Health Equity Monitoring for Healthcare Quality Assurance - small area analysis
This paper was contributed to by Professor Peter Goldblatt of the UCL Institute of Health Equity. Full Author list: R. Cookson; M. Asaria; S. Ali; R. Shaw; T. Doran; P. Goldblatt (IHE).
The paper aims to illustrate how the use of a new NHS Equity Indicator, developed by a team incuding Dr Peter Goldblatt of the UCL IHE, can be used as a tool to provide quality assurance information, about the NHS duty to consider reducing inequalities in both access and outcomes of healthcare (Health and Social Care Act, 2012).
Quality of care and health equity have become two of the key issues on policy agendas worldwide. Efforts to improve quality have focused on safety and cost-effectiveness, with improvements in equity largely a by-product of reducing variation in performance between providers, whereas policy responses to health equity have focused on the wider social determinants of health rather than healthcare delivery.
Due to this parallel development, quality improvement agencies (for example, the Organisation for Economic Co-operation and Development's (OECD) Health Care Quality Indicators project) and quality improvement frameworks (for example, the Quality and Outcomes Framework in the UK) and accountable care organizations (ACOs) in the US (Centers for Medicare and Medicaid Services, 2017) often overlook equity.
The paper illustrates the NHS equity indicator based on the sub-set of potentially avoidable emergency admissions for chronic ambulatory care sensitive conditions. This is an indicator of the quality of ambulatory care services in managing long-term conditions and the equity version of this indicator is intended to provide quality assurance information about the NHS duty to consider reducing inequalities in both access and outcomes of healthcare (Health and Social Care Act, 2012). This paper uses this indicator to illustrate the general analytical approach and discuss its potential application to healthcare quality assurance in other countries.