tools for measuring and monitoring equity in quality: the hospital perspective this web seminar will...
TRANSCRIPT
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
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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)
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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
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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
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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)
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• 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
Equity
AccessAccess to to ServicesServices
CareCareDeliveryDelivery
Health Health OutcomesOutcomes
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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)
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BHCS HEPA Dashboard
Baylor Health Care System - FY-10 Health Equity Performance Dashboard
Metric WHITE NON-WHITEEQUITY 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 84.3Favors Non-
Hispanic
AMI=Acute Myocardial Infarction; HF=Heart Failure; PNE=Pneumonia; SCIP=Surgical Complication Infection Prevention
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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.
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Health Equity Performance: ED Patient Satisfaction-Race
Persisting Racial
Inequity Observed
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Health Equity Performance:ED Patient Satisfaction-Race
First Qtr. PatientResponses
Baylor Hospitals
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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
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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
ALIT
Y DIS
PA
RIT
IESCOMPLIANCE
COMMUNITY
COMPETENCE
CARE
2010: “REALS” data
Race
Ethnicity
Age
Language (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)
Race
Ethnicity
Age
Language (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
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.