The National Call to Action to Eliminate Health Care Disparities: Hospitals Answering the Call

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• The National Call to Action to Eliminate Health
  Care Disparities Hospitals Answering the Call
• Cincinnati Expecting Success
• November 16, 2011
• Nancy Strassel
• Senior Vice President
• Greater Cincinnati Health Council

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Cincinnati Expecting SuccessAcknowledgements
The Greater Cincinnati  Health Council is leading
the work of Cincinnati Expecting Success as part
of Cincinnati Aligning Forces for Quality, an
initiative of the Health Collaborative and the
Robert Wood Johnson Foundation.
Marcia Wilson, Vickie Sears, Marsha Regenstein
AF4Q Program Office, George Washington
University Lisa R. Sloane, MHA Project
Consultant Lisa R. Sloane, LLC Health Care
Insights
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Cincinnati Experience

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Greater Cincinnati Health Council

• Representing area hospitals since 1957
• Long history of collaboration
• 33 diverse members in 14 counties
• SW Ohio, Northern Kentucky, Southeastern Indiana
• 290,000 discharges

Mission High quality/high value health care
improved health status
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Climate for Change

• Health transformation in full gear
• 40 million in investments
• Beacon Collaborative and Regional Extension
  Center (HealthBridge)
• Aligning Forces for Quality (Health
  Collaborative)
• Chartered Value Exchange (Health Collaborative
  and HealthBridge)

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Cincinnati Expecting Success

• Embracing early opportunity
• Health disparities as priority
• Engage as many hospitals as possible
• Work collaboratively
• Assess current state as first step

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Getting Buy In

• Do you know who your patients are?
• Support and leadership
• Upfront about how we would use hospital data
• Opportunity to be a leader and benefit from help
  of national experts
•  

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Survey of Hospitals
Goal Assess current R/E/L data collection
practices

• Survey based on national Expecting Success led by
  GWU
• Hospital characteristics, data collection
  practices, barriers to collection, use of data,
  language services, and more

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Participating Hospitals

• Adams County Regional Medical Center
• Atrium Medical Center
• Bethesda North Hospital
• Brown County General Hospital
• CMH Regional Health System
• Cincinnati Children's Hospital Medical Center
• Deaconess Hospital
• Dearborn County Hospital
• Drake Center
• Fort Hamilton Hospital
• Good Samaritan Hospital
• Highland District Hospital
• The Jewish Hospital Mercy Health
• Lindner Center of Hope

• Margaret Mary Community Hospital
• McCullough-Hyde Memorial Hospital
• Mercy Health Anderson Hospital
• Mercy Health Clermont Hospital
• Mercy Health - Mt. Airy Hospital
• Mercy Health - Western Hills Hospital
• Mercy Health Fairfield Hospital
• Regency Hospital Company of Cincinnati
• St. Elizabeth Health Care (5)
• Select Specialty Hospital
• The Christ Hospital
• University Hospital
• Veteran Affairs Medical Center
• West Chester Medical Center

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Where We Were

• One-third use standard categories
• Most include Hispanic/Latino category in race
  information
• A few include bi- or multi-racial category
• Method of collection self-report, observation,
  combination, referral, drivers license

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Where We Were

• Race majority were at or near 100
• Ethnicity some not collecting at all
• More than one- third had 100 of patient language
  data
• Some very confident in data others much less
  confident
• Variance in registration staff training

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Disparities?

• Most said they did not know, whether by race,
  ethnicity or language

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CategoriesAdopted by Cincinnati Area
Hospitals(Consistent with OMB categories - March
2010)
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Call to Action

• Hospitals across the region will collect
  standardized REL data by Q3 2010
• This applies to categories (OMB) and methods
  (self-report) of collection

• Q3 2009 CES representatives nominated by CEOs
• Q4 2009 gap analysis (determine what
  hospital/system needs to do provide tools)
• Q1 2010 registration systems adjusted
• Q2 2010 registration staff trained in patient
  self-reporting
• Q3 Q4 2010 community relations plan implemented

