Measuring and Addressing Disparities in the Quality of Care among Wisconsin Health Systems

The [WCHQ] report builds awareness of and quantifies the gaps we have in achieving health equity. The goal is not to achieve average performance —the goal is to eliminate disparities in our state. … Working with community partners, our health systems are committed to finding solutions that will raise the health status of every person living in Wisconsin.

– Chris Queram, WCHQ President/CEO

At a Glance

Wisconsin performs below the U.S. average on most metrics of disparities in quality of care. Because of this, quality of care is often lower for minority, low income and uninsured populations. These disparities contribute to poor health outcomes for disadvantaged patients and need to be publicly reported and addressed via sustained, collaborative action.Conclusion: The project has already produced one major study, the WCHQ Health Disparities Report, which was released in the fall of 2019. The study identifies where gaps in health outcomes and care exist in Wisconsin and incorporates data categorized by race and ethnicity, insurance coverage and geography. Further work is ongoing.

The Challenge

Wisconsin ranks high in overall quality of care nationally but performs poorly with respect to disparities in quality of care, performing worse than the U.S. average on 22 of 27 measures of disparity in the quality of care for Hispanics and Blacks relative to Whites. More generally, these disparities in healthcare quality also contribute to poor health outcomes for diverse populations such as people with lower income and less education, racial and ethnic minority populations, people with disabilities and residents of Milwaukee County and rural areas. To address this, comprehensive data on disparities in quality of care need to be made available and acted upon. Over the long term, programs to reduce disparities must be accelerated and sustained.

Project Goals

The objective of this project is to measure and report disparities in the quality of care for health systems across the state of Wisconsin and spur action to address those gaps, which could have a profound positive impact.To work toward these outcomes, the project’s long-term goal is to create a positive feedback loop within the state whereby: 1) Disparities are measured, 2) Results are reported publicly, 3) Health systems compare themselves to peers and 4) Poorly performing systems are motivated to undertake improvement activities to address these disparities. Specific aims under this grant are to: 1) Develop and implement a statewide publicly reported measure of disparity in the quality of care in Wisconsin and 2) Examine sources of disparities in the quality of care across the state.

Results

The grantees have already completed a report, published by the Wisconsin Collaborative for Healthcare Quality, that succinctly and comprehensively summarizes where health disparities exist in Wisconsin, addressing their first specific aim. For the WCHQ report, data were submitted by 25 health systems and medical clinics. The measures selected for the report include vaccinations, screenings, risk factors and chronic disease. The report found that some people in Wisconsin are experiencing a wide range of substantial disparities (defined as 10 percent lower than the best performing group) across several measures. Some standout findings are listed below:

1. Blacks are experiencing substantial disparities for childhood vaccinations, maintaining recommended weight, blood pressure control and not using tobacco if they have diabetes or health disease;
2. All the groups included in the report, except Asian which had the best rate, were not at the recommended weight;
3. There were substantial disparities in the American Indian population in childhood vaccinations, breast cancer screening and tobacco use related to diabetes and heart disease;
4. Whites had the lowest rate of HPV vaccination;
5. Hispanic/Latinos were substantially lower than other groups in controlling their blood sugar if they were diabetic; and
6. Asians have lower screening rates for both colorectal and breast cancer.

The report also found that Medicaid recipients had lower rates of childhood vaccinations, screening for cancer and depression and blood pressure control, among other disparities. Uninsured individuals had some of the same disparities, as well as a lower rate of HPV vaccination. Disparities generally were less stark between rural and urban areas, but more details are available in the report.

Looking to the Future

Work on this grant is ongoing. Now that the report has been completed, interventions can be developed as healthcare providers, researchers, policymakers and community organizations have the opportunity to act on the data.

Lasting Impact

The successful completion of the project could directly benefit Wisconsin’s most disadvantaged citizens by raising the visibility of disparities and motivating health systems to undertake targeted improvements that directly address these disparities. Further, eliminating health disparities is a task that cannot be done by health systems alone or accomplished in silos. The WCHQ report can also contribute to the identification of opportunities for health systems, health departments, policymakers, nonprofits and employers to develop collaborative approaches within their communities to create a healthier Wisconsin for all.