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WCHQ Report Identifies Health Disparities in Rural, Urban Locations

November 16, 2020

WCHQ shares data to inform work that will reduce health disparities associated with where people live

A report released today by the Wisconsin Collaborative for Healthcare Quality (WCHQ) identifies where disparities in health outcomes and care exist in rural and urban areas in Wisconsin. The report uses a unique categorization system developed by investigators at the University of Wisconsin Health Innovation Program (HIP) and provides important data to inform and accelerate the work statewide aimed at eliminating health disparities.

The “WCHQ Health Disparities Report: Rural and Urban Populations” shows where gaps in health outcomes and care exist in Wisconsin by urban or rural location. The data were submitted to WCHQ by 25 health systems and medical clinics and it represents the most complete and recent (2018) data available for this work.

“With this second report, WCHQ is providing the information that is necessary to create, implement and measure the results of interventions and programs aimed at reducing health disparities,” according to report co-author Matt Gigot, WCHQ director of performance measurement and analysis. “This information makes it possible to benchmark current performance and measure progress over time. Reliable data that are collected in a standardized and consistent way are essential when the goal is improving performance.”

The report found that some people in Wisconsin are experiencing a wide range of substantial disparities across several measures. Substantial was defined as 10 percent lower than the population group with the highest rate on the measure.

The results show:

  • People living in rural underserved areas are experiencing substantial disparities in colorectal cancer screening and are much less likely to be tobacco-free if they have heart disease;
  • Rural areas classified as advantaged have a much lower HPV vaccination rate;
  • There were substantial disparities in the urban underserved population in two areas: childhood vaccinations and optimal control of heart disease, which includes blood pressure control, use of statin and daily aspirin, and no tobacco use; and,  
  • Those who are categorized as urban advantaged were screened for depression significantly less often than the highest performing group.

“Disparities in health outcomes and health care exist across and within rural and urban areas. In the 2019 Wisconsin Disparities Report, we found that simply defining an area as rural or urban was masking disparities in health outcomes and care. We needed to account for the unique characteristics that influence health across and within rural and urban areas,” according to HIP investigator, Jennifer Weiss, MD, MS, a UW-Health tenured associate professor in the division of gastroenterology and hepatology at the University of Wisconsin School of Medicine and Public Health.

In the new report, the UW-Madison Health Innovation Program (HIP) presented six new and distinct rural and urban groupings: rural underserved, rural, rural advantaged, urban underserved, urban, and urban advantaged. These six groups were identified by examining health-related characteristics (i.e. health care capacity, economic status, and health status) of every ZIP code in Wisconsin. The results show that across and within rural and urban areas, there are significant variations in these health-related resources. Health care providers can use these geographical groupings to identify ways to better treat patients based on the characteristics of where patients live.

In the past, rural and urban definitions have been limited to broad descriptions that did not capture the difference between, for example, rural areas with few resources related to health and rural areas that are more affluent. That lack of specificity has hampered the creation or application of explicit policies and programs that address a specific area of the state.

“People experience health care in different ways, which are influenced by multiple factors. We know where people live is one of the biggest determinants of their health,” according to Weiss. “To close those gaps and improve care for everyone will require a community-wide response from multiple stakeholders who can address issues such as poverty, housing, food insecurity and many other factors that have an impact on overall health.”

Funding for the WCHQ Health Disparities Report  was provided by the Wisconsin Partnership Program at the UW School of Medicine and Public Health (SMPH), which is committed to improving the health of Wisconsin residents and reducing health disparities through research, education and community partnerships.

“This project represents an important strategic investment for the Wisconsin Partnership Program,” said Richard Moss, PhD, SMPH senior associate dean. “It aligns directly with our goal to advance health equity and improve health in Wisconsin. By identifying the unique ways individuals experience health disparities in both urban and rural settings, this data will guide health systems and others in developing approaches to addressing these gaps.”

While the data can be used to calculate a statewide average, WCHQ President/CEO Gabrielle Rude, PhD, said the goal is not to achieve a benchmark.

“The goal is not to be average. The goal is to eliminate disparities in our state, and the best way to do that is to start with reliable data that can be used to develop quality improvement initiatives, and then to monitor progress and see what works,” according to Dr. Rude. “The health systems are committed to raising the health status of every person living in Wisconsin, which requires a broad coalition of community stakeholders working together toward the same goal. We know it must and can be done.”

WCHQ has been collecting data from their members, sharing results and publicly reporting progress on specific measures of health quality for more than 15 years. Dr. Rude said Wisconsin health care organizations have consistently shown that what is measured, can be improved.  

“Health equity is a community strength and an economic development asset. We all want to live and work in an area where there are equal opportunities to be healthy,” Dr. Rude said. “This report and the work that it will support statewide will help us get a step closer to that goal.”

Contact:  Mary Kay Fahey, WCHQ

The Wisconsin Collaborative for Healthcare Quality collects and publicly reports health system clinical performance information that is used to improve the quality and affordability of care, which improves the health of individuals living in Wisconsin’s communities.

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