Ohio Health Policy News

The American Heart Association announced this week plans to release a new clinical tool that removes race as a factor in predicting who will have heart attacks or strokes (Source: “Race Cannot Be Used to Predict Heart Disease, Scientists Say,” New York Times, Nov. 14).
 
Doctors have long relied on a few key patient characteristics to assess risk of a heart attack or stroke, using a calculus that considers blood pressure, cholesterol, smoking and diabetes status, as well as demographics: age, sex and race. Now, the American Heart Association is taking race out of the equation.
 
The overhaul of the widely used cardiac-risk algorithm is an acknowledgment that, unlike sex or age, race identification in and of itself is not a biological risk factor. The scientists who modified the algorithm decided from the start that race itself did not belong in clinical tools used to guide medical decision-making, even though race might serve as a proxy for certain social circumstances, genetic predispositions or environmental exposures that raise the risk of cardiovascular disease.
 
The revision comes amid rising concern about health equity and racial bias within the U.S. health care system and is part of a broader trend toward removing race from a variety of clinical algorithms. “We should not be using race to inform whether someone gets a treatment or doesn’t get a treatment,” said Dr. Sadiya Khan, a preventive cardiologist at Northwestern University Feinberg School of Medicine, who chaired the statement writing committee for the American Heart Association.

Join HPIO on Thursday, Oct. 26, from 11 a.m.-12:30 p.m., for an online forum to explore how Ohio can grow its workforce, increase consumer spending, strengthen communities and reduce fiscal pressures on state and local budgets.

This forum will take a closer look at HPIO's recent brief, "Unlocking Ohio’s economic potential: The impact of eliminating racial disparities on Ohio businesses, governments and communities." Speakers will discuss the factors that contribute to racial disparities in Ohio, offer data and insight about the economic benefits Ohio could gain by eliminating disparities and provide examples of actions Ohioans can take to eliminate racism, improve health and increase economic vitality.

For more information and to register, click here.

The Health Policy Institute of Ohio has released an action guide that highlights policy options for addressing racism, one of the social drivers of infant mortality in Ohio. 

Earlier this year, HPIO produced the Social Drivers of Infant Mortality: Recommendations for Action and Accountability in Ohio report as an update to the 2017 A New Approach to Reduce Infant Mortality and Achieve Equity report.

This action guide takes a closer look at the recommendations related to racism in the Action and Accountability report and provides state and local health stakeholders with additional information and tools to support next steps. The guide, and additional tools posted on the HPIO website, can be used to prioritize, advocate for and implement the recommendations.
 
Everyone deserves to live a long, healthy and fulfilling life. However, Black infants in Ohio are over 2.5 times more likely to die before their first birthday compared to white infants, as illustrated in the graphic above.
 
“Racism (including internalized, interpersonal, institutional and structural racism) is at the root of racial health disparities, such as the racial differences in infant mortality rates,” according to the guide.

HPIO recently released similar action guides on housing, education, transportation and employment.

Support for this project was provided by the Bruening Foundation and HPIO’s other core funders.

The Health Policy Institute of Ohio today released new analysis that found that if Ohio eliminated racial disparities, by 2050 the state could gain $79 billion in economic output each year, an increase of 10% over current gross state product. 

Titled “Unlocking Ohio’s Economic Potential: The Impact of Eliminating Racial Disparities on Ohio Businesses, Governments and Communities,” the analysis is a first-of-its-kind look at the economic potential associated with eliminating racial and ethnic disparities in Ohio, as illustrated in the graphic above.  

“Beyond the substantial impacts on people and communities of color across Ohio, disparities in outcomes, such as life expectancy and overall health status, represent missed economic opportunities for Ohio businesses, governments and communities,” the report finds. “By eliminating racial disparities, leaders in Ohio can grow the workforce, increase consumer spending, strengthen communities and reduce fiscal pressures on state and local budgets.”   

The report also includes recommended action steps and examples of how states, counties and municipalities across the country are implementing policies to reduce disparities. 

“Ohioans of all ages and from all sectors, communities and backgrounds can take meaningful steps to dismantle systemic racism and improve the health and economic vitality of the state,” according to the report. 

Support for this project was provided by bi3, Interact for Health, The Columbus Foundation and HPIO’s other core funders. 

Even the highest-performing hospitals see racial health disparities in adverse patient safety events, according to a new report (Source: “Even At Top Hospitals, Racial Health Disparities in Patient Safety Are Steep,” Patient Engagement HIT, June 7).
 
The report from the Leapfrog Group and Urban Institute showing that, regardless of a hospital’s rating in the Leapfrog Group’s scorecard, white patients were less likely to experience an adverse patient safety event than their Black and Hispanic peers.
 
