Inequality in Quality

Fiscella, Kevin; Franks, Peter; Gold, Marthe R.; Clancy, Carolyn M.

doi:10.1001/jama.283.19.2579

Cited by 1,008 publications

(249 citation statements)

References 87 publications

Supporting

Mentioning

231

Contrasting

Order By: Relevance

“…26 Evidence suggests that interventions aimed all or in part at patients can be highly successful in improving BP control. 20,41 While quality improvement may lessen disparities in care, 42 our results suggest EMR reminders, a commonly employed quality improvement intervention, are unlikely to be sufficient to eliminate disparities in hypertension care and control. Thus, we conclude that a rising tide does not lift all boats equally, and that specifically targeted interventions must be used in future efforts to decrease disparities in the process and outcomes of hypertension care.…”

Section: Bp Control and Disparities Intervention -Kressin Et Almentioning

confidence: 73%

A Brief, Multifaceted, Generic Intervention to Improve Blood Pressure Control and Reduce Disparities Had Little Effect

et al. 2016

View full text Add to dashboard Cite

Results: Clinician counseling improved most at R+T. BP improved overall; R+T had a small but significantly greater reduction in diastolic BP (DBP; -1.7 mm Hg). White patients at RO experienced greater overall improvements in BP control. Site and race disparities trends suggested that disparities decreased at R+T, either stayed the same or decreased at Control; and stayed the same or increased at RO. Conclusions:More substantial or racial/ ethnically tailored interventions are needed.

show abstract

Section: Bp Control and Disparities Intervention -Kressin Et Almentioning

confidence: 73%

A Brief, Multifaceted, Generic Intervention to Improve Blood Pressure Control and Reduce Disparities Had Little Effect

et al. 2016

View full text Add to dashboard Cite

show abstract

“…The mechanisms underlying it, however, are not fully understood (Elo, 2009). Earlier research has suggested that one important cause of social inequality in health is differences in quality of health care (Beckfield et al, 2015;Fiscella et al, 2000). Quality of health care comprises both the effectiveness of and access to health care .…”

Section: Introductionmentioning

confidence: 99%

The Educational Gradient in Self-Rated Health in Europe: Does the Doctor-Patient Relationship Make a Difference?

Präg¹,

Wittek²,

Mills³

2017

Preprint

View full text Add to dashboard Cite

Research suggests that doctor-patient relations have evolved from a doctorcentered, paternalistic approach towards a more patient-centered, egalitarian model of interactions between physicians and their patients. Given the longrunning debate on the positive relationship between education and health, the question arises how this development in doctor-patient relations affects social inequalities in health. First, we test to what extent egalitarian (e.g. discussing treatment decisions with patients) doctor-patient relations are underlying the education-self-reported health association. Second, we test whether egalitarian and paternalistic (e.g. withholding some information from patients) doctor-patient relations show differential effects on self-reported health across educational groups. Analyses of the European Social Survey (ESS) 2004/2005 for 24 countries demonstrate that a more egalitarian doctor-patient relationship does not substantially reduce educational inequalities in self-reported health. However, some direct positive effects of egalitarian and direct negative effects of paternalistic doctor-patient relations on health ratings can be found. Finally, results show how the health status of the lower educated can improve with a more egalitarian and less paternalistic doctor-patient relationship.

show abstract

“…ad justed count lsoa = ad justed rate lsoa × population lsoa (1) The waiting times indicator was indirectly standardised in a similar manner at LSOA level but instead of standardising for age and sex this indicator was standardised for the specialty code of the treating consultant. This was done in order to risk-adjust waiting time for the specialty of the admission, on the basis of the value judgement that a difference in the patient's specialty of treatment may be a legitimate justification for a longer waiting time, but not a difference in their age or sex.…”

Section: Methodsmentioning

confidence: 99%

Health Equity Indicators for the English NHS: a longitudinal whole-population study at the small-area level

Cookson

Asaria

Ali

et al. 2016

Health Serv Deliv Res

View full text Add to dashboard Cite

Background: Inequalities in health-care access and outcomes raise concerns about quality of care and justice, and the NHS has a statutory duty to consider reducing them. Objectives: The objectives were to (1) develop indicators of socioeconomic inequality in health-care access and outcomes at different stages of the patient pathway; (2) develop methods for monitoring local NHS equity performance in tackling socioeconomic health-care inequalities; (3) track the evolution of socioeconomic health-care inequalities in the 2000s; and (4) develop ‘equity dashboards’ for communicating equity findings to decision-makers in a clear and concise format. Design: Longitudinal whole-population study at the small-area level. Setting: England from 2001/2 to 2011/12. Participants: A total of 32,482 small-area neighbourhoods (lower-layer super output areas) of approximately 1500 people. Main outcome measures: Slope index of inequality gaps between the most and least deprived neighbourhoods in England, adjusted for need or risk, for (1) patients per family doctor, (2) primary care quality, (3) inpatient hospital waiting time, (4) emergency hospitalisation for chronic ambulatory care-sensitive conditions, (5) repeat emergency hospitalisation in the same year, (6) dying in hospital, (7) mortality amenable to health care and (8) overall mortality. Data sources: Practice-level workforce data from the general practice census (indicator 1), practice-level Quality and Outcomes Framework data (indicator 2), inpatient hospital data from Hospital Episode Statistics (indicators 3–6) and mortality data from the Office for National Statistics (indicators 6–8). Results: Between 2004/5 and 2011/12, more deprived neighbourhoods gained larger absolute improvements on all indicators except waiting time, repeat hospitalisation and dying in hospital. In 2011/12, there was little measurable inequality in primary care supply and quality, but inequality was associated with 171,119 preventable hospitalisations and 41,123 deaths amenable to health care. In 2011/12, > 20% of Clinical Commissioning Groups performed statistically significantly better or worse than the England equity benchmark. Limitations: General practitioner supply is a limited measure of primary care access, need in deprived neighbourhoods may be underestimated because of a lack of data on multimorbidity, and the quality and outcomes indicators capture only one aspect of primary care quality. Health-care outcomes are adjusted for age and sex but not for other risk factors that contribute to unequal health-care outcomes and may be outside the control of the NHS, so they overestimate the extent of inequality for which the NHS can reasonably be held responsible. Conclusions: NHS actions can have a measurable impact on socioeconomic inequality in both health-care access and outcomes. Reducing inequality in health-care outcomes is more challenging than reducing inequality of access to health care. Local health-care equity monitoring against a national benchmark can be performed using any admini...

show abstract

Inequality in Quality

Cited by 1,008 publications

References 87 publications

A Brief, Multifaceted, Generic Intervention to Improve Blood Pressure Control and Reduce Disparities Had Little Effect

A Brief, Multifaceted, Generic Intervention to Improve Blood Pressure Control and Reduce Disparities Had Little Effect

The Educational Gradient in Self-Rated Health in Europe: Does the Doctor-Patient Relationship Make a Difference?

Health Equity Indicators for the English NHS: a longitudinal whole-population study at the small-area level

Contact Info

Product

Resources

About