Overview

To identify and reduce disparities in healthcare quality, we are partnering with the Wisconsin Collaborative for Healthcare Quality (WCHQ) and the Collaborative Center for Health Equity to measure and publicly report on disparities in the quality of healthcare in Wisconsin. On September 19, 2019, the 2019 Wisconsin Health Disparities Report was released. This report was developed by WCHQ in collaboration with the University of Wisconsin Health Innovation Program to identify where disparities in health outcomes and care exist in Wisconsin and to help inform and accelerate programs that are working to eliminate disparities.

The Clinical Problem

Although Wisconsin ranks high in overall quality of health care nationally, the state performs poorly with respect to disparities in quality of care—measuring worse than the U.S. average on most reported metrics. These gaps in quality contribute to poor health outcomes for underserved populations, such as people with lower income and less education, racial and ethnic minorities, people with disabilities and residents of urban and rural areas.

Our Response

Public reporting of health system performance

Through public reporting of health care quality measures, our project aims to improve patient care and outcomes by motivating poorly performing health systems to increase their focus on quality improvement as it relates to health disparities—an approach that has been successful in Minnesota.

Public reporting cycleWe expect public reporting of disparities to create a positive feedback loop within the state whereby: disparities are measured; results are reported publicly; health systems compare themselves to peers; and poorly performing systems are motivated to undertake improvement activities to address disparities.

To develop a publicly reported measure of disparity, existing quality of care measures, such as blood pressure control, will be stratified by race/ethnicity, payer, and/or rural/urban residence. For example, performance results representing a health system’s achievement of blood pressure control for patients with hypertension will be stratified and presented separately by a disparities indicator such as race/ethnicity. The stratification of the measures by disparity indicators will help inform and accelerate programs that are working to eliminate disparities.

WCHQ members will publicly report performance results by race/ethnicity, payer, or rural/urban residence for at least one publicly reported measure by fall 2021. To view current public performance reports visit: http://reports.wchq.org/

Development of a statewide health disparities report

In September 2019, WCHQ and HIP released the 2019 Wisconsin Health Disparities Report. To produce this report, WCHQ member submitted standardized and recent (2018) clinical data to provide a statewide snapshot that identified disparities by race/ethnicity, payer, and rural/urban residence across health outcomes and care measures. The goal of the report was to provide baseline information on disparities in health outcomes and care within Wisconsin.

"This data provides a next level of detail of where disparities exist. There’s an enormous opportunity now for multiple stakeholders that care about this issue to come together and really dive into the detail to understand where the opportunities are to really bring communities and health systems together" Dr. Maureen Smith

Results from statewide health disparities report

Health outcome and care measures that have substantial disparities in Wisconsin are presented in the report by race and ethnicity (see below) and by payer (see below). We did not find substantial disparities in health outcome and care measures by rural and urban residence. This is likely due to the categorization of rural and urban that was used for the report. A public report identifying disparities in health outcomes and care applying a nuanced rural and urban residence categorization will be released in 2020.

Race/Ethnicity Substantial Disparities in Wisconsin Compared to Population Group with the Highest Rate
American Indian/Alaska Native Childhood vaccinations; breast cancer screening; recommended weight; tobacco-free (diabetes; heart disease)
Asian/Pacific Islander Breast cancer screening; colorectal cancer screening
Black Childhood vaccinations; recommended weight; blood pressure control; tobacco-free (diabetes; heart disease)
Hispanic/Latino Recommended weight; blood sugar control (diabetes)
White

HPV vaccination; recommended weight

Payer  Substantial Disparities in Wisconsin Compared to Population Group with the Highest Rate
Commercial Recommended weight
Medicare Cervical cancer screening*
Medicaid Childhood vaccinations; breast and colorectal cancer screening; depression screening; recommended weight; blood pressure control; blood sugar control (diabetes); tobacco-free (diabetes; heart disease)
Uninsured Childhood vaccinations; HPV vaccination; breast, colorectal, and cervical cancer screening; depression screening; recommended weight; blood sugar control (diabetes)

*to see full results view the report here

Collaborative effort

Funded by the Wisconsin Partnership Program, this project is a joint effort of the Wisconsin Collaborative for Healthcare Quality (WCHQ), a nationally recognized collaborative to improve health care quality through public reporting of quality metrics for Wisconsin health systems, the Health Innovation Program (HIP) and the Collaborative Center for Health Equity (CCHE). WCHQ includes 38 health care organizations–including 22 large health systems—and represents 65 percent of Wisconsin primary care physicians and 60 percent of all Wisconsin physicians.

Lasting Impact

This project will directly benefit Wisconsin’s most disadvantaged citizens by raising the visibility of gaps in health care quality and creating a long-term and sustainable strategy through public reporting to promote health care improvement and public accountability.

The 2019 Wisconsin Health Disparities Report was the first step in identifying were substantial disparities in health outcomes and care exist in Wisconsin. The report was disseminated to 26 health systems, 111 health departments, and 61 organizations and groups engaged in health equity work throughout the state. The results of the report were presented at the WCHQ Statewide Assembly which was attended by 226 stakeholders from across the state.

The elimination of health disparities cannot be done by health systems alone or accomplished in silos. This results of this project will 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.

Next Steps

In 2020, a public report identifying disparities in health outcomes and care by rural and urban residence will be released. In 2021, a measure of disparity will be publicly reported for individual health systems on the Wisconsin Collaborative for Healthcare Quality website.

  • 27 Nov, 2018