AHRQ Resources for Research
Fact Sheet
The Agency for Healthcare Research and Quality (AHRQ) has supported extensive
research that has identified and helped explain the reasons for racial and
ethnic disparities in health status and health services delivery. Research by AHRQ results
in data, tools, and new models to help address issues of access and equity in
the Nation's health care system. AHRQ research also facilitates application of
sound health services research to patient-centered care.
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Contents
Data
Research Tools
Research Models
For More Information
Data
Healthcare Cost and Utilization Project (HCUP)
HCUP comprises a family of longitudinal
databases, tools, and software that can be used with HCUP data as well as with
other administrative databases. A Federal-State-industry partnership to build a
standardized, multi-State health data system, HCUP provides encounter-level data
converted into a uniform format to facilitate between-State comparisons.
HCUP's State Inpatient Databases(SID) provide hospital-discharge data from participating States (26
beginning with 1999 data). Similarly, HCUP's State Ambulatory Surgery Databases (SASD) provide ambulatory surgery encounter data from
participating States (13 beginning with 1999 data). The SID and SASD contain
State-specific data for a core set of elements (e.g. diagnoses, discharge
status, payment source, charges).
Most HCUP States also provide data by race/ethnicity, thus permitting
researchers to study ethnic/racial disparities in health care use for patients
in specific States, regardless of age or insurance status (including the
uninsured).
Medical Expenditure Panel Survey (MEPS)
MEPS is an ongoing nationally
representative survey that collects detailed information on:
- Health status.
- Health services use.
- Expenditures.
- Health insurance coverage of individuals and families in the United States.
It is the only national survey that provides up-to-date, detailed information
on how Americans use and pay for health care, including how changes in sources
of payment and insurance coverage affect racial and ethnic minorities and other
population groups.
MEPS enables researchers to investigate questions such as:
- How do access to care and satisfaction with care vary by racial and ethnic
group?
- In what ways do health services utilization and spending by blacks differ
from health care use and spending by whites?
- Do overall health care spending and use of services differ for various
Hispanic subgroups (e.g., individuals of Mexican, Puerto Rican, and Cuban
descent)?
Data releases from the Medical Expenditure Panel Survey are available on the
MEPS Web site at http://www.meps.ahrq.gov
HIV Cost and Services Utilization Study (HCSUS)
HCSUS interviewed a national
probability sample of HIV-infected adults who were receiving ongoing or regular
medical care in 1996. The sample was 49 percent white, 33 percent black, 15
percent Hispanic, and 3 percent other.
Public use tapes containing data from the baseline interview and two followup
interviews are now available in CD-ROM format for research on a broad array of
research and policy issues regarding HIV disease.
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Research Tools
Consumer Assessment of Health Plans (CAHPS®)
CAHPS®
is an easy-to-use kit of survey and report tools that provides reliable and
valid information to help consumers and purchasers assess and choose among
health plans. The kit contains a set of questionnaires to ask consumers about
their experience with their health plans, sample formats for reporting results
to consumers, and a handbook to help implement the surveys and produce the
reports.
All CAHPS® questionnaires are available in Spanish and English versions. As
the CAHPS® questionnaires were being developed, they were tested in both
languages. In fact, many decisions about the phrasing of the questionnaire items
in English were made to assure as clear a translation into Spanish as possible.
Subsequent evaluation has determined that both versions are psychometrically
comparable (as to their reliability and validity).
Medical Treatment Effectiveness Centers for Minority Populations
AHRQ-supported research at several of the Agency's minority MEDTEP research
centers has facilitated the development of tools for researchers interested in
examining racial/ethnic disparities in health status and health care and
addressing inequities in health care access and service delivery. For example:
Questionnaire to assess interpersonal processes of care (IPC) from the
perspective of minority patients. The questionnaire was developed and
validated by AHRQ's Medical Effectiveness Research Center (MERC) at the
University of California-San Francisco. The MERC IPC Questionnaire
incorporates the perspective of diverse racial/ethnic or socioeconomic groups
into a framework for investigating how processes of communication,
decisionmaking, and interpersonal style might account for observed ethnic and
socioeconomic differences in health and health care.
Stewart AL, Napoles-Springer A, Perez-Stable EJ, et al. Interpersonal
processes of care in diverse populations. Milbank Quarterly
1999;77(3):305-39.
Cross-cultural adaptation of the SF-36 Health Survey. Researchers at
AHRQ's UCLA MEDTEP Center translated the SF-36 into Japanese and validated the
translation with a Japanese American elderly population in two long-term care
facilities.
Harada N, Chiu V, Tsuneishi C, et al. Cross-cultural adaptation of the
SF-36 health survey for Japanese American elderly. Journal of Aging and
Ethnicity 1998;1(2):59-80.
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Cross-cultural adaptations and development of new data collection
instruments for Spanish-speaking adults. Researchers at the University of
Texas Health Sciences Center at San Antonio developed a consumer-based
decision aid for screening mammography and translated and validated a pain
questionnaire, hearing inventory and other existing data collection tools for
use with Mexican Americans.
Lawrence V, Streiner D, Hazuda H, et al. A cross-cultural consumer-based
decision aid for screening mammography. Preventive Medicine
2000;30(3):200-8.
