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

Cincinnati Expecting SuccessNovember 16, 2011

Nancy StrasselSenior Vice President

Greater Cincinnati Health Council

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, MHAProject Consultant

Lisa R. Sloane, LLC – Health Care Insights

Cincinnati Experience

Greater Cincinnati Health Council

Mission:High quality/high value health care; improved

health status

•Representing area hospitals since 1957•Long history of collaboration

•33 diverse members in 14 counties•SW Ohio, Northern Kentucky, Southeastern Indiana

•290,000 discharges

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)

Cincinnati Expecting Success

Embracing early opportunityHealth disparities as priorityEngage as many hospitals as possible Work collaborativelyAssess current state as first step

Getting Buy In

Do you know who your patients are?Support and leadershipUpfront about how we would use

hospital dataOpportunity to be a leader and benefit

from help of national experts

 

Survey of Hospitals

Survey based on national Expecting Success led by GWU

Hospital characteristics, data collection practices, barriers to collection, use of data, language services, and more

Goal: Assess current R/E/L data collection practices

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

12

Where We Were

One-third use standard categoriesMost include Hispanic/Latino category in

race informationA few include bi- or multi-racial category Method of collection –self-report,

observation, combination, referral, driver’s license

Where We Were

Race: majority were at or near 100%Ethnicity: some not collecting at allMore than one- third had 100% of patient

language dataSome very confident in data – others

much less confidentVariance in registration staff training

15

9

8

6

5

3

3

0 2 4 6 8 10 12 14 16

Identify need for interpreter

Comply with regulations

Research purposes

Compare health outcomes

Market for special programs

Compare satisfaction

Compare utilization

Use REL Data by Number of Survey Respondents

Disparities?

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

CategoriesAdopted by Cincinnati Area Hospitals

(Consistent with OMB categories - March 2010)

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 CEOsQ4 2009: gap analysis (determine what hospital/system needs to do; provide tools)Q1 2010: registration systems adjustedQ2 2010: registration staff trained in patient self-reportingQ3 & Q4 2010: community relations plan implemented

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

Sample Materials

INDICATORCASES Q42010

PERCENT WITH IND

CASES Q12011

PERCENT WITH IND

RACE 56865 68.88% 57627 90.25%ETHN 56865 40.79% 57627 69.38%LANG 56865 59.10% 57627 60.54%

Where We Are Now

Percent of inpatient discharges with indicator present

by quarter

Where We Are Now

Challenges and Lessons Learned

Training and data collection are ongoing processes

Better training gets better resultsTrain and retrainData flow “rules” can help and hinderPrepare staff and community for REL

data collection

Challenges and Lessons Learned

Ensure administrative systems crosswalk to clinical data systems

Work alongside your quality teamsMonitor data integrityFind opportunities to keep in front of

leadership

On the Horizon

Questions?

Nancy Strassel

Greater Cincinnati Health Council

513 878-2854

nstrassel@gchc.org

Thank You!

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

the Call

HRET Educational Webinar PresentationNovember 16, 2011

Anthony A, Armada, FACHEPresident

Advocate Lutheran General Hospital and Children’s HospitalPark Ridge, Illinois

Learning Objectives

A. Definition of Health and Health Care DisparitiesB. Health Disparities: The BasicsC. Drivers of DisparitiesD. What steps should CEO’s take to make meaningful progress?E. Lessons Learned from Several Initiatives

1. Hispanocare at Advocate Illinois Masonic Medical Center, Chicago, Illinois

2. Korean Concierge Program at Advocate Lutheran General Hospital and Children’s Hospital, Park Ridge, Illinois

3. Stroke Program at Advocate Trinity Hospital, Chicago, Illinois

F. Question and Answer

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

Driver of Disparities

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

Statement for the Record of the American College of Physicians“Addressing 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 individual’s 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.

What steps should CEO’s 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 systems5. 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 hospital’s management dashboard.

Lessons Learned

• Hispanocare at Advocate Illinois Masonic Medical Center, Chicago, Illinois

• Korean Concierge Program at Advocate Lutheran General Hospital and Children’s Hospital, Park Ridge, Illinois

• Stroke Program at Advocate Trinity Hospital, Chicago, Illinois

THANK YOU

QUESTIONS AND ANSWER ?

Anthony A. Armada FACHEPresident

Advocate Lutheran General Hospital and Children’s Hospital1775 Dempster Street

Park Ridge, Illinois 60068E-mail: anthony.armada@advocatehealth.com

Office: 847-723-8446Executive Assistant: Joanna Werling