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Achieving Equity in Care

Achieving Equity in Care. Essential Hospitals Engagement Network. June 25, 2013. Our new Name. We’ve rebranded! The National Association of Public Hospitals and Health Systems is now America’s Essential Hospitals .

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Achieving Equity in Care

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  1. Achieving Equity in Care Essential Hospitals Engagement Network June 25, 2013

  2. Our new Name We’ve rebranded! The National Association of Public Hospitals and Health Systems is now America’s Essential Hospitals. Although we’ve changed our name, our mission is the same: to champion hospitals and health systems that provide the highest quality of service to all by achieving the best health outcomes for every patient, especially those in greatest need. The new name underscores our members’ continuing public commitment and the essential nature of our work to care for the most vulnerable and provide vital community services, such as trauma care and disaster response. This is an exciting time for us and our members, as we lean forward into new care models, opportunities and challenges of reform, and quality and safety innovations that often take root in our member systems. Our new website address: www.EssentialHospitals.org

  3. “Q&A” and Chat Please use the “Q&A” or Chat tools on the webinar screen to type in your questions or comments at anytime during this event.

  4. Raise your Hand To raise your hand – you must be in the “Participants” pane. Your line will be un-muted to ask your question. Once your question has been answered, plus un-raise your hand.

  5. Essential Hospitals Engagement Network (eHEN) Achieving Equity in Care Vickie Sears, MS, RN Improvement Coach, America’s Essential Hospitals

  6. Today’s agenda • National Issues and Local Actions • REAL DATA: the San Mateo Medical Center Journey • Addressing Quality and Disparities at Truman Medical Centers • Q & A

  7. Partnership for Patients (pfp) • A public-private partnership to help improve the quality, safety and affordability of health care for all Americans, funded by CMS Innovation Center through the Affordable Care Act • PfP Goals: • Decrease 9 preventable hospital-acquired conditions (HACs) by 40 percent • Infections (CLABSI, CAUTI, SSI, VAP) • Morbidity from immobility (falls, pressure ulcers, VTEs) • Adverse events (drugs, obstetrical) • Reduce preventable readmissions by 20 percent • Engage patients and families to accomplish harm reduction goals

  8. Essential Hospitals Engagement Network (eHEN) • The PfP funds 26 Hospital Engagement Networks (HENs) to provide a wide array of initiatives and activities to improve patient safety. • HENs represent 3,700 hospitals nationwide. • Essential Hospitals Engagement Network (eHEN) is the only HEN in the PfP community focused on serving the most vulnerable population. • Special Focus: increasing health equity

  9. What Are Disparities in Health Care Quality? Differences in quality of health care received by members of different racial or ethic groups that are not explained by other factors. • Can occur at every stage in the continuum of care • Many possible causes and solutions • Disparities in care represent a failure in quality

  10. Why should we focus on disparities? Readmissions • Black patients have a 13% higher odds of readmissions than white patients for myocardial infarction, congestive heart failure, and pneumonia1 Pressure Ulcers • Black residents of nursing homes show higher pressure ulcer rates compared with white residents (16.8% versus 11.4%)2 Obstetrical Events • Preterm birth rates are one third higher for Non-Hispanic African Americans compared to whites3 • Black mothers are significantly less likely (odds ratio 0.31) to receive prenatal care in their first trimester compared to white mothers4 1 . Joynt KE, Orav JE, Jha AK. (2011). Thirty day readmission rates for Medicare beneficiaries by race and site of care. JAMA; 305(7), 675-681. 2. Li Y, Yin J, Cai W, et al. (2011). Association of race and site of care with pressure ulcers in high risk nursing home residents. JAMA; 306(2), 179-186. 3. Spong CY, Iams J, Goldenberg R. et al. (2011). Disparities in perinatal medicine: Preterm birth, stillbirth, and infant mortality. Obstetrics & Gynecology; 117(4), 948-955 4. Paul I, Lehman EB, Suliman AK, Hillemeier MM. (2008). Perinatal disparities for black m others and their newborns. Maternal Child Health Journal; 12, 452-460.

  11. Disparities Continue to exist in quality Source: 2011 National Healthcare Quality and Disparities Reports. March 2012. Agency for Healthcare Research and Quality, Rockville, MD.

  12. Growing u.s. minority population Note: Other includes all Hispanics regardless of race and Non-Hispanics whose race is not White Source: 2012 National Population Projections (Updated May 2013); United States Census Bureau.

