Measuring and reporting quality is supposed to improve the quality of healthcare. This presentation discusses how the agenda may exacerbate disparities, and what can be done about that. Presented at Minnesota Community Measurement, February 07.

1. Using Quality Measurement and Reporting to Confront Disparities Yiscah Bracha, M.S. Research Director Center for Urban Health at HCMC Minneapolis Medical Research Foundation

7. Premature mortality in MN by race:

8. Child health indicators in MN by race *Source: Minnesota Department of Health, Spring 2006

9. Indicators of SES by Minnesota race 46 14 23 12 6 16 11 8 39 4 n/a 6 Numbers inside bars represent Minnesota’s rank among states. Employer-sponsored insurance and Medicaid for non-elderly.

12. Growth in MN non-white population: Source: Minnesota State Demographic Center, August 2006

13. Change in MN youth population: Source: Minnesota State Demographic Center, August 2006

14. Projected changes in MN population: Source: Minnesota State Demographic Center, August 2006

28. Who is favored by what structure decision? Low resource providers Low resource patients High resource providers Low resource patients Observed to Expected Low resource providers Any kind of patient High resource providers Any kind of patient Adjusted or stratified: Low resource providers High resource patients High resource providers High resource patients Unadjusted Improvement Absolute target Reward Based on Achieving Outcome measure is:

29. Decisions now favor: Low resource providers Low resource patients High resource providers Low resource patients Observed to Expected Low resource providers Any kind of patient High resource providers Any kind of patient Adjusted or stratified: Low resource providers High resource patients High resource providers High resource patients Unadjusted Improvement Absolute target Reward Based on Achieving Outcome measure is:

30. Decisions could favor: Low resource providers Low resource patients High resource providers Low resource patients Observed to Expected Low resource providers Any kind of patient High resource providers Any kind of patient Adjusted or stratified: Low resource providers High resource patients High resource providers High resource patients Unadjusted Improvement Absolute target Reward Based on Achieving Outcome measure is:

35. This problem is solvable! Let’s start.

36. Extra slides

37. Chronic Care Model from E.H. Wagner 1998. What will it take to improve care for chronic illness? Effective Clinical Practice . 1(1):2-4

40. MN Health Strengths by Race* *Source: Minnesota Department of Health, Spring 2006 .

41. MN population growth rates by race:

42. Changes in MN demography by county