Escalante A, Lichtenstein MJ, Rios N, Hazuda HP. Measuring chronic
rheumatic pain in Mexican Americans: cross-cultural adaptation of the McGill
Pain Questionnaire. Journal of Clinical Epidemiology
1996;49(12):1389-99.
Lichtenstein M, Hazuda H. Cross-cultural adaptation of the Hearing Handicap
Inventory for the Elderly-Screening Version (HHIE-S) for use with
Spanish-speaking Mexican Americans. Journal of the American Geriatrics
Society 1998;46(4):492-98.
Translating Research Into Practice (TRIP-II) Projects
TRIP-II projects focus on
identifying and assessing implementation tools and methods associated with
successfully applying sound research findings to diverse clinical care settings.
Begun in September 2000, several TRIP-II studies are evaluating how these
implementation strategies affect health outcomes and address inequities in
health care access and delivery.
Examples of the types of tools and methods under study in AHRQ's TRIP-II
initiative include:
- Two strategies—an evidence-based case management model for children
enrolled in 29 Head Start programs, and a computer-based guideline prompt
system for children in a Medicaid managed care organization—for improving
pediatric asthma care.
- A quality improvement model that uses academic detailing with electronic
medical records to enhance prevention of cardiovascular disease and stroke in
primary care settings.
- A nurse-mediated, single standard-of-practice model for improving clinical
preventive service delivery in primary care clinics serving low-income,
largely Medicaid-eligible, populations.
- A two-part program for primary care providers that combines provider
training with a customized screening and charting instrument for use in
adolescent preventive services.
- A culturally sensitive, interactive multimedia computer program that aims
to enhance diabetes education and increase compliance with self-care.
- An educational and behavioral intervention (in English and Spanish) that
includes a staff knowledge and attitude survey, staff training videos on pain
assessment techniques and pain management strategies, and videos for residents
and family members on reporting and managing pain in nursing homes.
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Research Models
Excellence Centers To Eliminate Ethnic/Racial Disparities (EXCEED)
In September 2000, AHRQ awarded nine EXCEED
program grants as part of a major research initiative to improve knowledge of the factors underlying ethnic and racial inequities in health care. In addition, these projects aim to help
identify practical tools and strategies for eliminating these inequities and
develop capacity for further health services research in this field.
Each project, comprising a group of four to seven studies organized around a
central theme, focuses particularly on causes of ethnic/racial health
disparities that could be addressed through improvements in health services
delivery and health systems. The nine new research projects—which are supported
by AHRQ in partnership with the National Institutes of Health, the Health
Resources and Services Administration, and a number of private foundations—are
being conducted in collaboration with community health centers, other health
care providers, and universities that serve ethnically diverse populations.
Integrated Delivery System Research Network (IDSRN)
In fiscal year 2000, AHRQ implemented a new model of field-based research
that links researchers with large health care systems to examine questions of
health care delivery and to develop data and measurement capacity.
The IDSRN capitalizes on the
research capacity of large integrated health care delivery systems to determine
what works and what does not in terms of data and measurement systems and
organizational best practices related to care delivery and research diffusion.
Among the projects underway is a study of the current capacity of health
plans to investigate racial/ethnic disparities by using databases from managed
care organizations. The project also aims to identify strategies to improve this
capacity.
Primary Care Practice-Based Research Network (PBRN)
A PBRN is a group of ambulatory
practices devoted principally to the primary care of patients, affiliated with
each other (and often with an academic or professional organization) in order to
investigate questions related to community-based practice. These networks link
research questions with rigorous research methods to produce research findings
that can be more easily assimilated into everyday primary care practice.
In fiscal year 2000, AHRQ awarded planning grants to 19 networks to enhance
their capacity to:
- Study the health care of ethnically and socioeconomically diverse
population.
- Improve data collection.
- Develop methods to assist network clinicians in translating research
findings into practice.
Together, the 19 PBRNs provide access to over 5,000 primary care providers
and roughly 7 million patients in 49 States.
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For More Information
Printed copies of the following Fact Sheets are available without charge from
the AHRQ Publications Clearinghouse at 1-800-358-9295. Order by title and
publication number.
- Databases and related resources from the Healthcare Cost and Utilization
Project (HCUP). AHRQ Publication No. 00-P021, October 2000.
- The Medical Expenditure Panel Survey. A new national health information
resource. AHRQ Publication No. 00-P050, May 2000.
- Advantages of the Medical Expenditure Panel Survey. AHRQ Publication No. 00-P055,
May 2000.
- Excellence Centers To Eliminate Ethnic/Racial Disparities (EXCEED). AHRQ Publication
No. 01-P021, May 2001.
- Integrated Delivery System Research Network (IDSRN). AHRQ Publication No. 01-P004,
October 2000.
- Primary Care Practice-based Research Networks. AHRQ Publication No. 01-P020, June
2001.
- CAHPS®. Consumer Assessment of Health Plans. AHRQ Publication No. 00-P047, September
2000.
- Translating Research Into Practice (TRIP)-II. AHRQ Publication No. 01-P017, March
2001.
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AHRQ Publication No. 02-P009
Current as of December 2001
Internet Citation:
Reducing Ethnic and Racial Inequities in Health Care: AHRQ Resources for
Research. Fact Sheet. AHRQ Publication No.02-P009, December 2001. Agency
for Healthcare Research and Quality, Rockville, MD. http:www.ahrq.gov/research/inequities.htm
540 Gaither Road Rockville, MD 20850