Health Disparities in Utilization, Quality, and Outcomes for Three Common Ocular Conditions (HealthDOC)

Multiple past studies provide strong evidence that disparities exist in healthcare, including ophthalmology and the social determinants may health play an important role for explaining differences in ethnic and racial minority receipt of healthcare. With the passage of the Affordable Care Act and later the Medicare Access and CHIP Reauthorization Act of 2015, there has been emphasis on medical quality measures with implementation of the Medicare Incentive Payment System (MIPS) and National Quality Forum (NQF) related metrics. By law those participating in the Medicare program are required to report data on the quality of care to receive certain payments. However, ophthalmic quality reporting on healthcare disparities is poorly understood. Unfortunately, there has been little research to inform how the social determinant of health impact ophthalmology care practices on quality metrics for ethnic patients with cataract, glaucoma, and diabetic retinopathy and move towards medical quality progress for reducing health disparity quality of care differences over time. The proposed Health Disparities in Utilization, Quality, and Outcomes for Three Common Ocular Conditions (HealthDOC) study will have high significance by addressing prevailing gaps between clinical quality measures, evidence, and practice, by employing a rigorous health services and outcomes research study design that evaluates ophthalmic NQF, MIPS, and other clinically meaningful measures using The Sight Outcomes Research Collaborative (SOURCE) to study health disparities. SOURCE links and extracts data across healthcare systems from electronic health records to capture visual changes, clinical details (typically not available but through clinical trials) and capture health disparities which is ideal for responding to Healthy People 2030 ocular goals. This study will examine three major eye diseases (cataract, glaucoma, diabetic eye disease) and quantify the impact of social determinants of health (SDH) on achievement of established MIPS and NQF quality metrics, likelihood to receive diagnostic and therapeutic interventions, disease severity, other clinically meaningful measures on visual outcomes, and non-ocular morbidity and mortality. The ocular conditions we focus on are the most common causes of irreversible visual impairment and blindness in the U.S. and target goals for National Eye Institute and Healthy People 2030. The research strategies are innovative, stakeholder-driven, and aligned with healthcare management using accepted quality metrics (NQF, MIPS), leveraging existing data from electronic health records on over 15 ophthalmology program sites to move towards quality improvement initiatives aimed at reducing health disparities across SOURCE sites and abroad. The research approaches are designed to improve alignment of ophthalmology programs with the Health People 2030 NEI goals of reducing health disparities by assessing the quality of care and treatment for racial and ethnic minorities on the three most common ocular diseases of cataract, glaucoma, and diabetic retinopathy.