Healthy People Consortium Meeting and Public Hearing
"Building the Next Generation of Healthy People"
November 12 and 13, 1998
Capital Hilton, Washington, D.C.

Access to Quality Health Services

Notes are arranged by main topics of discussion, with specific comments about related draft objectives under each topic heading. The three main topics discussed by participants included:

1) Emergency Services,

2) Meaningful data about health disparities, and

3) Clinical preventive services and primary care.

In addition to these areas, there was discussion, but no agreement, about including more objectives based on the Patients' Bill of Rights. There were a few comments related to strengthening language: highlighting financial access as the most critical issue in the introduction, using words such as "unconscionable" in reference to the numbers uninsured, cite Medicare as an example of our ability to reduce disparity and poverty, etc.

When asked, several people thought the chapter should include some measures on inpatient care. Several possibilities were mentioned including hospital readmission rates, quality of discharge planning and information, and denials of admission. It was mentioned that JCAHO requires reporting readmissions within 72 hours of discharge.

There was a brief discussion of long-term care issues and recommendations were made to consider the access to defibrillators, fall incidence, restraint use, and use of Foley catheters.

A suggestion was made to specifically define an emergency. There was substantial discussion about managed care enrollees frequently having impeded access to emergency services, even in comparison with the uninsured and how objectives A1 and C2 could be made more accurate. Getting approval prior to treatment is often a barrier to access to care. A suggestion was made to look at access to care data that analyzes emergency department visits following initially declined treatments and/or hospital admissions. Specific data sources (i.e., Florida state and the VA databases) have been identified and can be used to assess emergency department visits within the past 72 hours.

Several comments were made about how to strengthen specific objectives; for example, to increase access to defibrillators, and decrease response time for first responders. Several potential data sources were mentioned including data from the International Association of Fire Fighters, local and county fire departments, and complaints monitored by the Health Care Financing Administration.

A1) Several people recommended that "emergency services" be deleted from the first sentence because of the impediments to emergency care among those insured through managed care.

C1) 9 minutes is too liberal and should be reduced to 5. There may be state level data as well as firefighter and private ambulance company data for measurement.

C2) Consider changing this measure to states having a system in place to review denials of claims and take action based on those reviews.

C2) Consider tracking other measures of access/denied access (e.g., "non-emergent patients readmission rates to emergency departments).

C2) The appropriateness of health care policy statements was questioned in reference to objective C2, line 44, which states, "However, health plan gate-keeping requirements discourage some enrollees from receiving emergency treatment when and where it is warranted."

C3) Consider changing the wording so that objective measures whether every resident has access to Poison Control Centers (i.e., the telephone number and a telephone). Also many centers not currently staffed 24 hours and that wording should be changed to state that all residents have 24-hour access to certified Poison Control Centers.

C4b) 10 minutes too liberal–decrease to 6 minutes.

C6) Add substance use. Meaningful data about health disparities It was stated that there is no mention of immigrants, refugees, migrant workers, or prison populations in the document. Because there is a very limited information about these populations, a suggestion was made to develop data sources to evaluate access to care issues for these groups. It was stated that language barriers interfere with access to care for minorities. More minority health professionals are needed to decrease cultural disparities; however, the cost of higher education was stated as an obstacle for minorities entering health professions.

A1) Use data source that allows measurement for Native Americans and Asian or Pacific Islanders.

A5) Cultural competency should be mentioned.

A5) Either be generic about including all providers or be more comprehensive in the listing (i.e., nurse practitioners not mentioned but physician assistants are).

A5) Mention injury prevention.

B4) Should measure for immigrants and other vulnerable populations as well.

C3) Should also measure language barriers to poison control centers.

C6, D1)Should have access to culturally competent services.

The time allowed per patient visit and the delivery of these services were suggested as reasons for limited opportunities for receipt of patient education from providers. Access to care for the elderly and rural populations is also effected by the amount of travel required to receive care. It was encouraged that a greater emphasis on disease management coupled with patient education be incorporated into the access objectives. Another recommendation was to include substance abuse counseling and education components of the access objectives into the specific chapters addressing tobacco and alcohol issues.

A2) Consider having objective on plan or company having guidelines for coverage of clinical preventive services rather than coverage of a specific package.

A3a) Add injury prevention and weight management.

B1a) Look at appropriate use of medical home (i.e., receive majority of care in a coordinated way).

B2) Look at by geographic areas (e.g., MSAs vs. non-MSAs, rural vs. urban).

B3) Consider deleting or major rewording. Partially addressed by B2 but very difficult to interpret as well.

B5a) Why should this be split out for nurses only and not physicians, dentists, etc.?