NQF lays out tactics to measure healthcare disparities

The National Quality Forum called on providers and payers this week to invest in evidence-based interventions that will enable them to better measure and assess healthcare disparities.

In a blueprint released Thursday, the NQF urged stakeholders to re-evaluate how they use existing quality measures and to invest in ways to create new measures that will help reduce health disparities and promote health equity.

"There is a lot of work still to be done on the measurement side," said Dr. Shantanu Agrawal, president and CEO of the NQF. "We know that data sources in this area are really lacking and it's not clear to healthcare stakeholders what the right data sources are."

The report noted there are existing measures that providers can leverage to detect differences in care among certain patient populations. To help identify measures, the NQF offers four questions providers can consider. One question, for example, asks how large the gap in quality, access or health outcome is between the group with social risk factors and the group with the highest quality ratings for that measure? This can show if the measure is an indicator for disparities in care among certain patients.

The NQF highlighted such measures as blood pressure levels and colorectal cancer screening as being very effective in spotlighting disparities in care.

The report also emphasized the importance of developing measures that assess health equity. The authors note that data on social risk factors is "currently limited." Stakeholders should begin to invest in data collection in areas related to housing stability, food insecurity, gender identity, sexual orientation, language and insurance coverage.

Agrawal insisted that more data on social risks can't be done without the help of local community governments and organizations. "We've got to start with partnerships with communities," he said. "It can't be done at the provider level."

Community groups can serve as a guide for healthcare organizations to better understand where disparities exist and how best to address them, he added.

Dr. Karen Joynt Maddox, an assistant professor of medicine at Washington University School of Medicine who wasn't involved in the report, said clinicians can also play a role in the gathering of social risk data of patients because it's often relevant to how they develop a care plan. "We should be thinking about ways to collect data and share data where it does make sense," she added.

The report also emphasized the role payers can make to improve health equity. "Health plans can implement pay-for-performance payment models that reward providers for reducing disparities in quality and access to care," it said.

Agrawal said private health plans' embrace of telehealth is an example of a recent payment innovation that addresses disparities. He said we need to build on such innovations.

Maddox admired the NQF report for the broad approach it took to find ways to promote health equity. "If we as a community of healthcare providers really want to move the needle on disparities we need to think big and systemically," she said, adding, "some of these things will take years" to implement like new payment models.