Informing Public Policy to Informing Public Policy to Address Health Care Disparities Address Health Care Disparities

Boisey Barnes, MD, F.A.C.C.Boisey Barnes, MD, F.A.C.C.

Founding Member and TrusteeFounding Member and Trustee

Association of Black CardiologistsAssociation of Black Cardiologists

Health care disparities – inequalities in care Health care disparities – inequalities in care directly associated with: directly associated with:

Race/ethnicityRace/ethnicity AgeAge GenderGender Health statusHealth status Low Income levelLow Income level Place of residence (inner city, rural)Place of residence (inner city, rural) Functional status Functional status Ability to communicateAbility to communicate

Disparities are present in:Disparities are present in:

Burden of illnessBurden of illness AccessAccess UseUse Quality of careQuality of care OutcomesOutcomes

According to the AHRQAccording to the AHRQ(Minority Health: Recent Findings AHRQ Pub. No. 09-P002, July 2009)(Minority Health: Recent Findings AHRQ Pub. No. 09-P002, July 2009)

Significant challenges remain in accessing care for cardiovascular diseaseSignificant challenges remain in accessing care for cardiovascular disease

Treatment and outcomes are poor for heart disease, congestive heart failure and heart attackTreatment and outcomes are poor for heart disease, congestive heart failure and heart attack

Blacks and Hispanics are much less likely to receive invasive cardiovascular services such as cardiac Blacks and Hispanics are much less likely to receive invasive cardiovascular services such as cardiac catheterization, bypass surgery or angioplastycatheterization, bypass surgery or angioplasty

Black and Hispanic patients stay in the hospital longer and have higher total charges as compared to Black and Hispanic patients stay in the hospital longer and have higher total charges as compared to WhitesWhites

Blacks are more likely to die following cardiovascular procedures than Hispanic or White patientsBlacks are more likely to die following cardiovascular procedures than Hispanic or White patients

Important Elements - Informing Public PolicyImportant Elements - Informing Public Policy

Investment in preventive careInvestment in preventive care Focus on health care workforceFocus on health care workforce Support for research investmentsSupport for research investments

Investment in Preventive Care Investment in Preventive Care

Waiver of copays for preventive services Waiver of copays for preventive services Creation of Community Preventive Services Grants (½ Creation of Community Preventive Services Grants (½

of funds to be used for services to reduce health care of funds to be used for services to reduce health care disparities) - very important for heart failure and disparities) - very important for heart failure and hypertension clinicshypertension clinics

Must increase public awareness of available benefits Must increase public awareness of available benefits through community outreachthrough community outreach

Focus on WorkforceFocus on Workforce Critical shortages in primary and cardiovascular careCritical shortages in primary and cardiovascular care Estimated shortage of 16,000 general clinical Estimated shortage of 16,000 general clinical

cardiologists in 2025cardiologists in 2025 Blacks, Hispanics and Native Americans comprise only Blacks, Hispanics and Native Americans comprise only

6 percent of practicing physicians and 3 percent of 6 percent of practicing physicians and 3 percent of cardiologistscardiologists

Investment needed in workforce and cultural Investment needed in workforce and cultural competencecompetence

Support for Research Investment Support for Research Investment

NIH fundingNIH funding AHRQ fundingAHRQ funding CDC fundingCDC funding Patient Centered Outcomes Research Institute (PCORI) and Patient Centered Outcomes Research Institute (PCORI) and

comparative effectiveness research - evaluates clinical comparative effectiveness research - evaluates clinical effectiveness, outcomes and risks/benefits of two or more effectiveness, outcomes and risks/benefits of two or more medical treatments to address a specific medical condition in medical treatments to address a specific medical condition in representative patient populationsrepresentative patient populations

Must ensure PCORI directs adequate resources to disparities Must ensure PCORI directs adequate resources to disparities researchresearch