tools for measuring and monitoring equity in quality: the hospital perspective

Tools for Measuring and Monitoring Equity in Quality: The Hospital

Perspective

This web seminar will begin momentarily.This web seminar will begin momentarily.

Thursday, January 27, 20103:00-4:30pm EST2:00-3:30pm CST1:00-2:30pm MST 12:00-1:30pm PST

Susana Rinderle, MAManager, Diversity, Equity & Inclusion

(DEI) at University of New Mexico Hospitals,

Albuquerque, NM

James Walton, DO, MBAVice President and Chief

Health Equity Officer, Baylor Health Care System, Dallas, TX

Sarah Rafton, MSW Director, Center for Diversity and Health

Equity, Seattle Children’s Hospital,

Seattle, WA

Joseph R. Betancourt, MD, MPH

Director, The Disparities Solutions Center at MGH

Moderator

Tools for Measuring and Monitoring Equity in Quality: The Hospital Perspective

Health Equity Improvement: The Baylor Health Care System Vision and Experience

Jim Walton, DO, MBA Vice President & Chief Health Equity Officer

Baylor Health Care SystemDallas, Texas

“Tools for Measuring and Monitoring Equity in Quality: The Hospital Perspective”

January 27, 2-3:30 pm CST

©2009 Baylor Health Care System

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Baylor Health Care System

• North Texas integrated health care system:

– 24 owned, leased, affiliated and short-stay hospitals – 120+ primary care, specialty care, and senior health centers – 17 ambulatory surgery centers– 450+ employed physicians in the BHCS

affiliated physician network, HealthTexas

• 20,000+ employees

• ~127,000 inpatient admissions annually

• >$3.8B net operating revenue (FY09)



Founding Statement

“Is it not now time to build a great humanitarian hospital, one to which men of all creeds and those of none may come with equal confidence?”

Dr. George W. Truett, 1903

Co-founder of Texas Baptist Memorial Sanitarium, predecessor of Baylor Health Care System



Milestones in Baylor Health Care System’s Journey to Equitable Care

Board of Trustees passed Quality Resolution (2000) System-level Best Care Committee created to develop,

implement, and lead quality improvement projects related to achieving STEEEP objectives

Executive compensation aligned with process-of-care measures through the Performance Award Program



Office of Health Equity

• Office of Health Equity (OHE) developed in 2006• To reduce variation in health care access, care

delivery and health outcomes due to:• Race and ethnicity• Income and education (i.e., socioeconomic status) • Age• Gender• Other personal characteristics (e.g., primary

language skills)



• Design and implement an annual “BHCS Health Equity Performance Analysis” (HEPA) & Report: Quality of Care measures (Core Measures) Experience of Care measures (Satisfaction) Outcome measures (Mortality & Readmission)

• Utilize Health Equity Performance Report as a tool to focus resources and efforts to reduce inequalities and improve quality

Office of Health Equity: Goals


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BHCS Health Equity Improvement Model

Collect Data

Analyze for DisparitiesIntervene & Improve

ReportConvene Workgroups & Design Intervention

Socialize Data

Health EquityImprovement

EquityAccessAccess to to ServicesServices

CareCareDeliveryDelivery

Health Health OutcomesOutcomes



BHCS Analysis Methodology

For each equity measure: Patient population broken down into dichotomous

variables • Race: White vs. Non-White• Ethnicity: Hispanic vs. Non-Hispanic• SES Proxy: Commercially Insured vs. Self-Pay/ Medicaid

Percentages of eligible patients calculated, and the differences between each dichotomous variable are calculated

• Identify dichotomous variable differences that are statistically significant (p<=.05)



BHCS HEPA Dashboard

Baylor Health Care System - FY-10 Health Equity Performance Dashboard

Metric WHITE NON-WHITE EQUITY OF CARE NON-HISPANIC HISPANIC EQUITY OF

CARE

AMI perfect care bundle (%) 97.9 97.4 = 97.8 98.1 =

HF perfect care bundle (%) 96 94.1 Favors White 95.5 93.9 =

PNE perfect care bundle (%) 92.1 91.8 = 91.9 92 =

SCIP perfect care bundle (%) 94.5 94.5 = 94.6 94 =

Inpatient overall satisfaction mean score 88.1 87.4 Favors White 87.9 88.9 Favors Hispanic

Emergency Department overall satisfaction mean score 87.5 84.2 Favors White 87.1 84.3 Favors Non-

Hispanic

AMI=Acute Myocardial Infarction; HF=Heart Failure; PNE=Pneumonia; SCIP=Surgical Complication Infection Prevention



Office of Health Equity: Patient Experience Measures

Health Equity Performance Metric: Utilize Press Ganey measurements of patient

satisfaction to detect differences among patient variables.

Measurement offers standardized approach to data collection and national baselines for comparison.



Health Equity Performance: ED Patient Satisfaction-Race

Persisting Racial

Inequity Observed



Health Equity Performance:ED Patient Satisfaction-Race

First Qtr. PatientResponses

Baylor Hospitals



BHCS Health Equity Improvement Strategy

Establish organizational disparity sensitivity Push data out to operating unit (hospital)

leaders, influencers and front line staff Ready evidence-based literature supporting

evaluation metrics and conclusions Assemble workgroups evenly dispersed

organizationally and by experience level Analyze again…and again



Module 3: Health Equity Performance Improvement Exercise

Health Equity must be a shared value; Disparities in health outcomes exist as do

inequities in health care access and delivery: find the evidence;

As health care professionals, we have a duty to lead with evidence and improve health inequities.

