Integrating Women into Health Care Research, Quality Improvement, and Value Assessment

Person wearing a medical gown. Doctor standing in the foreground

By Sophia Kenward, SWHR Communications and Policy Intern

Across research and health policy, the unique needs of women as patients, caregivers, and primary health care decision-makers for their families are receiving more attention. This includes considering how sex and gender influence patient needs and health outcomes.

During SWHR’s June Policy Advisory Council meeting, SWHR hosted two experts in value assessment and health care research and quality improvement: Dr. Richard Chapman, chief science officer at the Innovation and Value Initiative (IVI), and Dr. Camille Fabiyi, senior advisor for women’s health and gender research at the Agency for Healthcare Research and Quality (AHRQ). Chapman and Fabiyi shared insight on women’s health priorities and the important work that their organizations are engaged in to address equity issues within the health care system. 

Considering Women’s Perspectives in Value Assessment

When a new health care innovation comes to market, organizations like IVI seek to determine the value of the product through examining clinical, economic, and other relevant evidence to determine how the new intervention compares to the current clinical standard in improving health. However, Chapman noted the need for value assessment to evolve. He shared that a broader range of evidence in value assessment could better account for a woman’s reality, such as the impact that living with a health condition has on a woman’s ability to work and perform daily tasks.

The health care system must also take into account the needs of women who are caregivers and the primary decision-makers in their families. Women juggle many roles and are therefore uniquely positioned to provide a variety of perspectives on the value of a treatment and how it impacts their daily lives and their ability to fulfill their roles in society. “Right now, the current attention that is being paid to equity issues in health care — because of COVID-19 and the Black Lives Matter movement — give us an opportunity to shape the future of value assessment methods and make sure when we do these types of analyses that we’re not ‘hard-wiring’ in current inequities,” Chapman said.

Chapman’s comments highlighted the importance of developing value frameworks that are designed to comprehensively measure value and ensure women have appropriate access to innovative new therapies and interventions. SWHR regularly advocates for the consideration of women’s needs and patient diversity in the value assessment process and developed principles to ensure that health care value frameworks and assessments work for this population.

Gathering Data on Women to Guide Health Care Decisions

AHRQ has implemented several programs and policies in order to prioritize women’s health in its work, Fabiyi said. These initiatives, some of which are outlined below, inform quality improvement and drive health services research.

The Healthcare Research and Quality Act of 1999 first established priority populations for AHRQ, directing the agency to conduct and support research with respect to the delivery of health care in inner-city and rural areas and for a number of priority populations, including women.

AHRQ’s Medical Expenditure Panel Survey (MEPS) is a nationally representative survey of nearly 15,000 households that is used to make estimates regarding health care utilization, accessibility and quality of care, and medical conditions. MEPS data can be used to identify and report on health conditions specific to women or that disproportionately or differently affect women. For example, a study funded by the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) used MEPS data to examine pregnancy among women with various types of disabilities and with differing levels of disability complexity, compared to women without disabilities.

AHRQ also releases the annual National Healthcare Quality and Disparities Reports (QDR), which measure access to care, affordable care, care coordination, effective treatment, healthy living, patient safety, and person-centered care. The QDR presents the latest findings on health care quality and disparities related to race and ethnicity, income, and other social determinants of health, including gender. “The QDR is unique in that it is the only report that tracks the nation’s progress each year in improving health care quality over time while also taking a snapshot of the health care disparities,” Fabiyi said.

The MEPS and the QDR are accessible to the public and used to inform research, policy, and other health care decisions. Data that examine subpopulations and address disparities allow clinicians, researchers, policymakers and other decision-makers to prioritize efforts to improve care for conditions that impact underserved populations.

Looking Forward

“Part of what the COVID pandemic has done is highlight some of the inequities in the system,” Chapman said. “As we come out of this, the worst thing that can happen would be that we go back to the status quo.”

“Going forward, with our new administration making [equity] a priority, I think it will be top of mind for researchers to be thoughtful in how they go about including [underserved] groups” Fabiyi said.

Collaborations between federal agencies, medical professional societies, and health systems can create better health care policy, better clinical guidelines, and better health decisions, leading to longer and healthier lives for all Americans. But these decisions must be informed by examining existing inequities and disparities from a patient-focused lens. SWHR remains committed to amplifying the voices of women and underserved populations so that they can access health care that works for them.