  13. Legislative and regulatory attention

  14. Launched in 2011, the National Call Action is a national initiative to end health care disparities and promote diversity. The group is committed to three core areas that have the potential to most effectively impact the field. National Call To Action to Eliminate Health Care Disparities • Goals and Milestone (2013 – 2020) • Goal1) Increasing the collection and use of race, ethnicity and language preference (REAL), • 2011 – 18 percent *(baseline) • 2015 – 25 percent • 2017 – 50 percent • 2020 – 75 percent • Goal 2) Increasing cultural competency training, • 2011 – 81 percent (*baseline) • 2015 – 90 percent • 2017 – 95 percent • 2020 – 100 percent • Goal 3) Increasing diversity in governance and leadership. • 2011 - Governance 14 percent / Leadership 11 percent (*baseline) • 2015 - Governance 16 percent / Leadership 13 percent (or reflective of community served) 2017 - Governance 18 percent / Leadership 15 percent (or reflective of community served) 2020 - Governance 20 percent / Leadership 17 percent (or reflective of community served) *Survey Questions: 1) Is race, ethnicity and primary language data collected at the first patient encounter and used to benchmark gaps in care. 2) Hospital educates all clinical staff during orientation about how to address the unique cultural and linguistic factors affecting the care of diverse patients and communities. 3)Racial/ethnic breakdown for each of the executive leadership positions and members of the hospital’s board in your hospital.

  15. REAL Data: three key actions Standardize categories and methods for data collection • Use Office of Management and Budget (OMB) categories • Patient self-reports Stratification and analysis of performance measures • Compare patients within an organization • Consolidate data to identify community-level trends Use stratified data to identify gaps in care and develop quality improvement interventions to address disparities Source: (IOM) Institute of Medicine. 2009. Race, Ethnicity, and Language Data: standardization for Health care Quality Improvement. Washington , DC: The National Academies Press.

  16. National snapshot of real data use Source: AHA Diversity & Disparities: A benchmark study of U.S. hospitals, June 2012

  17. Collection of patient ReAl data in eHEN hospitals Source: 2012 Organizational Assessment Tool (OAT) – over 90% of eHEN hospitals reporting

  18. Methods for collecting patient reAl dataamong eHEN hospitals Uses Staff Observation at Times(43%) Source: 2012 Organizational Assessment Tool (OAT) – over 90% of eHEN hospital reporting

  19. Common languages spoken by patients in eHEN hospitals Source: 2012 Organizational Assessment Tool (OAT) – over 90% of eHEN hospitals reporting

  20. The Opportunities in eHEN Hospitals Source: 2012 Organizational Assessment Tool (OAT) – over 90% of eHEN hospital reporting

  21. Moving towards action • Disparities in care are far to common • Some are under our control • We must start with actionable data (REAL) “Effective data collection is the linchpin of any comprehensive strategy to eliminate racial and ethnic disparities in health.” – Thomas Perez, JD MPP, Current Assistant US Attorney General for the Civil Rights Division, from Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, March 2002

  22. Moving towards action: eHEN 6 month PLan • Next Equity Webinar: September 5th at 2:00pm ET • Topic: Exploring Health Literacy • Mid-September: eHEN data feedback report on outcome measures stratified by race and ethnicity • Offer training to hospital staff on standardizing self-reported REAL data • Disseminate “bright spots” in achieving equity

  23. San mateo Medical Center Jonathan S. Mesinger, PhDCultural Competence LeaderClinics ManagerSan Mateo Medical CenterEmail:jmesinger@co.sanmateo.ca.us Phone:  (650) 578-7187

  24. Identifying & Addressing Disparities in Healthcare REAL Data Jonathan Mesinger Cultural Competence Coordinator San Mateo Medical Center 2013 jmesinger@smcgov.org

  25. Concepts • Disparities in medical outcomes and provision of healthcare services, based on cultural and language differences, are a pervasive problem • Identifying the nature and extent of these disparities at the local level requires careful analysis of patient demographic data and core measures • The accuracy and relevance of the demographic information can determine the success of this analysis • The organization must be committed to making changes in data collection needed to guarantee accurate, useful data

  26. Race, Ethnicity and Language Data THE PROBLEM • Patient demographics were collected using a list of categories and responses that were archaic and not very useful • Staff did not understand the importance of the information, so were collecting data that were inaccurate, incomplete or based on assumptions • No attempt had been made to link this inadequate patient cultural data to health outcomes for disparities analysis • Information on patient language did not indicate the level of English proficiency or the patient’s language preference.