Improving health equity is consistent with the Baylor mission

Conclusions

Diversity, Equity & Inclusion (DEI)Diversity, Equity & Inclusion (DEI)at UNM Hospitals: at UNM Hospitals:

Tools for Measuring & Monitoring Tools for Measuring & Monitoring EquityEquity

Susana Rinderle, M.A.Manager ~ Diversity, Equity & Inclusion

University of New Mexico Hospitals

DSC webinar January 27, 2011

UNM Hospitals• Only public and only teaching hospital of note in New Mexico

– One of only 30 hospitals nationwide who are both public safety net and teaching/academic

• Only Level I Trauma Center in the region• Only emergency adult psychiatric services• 619 beds: 5 hospitals, 48 clinics (22 offsite)• Employees: ~6,000• Providers: 579 faculty, 116 midlevels• Outpatient visits: 492,000• Inpatient days: 180,000• Budget: $705 million

New Mexico• Population: nearly 2 million• State with fourth highest percentage of “frontier

lands”• One of only two states in the U.S. that have always

been “majority-minority”• The only majority Hispanic state in the U.S. at 45.6%

(California and Texas follow behind at 37%)• State with second highest percentage of Native

Americans (fifth highest total number)• The state with the second highest percentage of

residents that speak a language other than English at home, at 36.5%

Source: Census Bureau

Diversity, Equity & Inclusion

• Interpretation – since 2003• 18 full time interpreters (14 Spanish, 3 Vietnamese,

1 Navajo), 1 educator, 2 admin support staff• Only in-house interpreter dept. in state

• 130 dual role interpreters in 9 languages• Video interpreting• Pacific Interpreters 24-hour phone line

• Participation in the Disparities Solutions Center Disparities Leadership Program, third cohort 2009-2010

• Office of DEI created October 2010

What is DEI?The UNMH Office of Diversity, Equity & Inclusion leads the effort to make sure that every UNMH patient receives the safest, most effective, most

sensitive medical care possible, regardless of the patient’s race, ethnicity, or any other group identity.

We do this through data collection and analysis; community collaboration; cultural “competence”

training, education and consulting; and process improvement.

How does DEI do these things?

Diversity is a driver of Diversity is a driver of qualityquality

QU

ALITY D

ISPA

RIT

IESCOMPLIANCE

COMMUNITY

COMPETENCE

CARE

2010: “REALS” data

RaceEthnicityAgeLanguage (primary oral)Sex

Collection and use of REALS

• 100% electronic medical record (EMR)• Outpatient

• Self-reported on a form at registration and data entered into EMR by staff

• Inpatient• Same self-reporting process at all points of

entry (ED, admitting)• Included in unit/department “Operational

Plans” effective July 2010

1. Please select the language you would like to receive services in.

Most Common at UNM Hospitals: English Spanish/Español Vietnamese Sign Language/ASL Keresan Navajo Tiwa, Tewa or Towa (circle)

Other Languages: Arabic Chinese (Mandarin) Dutch/Nederland Farsi French/Français German/Deutsch Italian/Italiano

American Indian or Alaskan Native Tribal Affiliation____________________________________________________________________________

Asian, Vietnamese, or _______________________________________________________________ Native Hawaiian/Pacific Islander, or ___________________________________________________ Black or African American or ________________________________________________________ Hispanic or Latino or _______________________________________________________________ White or Anglo____________________________________________________________________ Other ____________________________________________________________________________ Decline to answer.

4. Patient signature: ____________________________________________________________ Date: ____________________ Thank you for your assistance! If you have any questions, please ask one of our staff.

2. If you would like an interpreter, we can provide one free of charge, either in-person or by phone. Do you want UNM Hospitals to provide an interpreter for your visit today? (please circle) Yes No

3. Select from the following choices to provide us with your race/ethnicity information. If you are multiracial, please select the race/ethnicity with which you primarily identify yourself.

Japanese Portugese/Portugais Russian Swahili Turkish Zuni Other ___________________

Please place patient’s registration sticker here.

You have a right to an interpreter. UNM Hospitals will provide one free of charge – just ask us!

UNM Hospitals is dedicated to providing the highest quality care regardless of a patient’s race/ethnicity. Your response to the questions below will help us to monitor care and ensure our patients receive the best care possible. Your information will remain private and access to this information will be highly restricted.

Hospital staff: Please enter response into Cerner and then forward this info through campus mail to Interpreter Services, 1-South

2011: “SOREAL” data!

Sex Orientation (sexual orientation/transgender)RaceEthnicityAgeLanguage (primary oral and written)

Initial data indicatorsClinical:

• Mortality• Length of stay (LOS)• Readmission rates• HgA1C levels • Outpatient pneumovax vaccines• Inpatient core measures for pneumonia• Childhood immunizations or asthma• Colorectal cancer screening

Non-clinical:• Employee race, ethnicity, age, sex and (a) job position and (b)

organizational level• Employee satisfaction • Patient satisfaction• Patient no-show rates• Patient/family complaints• Self-reported employee/provider awareness, attitudes, beliefs

(pending)

First equity dashboard

Next steps• Modifications to data fields and collection form

• Separation of race & ethnicity• Changes to tribal and religion categories• Exploring options for multiracial category• Addition of written language• Adding LGBT information

• Analysis of initial equity dashboard findings• Strategic plan and recommendations to

Competence and Care task forces• Rollout of unit-specific and organization-wide

training, system and process changes, and other interventions

What questions do you have?

Susana Rinderle, M.A.Manager, Diversity, Equity & Inclusion (DEI) Chair, Health Literacy Task ForceUNM Hospitals933 Bradbury Drive SE, Suite 3057Albuquerque, NM 87106

tel (505) 272-1698pager (505) 951-3927fax (505) 272-5477http://hospitals.unm.edu/dei/index.shtml

Question and Answer PeriodQuestion and Answer Period

Thank you for your participation.

tools for measuring and monitoring equity in quality: the hospital perspective

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