Ample evidence indicates that disparities in care delivery and outcomes persist at the point of care. The examples below demonstrate the disparities at the point of care that occur along one or several demographic characteristics such as race, ethnicity, gender identity and sexual orientation, age, and language (REGAL).
Gender identity/sexual orientation
Disparities at the point of care have far-reaching consequences for patients, as well as for health systems’ business priorities. As payment models increasingly incorporate patient experience and quality of care, disparities in care delivery will negatively impact provider organizations’ bottom lines. In addition, the discrimination patients experience within health care settings can influence their future behavior. Patients may avoid seeking care as a result of discrimination they have experienced or anticipate they will experience. Simultaneously, minority populations are growing, and their access to health care is expanding. Health systems must ensure inclusive and effective care for all groups within their community to remain successful.
Health systems are often unaware of differences in the care experiences and health outcomes of their patients, and they frequently do not account for patient social needs that may be driving those differences. The framework below provides guidance on how health systems can develop a strategy for detecting and addressing disparities among their patients.
• Educate leaders about the prevalence and impacts of health disparities, at the pointof care and more broadly at the population level.• Get leadership buy-in to focus on reducing disparities for your workforce, patients,and community.
• Develop a data-collection strategy with the ability to stratify clinical outcomes andprocess-of-care metrics by REGAL demographic data at a minimum.
• Detect major patterns of disparities in care.• Analyze impact of disparities on the community.• Take an intersectional approach to data analysis to identify groups most at risk ofexperiencing inequities.
• Investigate high-impact disparities to identify underlying root causes and drivers.• Use qualitative data sources to add context to patterns in quantitative data.
• Develop interventions aimed at addressing the specific drivers and root causes ofmajor disparities.• Uplift and center community perspectives to build effective, sustainable interventions.
• Establish formal methodology for evaluating interventions’ impact on reducing healthdisparities at the point of care.• Assign clear accountability for program improvement responsibilities.
Health disparities are differences in illness, injury, disability, or mortality rates across population groups. Certain population groups experience poorer health outcomes and health care services relative to other groups, even after accounting for variations in health care needs, patient preferences, insurance status, and recommended treatments.
Health disparities are the result of more than individual, interpersonal, or biological factors. They are driven by complex interactions between many factors relating to individuals, clinicians, health care systems, environments, communities, and society.
Health disparities at the point of care occur when different demographic groups experience inequitable treatment while interacting with health systems, care teams, and staff. This inequitable treatment can negatively impact clinical outcomes, patient safety, length of stay, readmissions, and the patient experience.
Disparities in care delivery are often caused by the patient-provider interactions and other health care system-level factors listed in the rightmost column of the table above. Disparities at the point of care can result from an insufficient understanding of patient needs, to bias and discrimination from the level of the entire health care industry to the individual provider level.
Historically, health care has been unequally allocated among demographic groups. And despite changes in policy and public sentiment, this historical legacy continues to negatively influence the modern health care industry and perpetuates inequitable care delivery.
While most clinicians are committed to treating patients equally, they still operate within a society and health care industry that is inherently biased and unjust. Clinicians, like the rest of the general population, hold explicit and implicit biases. Clinicians’ implicit biases, or their unconscious attitudes and stereotypes about groups of people, can easily affect the way they treat patients. These unconscious views can lead clinicians to make unintentional judgments and ultimately contribute to unequal treatment and worse health outcomes for certain patient populations.
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