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Action Areas

• Embracing local recommendations for REL
  categories hospital IT system revisions to
  accommodate categories
• Train admissions staff to collect self-reported
  data
• Educate patients so they understand why they are
  being asked REL questions

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Sample Materials
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Where We Are Now

• Percent of inpatient discharges with indicator
  present
• by quarter

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Where We Are Now
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Challenges and Lessons Learned

• Training and data collection are ongoing
  processes
• Better training gets better results
• Train and retrain
• Data flow rules can help and hinder
• Prepare staff and community for REL data
  collection

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Challenges and Lessons Learned

• Ensure administrative systems crosswalk to
  clinical data systems
• Work alongside your quality teams
• Monitor data integrity
• Find opportunities to keep in front of leadership

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On the Horizon
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Questions?

• Nancy Strassel
• Greater Cincinnati Health Council
• 513 878-2854
• nstrassel_at_gchc.org

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Thank You!
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The National Call to Action to Eliminate Health
Care Disparities Hospitals Answering the Call

• HRET Educational Webinar Presentation
• November 16, 2011
• Anthony A, Armada, FACHE
• President
• Advocate Lutheran General Hospital and Childrens
  Hospital
• Park Ridge, Illinois

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Learning Objectives

• Definition of Health and Health Care Disparities
• Health Disparities The Basics
• Drivers of Disparities
• What steps should CEOs take to make meaningful
  progress?
• Lessons Learned from Several Initiatives
• Hispanocare at Advocate Illinois Masonic Medical
  Center, Chicago, Illinois
• Korean Concierge Program at Advocate Lutheran
  General Hospital and Childrens Hospital, Park
  Ridge, Illinois
• Stroke Program at Advocate Trinity Hospital,
  Chicago, Illinois
• Question and Answer

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Definition of Health andHealth Care Disparities

• Health Disparities are differences in health
  status between people that are related to social
  or demographic factors such as race, gender,
  income or geographic region
• Disparities in health care are differences in the
  preventative, diagnostic and treatment services
  offered to people with similar conditions

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Driver of Disparities

• Racial or Ethnic Health Disparities
• Socioeconomic Health Disparities
• Gender Health Disparities
• Rural Health Disparities

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Statement for the Record of the American College
of PhysiciansAddressing Disparities in Health
and Healthcare

• Timely access to appropriate health care is
  critical to improving health outcomes
• Effective patient-provider communications
  increases patient understanding and is a critical
  component of patient-centered care.
• Language is one aspect of an individuals culture
  that may affect patient provider communication,
  quality of the encounter and patient outcome.
  Physicians and other health care providers must
  realize the impact of culture on health status
• Eliminating health disparities will require an
  adequate supply of culturally competent health
  care providers
• A diverse workforce of health professionals is
  also an integral part of eliminating disparities
  among racial and ethnic minorities
• Eliminating health disparities and improving
  quality of care requires evidence-based policies
  and programs.

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What steps should CEOs take to make meaningful
progress?

1. Cultivate a clinical leader who can champion the
   cause of patient equity.
2. Conduct a CLAS-based organizational assessment.
3. Collect patient race, ethnicity and language
   data.
4. Focus on improving the quality and safety of
   hospital language access systems
5. Place culture within the context of an interwoven
   network of community relationships between
   language and traditions, etc.
6. Keep racial and ethnic disparities on your
   hospitals management dashboard.

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Lessons Learned

• Hispanocare at Advocate Illinois Masonic Medical
  Center, Chicago, Illinois
• Korean Concierge Program at Advocate Lutheran
  General Hospital and Childrens Hospital, Park
  Ridge, Illinois
• Stroke Program at Advocate Trinity Hospital,
  Chicago, Illinois

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THANK YOU

• QUESTIONS AND ANSWER ?
• Anthony A. Armada FACHE
• President
• Advocate Lutheran General Hospital and
  Childrens Hospital
• 1775 Dempster Street
• Park Ridge, Illinois 60068
• E-mail anthony.armada_at_advocatehealth.com
• Office 847-723-8446
• Executive Assistant Joanna Werling