows Federal government, other entities to
  adopt NQF-endorsed standards more readily
• Non-profit, open membership organization
  structured around 4 Member Councils
• Consumers
• Purchasers
• Health Professionals/Providers/Plans
• Research/Quality Improvement Organizations
• Over 260 Member organizations, including JCAHO
  and NCQA

5
NQFs Mission

• To improve healthcare quality by
  establishingmeasurement and reporting systems
  that are
• Safe
• Equitable
• Patient-centered
• Beneficial
• Timely
• Efficient

6
Examples of NQF Standards

• Performance measures
• Hospital Care Performance
• Nursing Home Care
• Cardiac Surgery
• Adult Diabetes Care
• Patient safety
• Safe Practices for Better Healthcare
• Serious Reportable Events
• Guiding frameworks, priorities, goals
• Comprehensive Framework for Hospital Care
  Performance Evaluation
• National Priorities for Healthcare Quality
  Measurement and Reporting

7
What Can the NQF Do?

• Convene stakeholders
• As a precursor to standard performance measures
• For national policy recommendations, action plans
• Active multi-stakeholder involvement
• Engage the NQF Membership
• Commit to use, implement, disseminate NQF
  standards
• Broad constituency, including major regulatory
  and policy-setting entities, both public and
  private
• Establish voluntary consensus standards
• Need for national standards to drive performance
  measurement and quality improvement in healthcare
  for diverse populations

8
What Has NQFDone Already?

• General approach
• Evidence of disparities included in the criteria
  for evaluating proposed consensus
  standards/measures
• Embedded in underlying frameworks/priorities
• National priorities for measurement and reporting
• Hospital care performance measurement
• Specific projects on diverse/underserved groups
• Improving Patient Safety Through Informed Consent
• Improving Use of Prescription Medications
• Measuring and Reporting Healthcare Quality for
  Minority Populations

9
Informed Consent Project

• Goal
• To evaluate implementation of NQF-endorsed Safe
  Practice 10 (i.e., teach back) and identify
  strategies to facilitate broader adoption by
  providers
• Focus on communication for those with low health
  literacy, including limited English proficiency
  (LEP)
• Method
• In-depth assessments of early adopters of Safe
  Practice 10 informant phone interviews with non
  adopters and a multi-stakeholder workshop
• Outcomes (available mid-2005)
• Project report with analysis and recommendations
• User guide for healthcare professionals/providers

10
Medication Use Project

• Goal
• To identify a national action plan for broadly
  improving consumer use of prescription
  medications
• Focus on medication adherence for groups with low
  health literacy, including LEP
• Method
• Comprehensive evidence review expert focus
  group multi-stakeholder workshop
• Outcomes (available mid-2005)
• Project report with national action plan for
  widespread dissemination to targeted
  stakeholders, future steps for improvement

11
Quality Measurement and Reporting for
Minorities Project

• Goal
• To explore issues and identify recommended
  priority actions around how to improve the
  quality of care for racial/ethnic minority
  populations through quality measurement and
  reporting
• Method
• Expert background papers multi-stakeholder
  workshop
• Outcomes
• Improving Healthcare Quality for Minority
  Populations Workshop Proceedings (National
  Quality Forum Washington, DC 2002)

12
What Progress Has Been Made?

• Disparities now a top priority for major
  policymakers
• Federal entities (DHHS, AHRQ, Congress)
• Provider associations (AMA)
• Health plans (Aetna)
• Purchasers (Verizon)
• Pharmaceutical industry (Pfizer)
• Private foundations (RWJF, California Healthcare
  Foundation, Commonwealth Fund)
• Accreditors (JCAHO, NCQA)
• Many efforts to collect/report quality using
  race/ethnicity/primary language data
• The tipping point is within sight!

13
Gaps and Barriers to Establishing NQF Standards

• Insufficient evidence on how to eliminate
  disparities
• Strategies for Improving Minority Healthcare
  Quality (AHRQ, Evidence-Based Practice Center,
  2004)
• Availability of race/ethnicity data
• Data collection inconsistent despite Federal,
  other policy requirements to collect
• Provider/plan-reported challenges
• Stakeholder resistance
• Provider buy-in needed
• Implementation of NQF-endorsed consensus
  standards is voluntary

14
The Basics (again)

• Quality healthcare is equitable healthcare.
  Inequality and quality cannot co-exist.
• Disparities must be addressed across all domains
  of quality these are NOT separate issues.
• In order to improve care for ethnically,
  racially, linguistically, and culturally diverse
  groups, we must be able to measure the quality of
  their care.
• Standardized approaches to quality measurement
  are needed to create valid scorecards of
  provider/health plan performance.

15
Reaching the Tipping Point

• Establish standards for measuring, reporting, and
  improving quality for all populations that are
  developed around disparities as a cross-cutting
  theme
• Focus on vulnerable populations to reduce
  disparities in health and healthcare
• Pursue, promote NQF-endorsed standards for
  measures, practices
• Leverage existing quality measurement, reporting,
  and improvement efforts
• Require routine, standardized collection and
  reporting of race/ethnicity/primary language data
  in all quality initiatives
• AHRQ National Quality/Disparities Reports model

16
Disparity Defined

• That which is markedly distinct in quality or
  character (Merriam-Webster)
• Over 83,000 more deaths every year in
  African-Americans, compared to whites, due to
  disparities in the quality of healthcare
  (Satcher, Health Affairs, 2005)

17
Contact Information

• Helen W. Wu, MSc
• Program Director
• National Quality Forum
• 601 13th St. NW, Suite 500N
• Washington, DC 20005
• Phone [phone]
• E-mail hwu_at_qualityforum.org
• Website http//www.qualityforum.org