By Sophia Kenward, SWHR Communications and Policy Intern

Across research and health policy, the unique needs of women as patients, caregivers, and primary health care decision-makers for their families are receiving more attention. This includes considering how sex and gender influence patient needs and health outcomes.

During SWHR’s June Policy Advisory Council meeting, SWHR hosted two experts in value assessment and health care research and quality improvement: Dr. Richard Chapman, chief science officer at the Innovation and Value Initiative (IVI), and Dr. Camille Fabiyi, senior advisor for women’s health and gender research at the Agency for Healthcare Research and Quality (AHRQ). Chapman and Fabiyi shared insight on women’s health priorities and the important work that their organizations are engaged in to address equity issues within the health care system. 

Considering Women’s Perspectives in Value Assessment

When a new health care innovation comes to market, organizations like IVI seek to determine the value of the product through examining clinical, economic, and other relevant evidence to determine how the new intervention compares to the current clinical standard in improving health. However, Chapman noted the need for value assessment to evolve. He shared that a broader range of evidence in value assessment could better account for a woman’s reality, such as the impact that living with a health condition has on a woman’s ability to work and perform daily tasks.

The health care system must also take into account the needs of women who are caregivers and the primary decision-makers in their families. Women juggle many roles and are therefore uniquely positioned to provide a variety of perspectives on the value of a treatment and how it impacts their daily lives and their ability to fulfill their roles in society. “Right now, the current attention that is being paid to equity issues in health care — because of COVID-19 and the Black Lives Matter movement — give us an opportunity to shape the future of value assessment methods and make sure when we do these types of analyses that we’re not ‘hard-wiring’ in current inequities,” Chapman said.

Chapman’s comments highlighted the importance of developing value frameworks that are designed to comprehensively measure value and ensure women have appropriate access to innovative new therapies and interventions. SWHR regularly advocates for the consideration of women’s needs and patient diversity in the value assessment process and developed principles to ensure that health care value frameworks and assessments work for this population.

Gathering Data on Women to Guide Health Care Decisions

AHRQ has implemented several programs and policies in order to prioritize women’s health in its work, Fabiyi said. These initiatives, some of which are outlined below, inform quality improvement and drive health services research.

The Healthcare Research and Quality Act of 1999 first established priority populations for AHRQ, directing the agency to conduct and support research with respect to the delivery of health care in inner-city and rural areas and for a number of priority populations, including women.

AHRQ’s Medical Expenditure Panel Survey (MEPS) is a nationally representative survey of nearly 15,000 households that is used to make estimates regarding health care utilization, accessibility and quality of care, and medical conditions. MEPS data can be used to identify and report on health conditions specific to women or that disproportionately or differently affect women. For example, a study funded by the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) used MEPS data to examine pregnancy among women with various types of disabilities and with differing levels of disability complexity, compared to women without disabilities.

AHRQ also releases the annual National Healthcare Quality and Disparities Reports (QDR), which measure access to care, affordable care, care coordination, effective treatment, healthy living, patient safety, and person-centered care. The QDR presents the latest findings on health care quality and disparities related to race and ethnicity, income, and other social determinants of health, including gender. “The QDR is unique in that it is the only report that tracks the nation’s progress each year in improving health care quality over time while also taking a snapshot of the health care disparities,” Fabiyi said.

The MEPS and the QDR are accessible to the public and used to inform research, policy, and other health care decisions. Data that examine subpopulations and address disparities allow clinicians, researchers, policymakers and other decision-makers to prioritize efforts to improve care for conditions that impact underserved populations.

Looking Forward

“Part of what the COVID pandemic has done is highlight some of the inequities in the system,” Chapman said. “As we come out of this, the worst thing that can happen would be that we go back to the status quo.”

“Going forward, with our new administration making [equity] a priority, I think it will be top of mind for researchers to be thoughtful in how they go about including [underserved] groups” Fabiyi said.

Collaborations between federal agencies, medical professional societies, and health systems can create better health care policy, better clinical guidelines, and better health decisions, leading to longer and healthier lives for all Americans. But these decisions must be informed by examining existing inequities and disparities from a patient-focused lens. SWHR remains committed to amplifying the voices of women and underserved populations so that they can access health care that works for them.