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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
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“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.
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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.
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Achieving Equity in Care
Vickie Sears, MS, RNImprovement Coach, America’s Essential Hospitals
Essential Hospitals Engagement Network (eHEN)
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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
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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
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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
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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
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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), 948-9554. 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.
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DISPARITIES CONTINUE TO EXIST IN QUALITY
Source: 2011 National Healthcare Quality and Disparities Reports. March 2012. Agency for Healthcare Research and Quality, Rockville, MD.
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GROWING U.S. MINORITY POPULATION
Note: Other includes all Hispanics regardless of race and Non-Hispanics whose race is not WhiteSource: 2012 National Population Projections (Updated May 2013); United States Census Bureau.
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LEGISLATIVE AND REGULATORY ATTENTION
Action Description / Summary2001—IOM Report, Crossing the Quality Chasm: A New Health System for the 21st Century
Named equity as one of six domains of quality that all health care organizations need to address.
2002—IOM Report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care
Reviewed 10 years of research and found that minorities are less likely to receive recommended care and more likely to receive lower quality care, regardless of insurance status or income level.
2009—American Recovery and Reinvestment Act
Created financial incentives for meaningful use of electronic health records that included recording patient demographics, such as preferred language, gender, race, ethnicity, and date of birth.
2010—Patient Protection and Affordable Care Act (ACA)
Requires federally funded programs to collect data on race, ethnicity, primary language, disability status, and gender.
2011—Standards for Patient Centered Medical Homes (PCMH)
Allows providers to earn points towards the PCMH recognition process by collecting and analyzing REL data.
2011—HHS Action Plan to Reduce Health Disparities
Outlines ways to increase health equity, including expanding access to care and upgrading collection and analysis of data on REL and other demographic categories in line with the ACA.
2011—Equity of Care Nation Call to Action
ACHE, AHA, AAMC, CHA and NAPH together call for action to eliminate health care disparities
2012—Joint Commission Patient-Centered Communication Standards
Requires hospitals to collect a patient’s race, ethnicity and preferred language for both oral and written communication regarding their care, beginning July 1, 2012.
2013-Enhanced National CLAS Standards
Provides a blueprint for individuals and health and health care organizations to implement culturally and linguistically appropriate services.
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 percent2017 – 50 percent2020 – 75 percent
Goal 2) Increasing cultural competency training, 2011 – 81 percent (*baseline)2015 – 90 percent2017 – 95 percent2020 – 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)
Goals and Milestone (2013 – 2020)Goal1) Increasing the collection and use of race, ethnicity and language preference (REAL),
2011 – 18 percent *(baseline)2015 – 25 percent2017 – 50 percent2020 – 75 percent
Goal 2) Increasing cultural competency training, 2011 – 81 percent (*baseline)2015 – 90 percent2017 – 95 percent2020 – 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.
*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.
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.
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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.
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NATIONAL SNAPSHOT OF REAL DATA USE
Source: AHA Diversity & Disparities: A benchmark study of U.S. hospitals, June 2012
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COLLECTION OF PATIENT REAL DATA IN eHEN HOSPITALS
Source: 2012 Organizational Assessment Tool (OAT) – over 90% of eHEN hospitals reporting
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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
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COMMON LANGUAGES SPOKEN BY PATIENTS IN eHEN HOSPITALS
Source: 2012 Organizational Assessment Tool (OAT) – over 90% of eHEN hospitals reporting
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THE OPPORTUNITIES IN eHEN HOSPITALS
Source: 2012 Organizational Assessment Tool (OAT) – over 90% of eHEN hospital reporting
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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
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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
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SAN MATEO MEDICAL CENTER
Jonathan S. Mesinger, PhDCultural Competence LeaderClinics ManagerSan Mateo Medical CenterEmail:[email protected]
Phone: (650) 578-7187
Jonathan Mesinger Cultural Competence CoordinatorSan Mateo Medical Center [email protected]
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
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.
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
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
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?
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.
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
Race, Ethnicity and Language Data
America’s Essential Hospitals
Equity Webinar
2012
John W. BlufordPresident/CEO Truman Medical Centers
2012 40
Diversity in Governance
Diverse Perspectives
Better Decisions!Better Outcomes!
Diversity in Governance Makes Good Business Sense
Good Governance is Important!
TRUMAN MEDICAL CENTERS
Truman Medical Centers: Diversity OnBoard
Dennis O’Leary
Jon Gray Peggy Dunn
Juan Rangel
Bucky BrooksPaul Black
Mark Steele Rev. Eric Williams
Joy Wheeler
Phil Richter
Ryan WatsonLeo Morton Peter Levi
Joanne Collins
Sarah Chavez
2012
Hospital Hill Pneumonia (PN) Measures
Q4 2011
PN-2 PN-3a PN-3b PN-4 PN-5c
Freq 90.00% 90.00% 100.00% 90.00% 90.00%
BY RACE
White Q 100.00% 100.00% 62.50% 100.00% 90.91%
Black/African American Q 100.00% 100.00% 85.71% 100.00% 93.33%
American Indian/Alaska Native Q
Asian Q 100.00% 0.00%
Native Hawaiian/Pacific Islander Q
Unable to Determine Q 50.00% 100.00% 100.00% 75.00%
Race Code Data Not Supplied Q
By Ethnicity
Hispanic Q 100.00% 100.00% 100.00%
Not Hispanic Q 100.00% 85.71% 80.00% 100.00% 86.67%
Unavailable Q
By Gender
Male Q 100.00% 75.00% 84.62% 100.00% 82.35%
Female Q 100.00% 100.00% 76.92% 100.00% 92.86%
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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