The consistency of health disparities across all hospital rating grades indicates that the Leapfrog Group reports “cannot be used to convey information on the underlying disparity in safe inpatient care,” the researchers said. That means patients who fall into the groups facing more adverse events may need additional tools to help with care access decision-making.

The Health Policy Institute of Ohio has released the latest edition of its biennial Health Value Dashboard, which found that Ohio ranks 44 on heath value compared to other states and D.C. (as displayed in the graphic above).

That means that Ohioans are living less healthy lives and spending more on health care than people in most other states.

The Dashboard is designed for policymakers and other public- and private-sector leaders to examine Ohio’s performance relative to other states, track change over time and identify and explore health disparities and inequities in Ohio. The report also highlights evidence-informed strategies that can be implemented to improve Ohio’s performance.

With more than 100 data metrics, the report can be a valuable tool as Ohio’s leaders continue to develop the state’s biennial budget over the next two months.

In the fifth edition of the Dashboard, HPIO identified three specific areas of strengths on which Ohio can build to create opportunities for improved health value in the state:

• Strengthen Ohio’s workforce: Ohio can build upon recent success in attracting employers in high-growth industries to strengthen the workforce and reduce poverty
• Foster mental well-being: Ohio can build upon expertise with, and community response to, the addiction crisis to become a national leader in behavioral health
• Improve healthcare effectiveness: Ohio can build upon strengths in access to care to reinvigorate approaches to improving outcomes and controlling healthcare spending

Policy changes made in Ohio over the last decade that have expanded access to care also reduced the gap between Black and white Ohioans who report going without care due to cost, as displayed in the graphic above.

As Ohio observes Minority Health Month in April, it is clear that although progress has been made, there is still work to be done to eliminate health disparities. In HPIO’s 2023 Health Value Dashboard, which will be released in late April, the Institute found that if the racial gap in ability to pay for health care was fully closed, nearly 45,000 more Black Ohioans would not experience financial barriers to care.

HPIO is hosting a forum from 10:30 a.m.- 4 p.m. on Monday, May 1, focused on the release of the 2023 Dashboard. The event will be held in-person at the Grand Event Center in Grandview/Columbus. Throughout the forum, we will celebrate HPIO’s 20th anniversary. In appreciation of all of our supporters and partners, we will host a reception immediately following the forum, from 4 p.m.- 5:30 p.m. The last day to register is Friday, April 21, 2023.

As new generative AI models like ChatGPT gain popularity, some experts are saying that to ensure such tools work in healthcare, implicit racial biases baked into health data must be accounted for (Source: “Google, Microsoft execs share how racial bias can hinder expansion of health AI,” Fierce Healthcare, Feb. 23). 
 
The goal is for AI to one day “support clinical decision-making [and] enhance patient literacy with educational tools that reduce jargon,” said Jacqueline Shreibati, M.D., senior clinical lead at Google. 
 
However, there are gaps around the use of these models in healthcare. Chief among them is that clinical evidence is always evolving and changing. Another key problem is the data themselves may have racial bias that needs to be mitigated. 
 
“A lot of our data has structural racism baked into the code,” Shrebati said.

Research by the federal Office of the National Coordinator for Health IT has found racial and ethnic disparities in patient access to, and usage of, electronic health records (Source: “Report confirms racial disparities in patient access to their health data,” Healthcare IT News, Jan. 5).

Published in the Journal of the American Medical Informatics Association, the ONC study found that in 2019 and 2020, "black and Hispanic individuals were significantly less likely to report being offered and subsequently accessing their portal."

Black and Hispanic people were not offered (5.2 percentage points less likely) and did not access patient portals (7.9 percentage points less likely) nearly as often as white people. 

But when offered access, disparities largely diminished. According to the study, "individuals offered a portal and encouraged to use it by their providers "were 21 percentage points more likely to access it."

"Taken together, our findings point to the important role of healthcare providers in increasing access to EHI by offering portals and encouraging their use," study coauthor Chelsea Richwine, an economist with ONC's Office of Technology, wrote.

Urban centers are seeing the highest rates of pregnancy complications for Ohio women, followed by Appalachia, with Black women being impacted the most, a report from HPIO found (Source: “Severe pregnancy complications are affecting Black women in Ohio the most,” Ohio Capital Journal, Nov. 28).

The brief, Racial and Geographic Disparities in Maternal Morbidity and Mortality, points to systemic racism, a lack of health care access and poor community conditions as reasons for the disparities.

Not only are there disparities in general maternal health, but also in maternal morbidity: severe complications that happen during or after labor and delivery that can lead to other major health problems, including hysterectomy or the need for a blood transfusion, according to the brief.