The Role of Safety-Net Hospitals in Reducing Disparities in Breast Cancer Care.

Advances in breast cancer screening and systemic therapies have been credited with profound improvements in breast cancer outcomes; indeed, 5-year relative survival rate approaches 91% in the USA (U.S. National Institutes of Health NCI.

Everyone agrees the ACA isn't perfect, but let's 'fix and innovate; not 'repeal and replace'.

The House Republicans' campaign to repeal the Affordable Care Act and shrink Medicaid funding has produced a lot of drama-and an unexpected realization for repeal proponents: People like the ACA. And they're pretty fond of Medicaid, too.

A quality improvement framework for equity in cardiovascular care: results of a national collaborative.

Disparities in the quality of cardiovascular care provided to minorities have been well documented, but less is known about the use of quality improvement methods to eliminate these disparities. Measurement is also often impeded by a lack of reliable patient demographic data. The objective of this study was to assess the ability of hospitals with large minority populations to measure and improve the care rendered to Black and Hispanic patients.

Improving cardiovascular care through outpatient cardiac rehabilitation: an analysis of payment models that would improve quality and promote use.

Background: Much attention has been paid to improving the care of patients with cardiovascular disease by focusing attention on delivery system redesign and payment reforms that encompass the healthcare spectrum, from an acute episode to maintenance of care. However, 1 area of cardiovascular disease care that has received little attention in the advancement of quality is cardiac rehabilitation (CR), a comprehensive secondary prevention program that is significantly underused despite evidence-based guidelines that recommending its use.

Purpose: The purpose of this article was to analyze the applicability of 2 payment and reimbursement models-pay-for-performance and bundled payments for episodes of care--that can promote the use of CR.

Residents' awareness of racial and ethnic disparities in cardiovascular care.

Purpose: To characterize attitudes of residents toward racial/ethnic disparities in health care and to explore the effect of a simple intervention to improve awareness of these disparities.

Methods: The authors surveyed residents in internal and emergency medicine rotating through the Coronary Care Unit of a major teaching hospital about their attitudes toward disparities in cardiovascular care before and after an intervention that fostered discussion of evidence for the existence of disparities, possible causes of disparities, and clinically focused approaches to quality improvement tailored to the residents' practice environment.

Results: Before the intervention, 35% of residents agreed that racial/ethnic disparities might occur for patients within the US health care system in general, and only 7% agreed that patients they personally treated might experience racial/ethnic disparities in healthcare.

The use of and satisfaction with the Emergency Severity Index.

Introduction: The Emergency Severity Index (ESI) is a 5-level emergency department triage algorithm designed to facilitate the sorting and streaming of patients. The purpose of this study was to assess the use of the ESI in emergency departments, including satisfaction with the ESI, usefulness of the ESI compared with other triage algorithms, and lessons learned from implementation.

Methods: A self-administered questionnaire was sent to 935 people who requested the ESI training materials from the Agency for Healthcare Research and Quality (AHRQ) at the U.

The past, present, and future of urgent matters: lessons learned from a decade of emergency department flow improvement.

Over the past decade, emergency departments (ED) have encountered major challenges due to increased crowding and a greater public focus on quality measurement and quality improvement. Responding to these challenges, many EDs have worked to improve their processes and develop new and innovative models of care delivery. Urgent Matters has contributed to ED quality and patient flow improvement by working with hospitals throughout the United States.

Practical implications of implementing emergency department crowding interventions: summary of a moderated panel.

Emergency department (ED) crowding continues to be a major public health problem in the United States and around the world. In June 2011, the Academic Emergency Medicine consensus conference focused on exploring interventions to alleviate ED crowding and to generate a series of research agendas on the topic. As part of the conference, a panel of leaders in the emergency care community shared their perspectives on emergency care, crowding, and some of the fundamental issues facing emergency care today.

Measuring healthcare disparities and racial segregation in Missouri nursing homes.

Measuring and, ultimately, addressing disparities in long-term care quality continue to be a challenge. Although literature suggests that disparities in healthcare quality exist and nursing homes remain relatively segregated, healthcare professionals and policymakers stand to benefit from improvements in measuring both racial segregation and healthcare disparities. This paper quantifies the relationships between healthcare disparities and racial segregation using the disparities quality index and dissimilarity index.

A field test of time-based emergency department quality measures.

Study Objective: We examine practical aspects of collecting time-based emergency department (ED) performance measures.

Methods: Seven measures were implemented in 6 hospitals during 1 year. Structured interviews were used to assess the benefits and burdens of reporting.

How health care organizations are using data on patients' race and ethnicity to improve quality of care.

Context: Racial and ethnic disparities in the quality of health care are well documented in the U.S. health care system.

Gender differences in psychosocial issues affecting low-income, underserved patients' ability to manage cardiovascular disease.

Research Objective: This paper examines the psychosocial challenges that interfere with low-income, underserved patients' ability to manage cardiovascular disease (CVD) and seeks to explore the differences in how men and women manifest these issues.

Study Design: We convened 33 focus group discussions with low-income, underserved heart patients in 10 U.S.

Barriers to effective self-management in cardiac patients: the patient's experience.

Objective: This paper identifies common obstacles impeding effective self-management among patients with heart disease and explores how for disadvantaged patients access barriers interfere with typical management challenges to undermine patients' efforts to care for their illnesses.

Methods: We convened 33 focus group discussions with heart patients in 10 U.S.

Measuring equity: an index of health care disparities.

Objective: To create an index that would serve as a simple tool to measure the quality of hospital care by race and ethnicity.

Study Design: Following extensive review of existing disparities indices, we created a disparities quality index (DQI) designed to easily measure differences in the quality of care hospitals deliver to different populations. The DQI uses performance data already collected by virtually all hospitals.

Private gain and public pain: financing American health care.

Health care spending comprises about 16% of the total United States gross domestic product and continues to rise. This article examines patterns of health care spending and the factors underlying their proportional growth. We examine the "usual suspects" most frequently cited as drivers of health care costs and explain why these may not be as important as they seem.