Wednesday, February 16, 2011

The door to door approach to disparities

Lately, I've been noticing a steady stream of reports on health care disparities, most of which feature alarming factoids within an overall picture of slow progress to reverse those trends. For instance, a recent report from the CDC included the following, troubling findings:
  • Infants born to African-American women are 1.5 to 3 times more likely to die than infants born to all other American mothers.
  • Rates of preventable hospitalizations increase as incomes decrease.
  • Lower-income Americans report fewer healthy days per month.
Overall, the report forecast that the nation is likely to "continue experiencing substantial racial/ethnic and socioeconomic health disparities" even as overall health outcomes improve.

About a week ago, the American Cancer Society came out with a report that found while disparities in cancer mortality for African-Americans are falling, their survival rates still lag other ethnic groups for most cancers.

And even as I was writing this blog entry, I came across a just-published JAMA article that called progress toward reducing disparities "painfully slow."

But even as the disparities headlines continue to filter in, all with the same general theme, there are some signs of improvement. Even the authors of the skeptical JAMA article speculated that the current hubbub about care coordination—including those white-hot ACOs—might drive more health care experimentation in economically depressed areas that would ultimately lead to better care delivery and, theoretically, a reduction in disparities.

Of course, plenty of hospitals are already experimenting with grassroots techniques to identify high-risk patients and provide them with better access to regular care. I recently interviewed Alan Channing, CEO of Sinai Health System, a safety net hospital on Chicago's West Side that has begun literally going door to door to assess everyone in the community for diabetes and asthma. And in a recent New Yorker article, Atul Gawande profiled a New Jersey physician who mapped health care costs in impoverished neighborhoods of Camden, N.J., learned that 1 percent of city patients accounted for thirty percent of costs, and then began—again, knocking on doors—to find those patients and try to provide them with better access to primary care.

Even with slow national progress, plenty of hospitals are addressing disparities at the local level—often by literally knocking on doors. And it's that kind of energy that, one hopes, will eventually reverse the tide of discouraging disparities news.


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