  27. Race, Ethnicity and Language Data REPORTING LIMITATIONS • Federal and State reporting requirements dictate the structure and response set for patient demographics • Staff responsible for reporting are resistant to change that might interfere with their adherence to reporting requirements • Changes in the data fields and responses need to preserve the integrity of the required data, while improving the ability of the organization to acquire meaningful patient cultural information • Reporting staff need to be convinced that these changes are possible and non-threatening

  28. Race, Ethnicity and Language Data THE REAL DATA INITIATIVE • Obtain the blessing of executive management for the project and include it in the organization’s DSRIP goals • Work with key stakeholders within the organization and the community to develop standards for cultural data collection • Create a new set of race, ethnicity and language categories and responses • Align the new data elements with federal and state reporting requirements, as well as CLAS and Joint Commission standards • Revise policies and procedures to reflect the new process

  29. Race, Ethnicity and Language Data RACE • Categories are defined by OMB and cannot be changed • Hispanic or Latino not listed as a race • Many patients are multiracial or do not know their race • Accuracy based on patient self-report, not assumptions • Is race a meaningful way to differentiate our patients?

  30. Race, Ethnicity and Language Data ETHNICITY • The only federal “ethnicity” question is “Are you Hispanic?” • OMB has a suggested granular list of ethnicities, but this list can be tailored to the reflect the patient population • The granular list provides a more vivid, robust and meaningful characterization of the organization’s patients • The ethnicity list provides information beyond what is reported and allows the patient to self-determine • Ethnicity data help us understand who are patients are and how we can improve their care

  31. Race, Ethnicity and Language Data LANGUAGE • In California, acceptable language reporting responses are determined by OSHPD (Office of Statewide Health, Planning & Development) • HRSA requires a question about English proficiency • In REAL Data, staff are trained to ask the patient what language they prefer to use, not just their primary language: “What language do you feel most comfortable speaking with your Doctor or your Nurse Practitioner today?” • Meaningful, accurate patient language data are useful for • Identifying and addressing disparities in health care • Determining the need for interpretation • Improving patient services and satisfaction • Meeting Joint Commission standards

  32. Race, Ethnicity and Language Data THE REAL DATA INITIATIVE • Work with IT staff to change the data entry fields in the patient registration system (Invision) • Create a data survey form to collect the data for the new system • Create scripts for staff use in obtaining information from patients • Train staff at all points of patient demographic data collection on the new way of collecting and entering this information • Implement the new REAL Data initiative simultaneously, organization-wide.

  33. RACE • Hispanic? • ETHNICITY • English Proficiency • Preferred LANGUAGE

  34. Race, Ethnicity and Language Data BASIC DISPARITIES ANALYSIS

  35. Race, Ethnicity and Language Data FOLLOWING UP: • Monitor data regularly for accuracy and completeness • Retrain staff as needed to improve data quality • Produce REAL Data reports for the organization • Check individual patient’s preferred language and English proficiency to determine interpretation needs • Quality Department uses REAL Data and core measures/health outcomes/service provision data, to illuminate any disparities and develop initiatives to address them

  36. Truman Medical Centers John W. Bluford, MBA, FACHEPresident & CEOTruman Medical Centers

  37. America’s Essential HospitalsEquity Webinar John W. Bluford President/CEO Truman Medical Centers

  38. Diversity in Governance Makes Good Business Sense Diversity in Governance Diverse Perspectives Better Decisions! Better Outcomes! Good Governance is Important!

  39. Truman Medical Centers: Diversity OnBoard Paul Black Jon Gray Peggy Dunn Joanne Collins Bucky Brooks Juan Rangel Mark Steele Rev. Eric Williams Phil Richter Sarah Chavez Leo Morton Peter Levi Joy Wheeler Dennis O’Leary Ryan Watson 2012 Truman Medical Centers

  40. Truman Medical Centers

  41. Truman Medical Centers

  42. Thank you for attending! • Save the Date: Exploring Health Literacy – Sept. 5 • 2-3 pm Eastern • Evaluation: Following the webinar, when you close out of WebEx, a yellow evaluation of the webinar will open in your browser. We greatly appreciate your feedback! • Essential Hospitals Engagement Network website: http://tc.nphhi.org/Collaborate

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