Ethnicity

How health disparity initiatives at US News’ top hospitals are faring a year later

[ad_1]

Last year, Becker’s spoke to the top 10 hospitals named to U.S. News and World Report’s 2020-21 Best Hospitals Honor Roll to look at what they are doing to address health disparities. A year later, Becker’s checked in with those systems to look at how their health equity initiatives have evolved, what has been the most successful and if there are any results to report from those initiatives.

Mayo Clinic

In 2020, Rochester, Minn.-based Mayo Clinic announced an investment of $100 million over 10 years to combat health disparities.

This was a “big, bold move” for health system leaders, who have spent time over the last year identifying strategic priorities related to the investment, said John Knudsen, MD, medical director for Mayo Clinic’s Office of Health Equity and Inclusion.

Dr. Knudsen said Mayo has specifically considered how it will allocate this money across the organization from a multisite perspective, as well as how it will distribute the funds within research and education.

One part of the investment is developing an advanced diversity, equity and inclusion platform to identify and track progress in addressing disparities. It is intended to use both qualitative and quantitative metrics.

“This was one thing we thought was important, sort of a high-level dashboard, analytic platform to look at all aspects [of diversity, equity and inclusion],” said Dr. Knudsen. “And, obviously, it’s not just something that’s a single page. It’s intended to say, ‘What are we doing with workforce? What about research?’ All of these things would have a place or a home in this platform.”

Through pilot projects, he said Mayo has also identified and is now targeting health disparities in diabetes between white and Black patient populations and between the non-Hispanic or Latino and the Hispanic or Latino patient populations. Additionally, it is targeting similar health disparities in colon cancer screenings.

“A whole series of tactics will be deployed in the coming month to dig down and understand not only what’s causing the disparities but what we can do to address them. We’re looking at success as eliminating those,” Dr. Knudsen said.

Mayo is not only focusing on patients, but also the workforce. For instance, part of the $100 million investment to combat health disparities has gone toward a pilot education and training program using virtual reality technology. Dr. Knudsen said the idea behind the program is to enhance the nursing team’s empathic understanding of people’s lived experiences and to create more realistic role-playing to better navigate difficult interactions with patients, patients’ families or co-workers.

He said Mayo also used a technology platform last year to collect stories from employees who experienced or witnessed racism, bias or discrimination at work. Now, human resources and leadership are using the stories to inform policy and other workplace initiatives.

In August, Mayo launched the second phase of that platform allowing for sharing and learning for experiences of allyship among employees.

“There’s a real yearning and interest in our workforce to do what they can to address some of these issues we know some of our workers are experiencing and facing,” explained Dr. Knudsen. “So allyship has become something a lot of people have been looking for opportunities to get behind. This has been another way to get the workforce behind some of these efforts to not only recruit and retain a more diverse workforce but also to improve the work environment.”

With research and community engagement, he said Mayo has worked hard to build strong relationships with community partners to get information out there from trusted sources but also create bidirectional communication frameworks, so the organization hears from communities about issues they’re facing or information they’re missing.

“In an organization with so many competing priorities and many activities going on, we’re always looking at what’s being supported by top leaders. That $100 million was an important message to all of us that this is something Mayo Clinic really cares about. It has reawakened and really activated a lot of people in the organization to begin to think of ways of how they or their practice or their domain could advance some of these goals around equity, inclusion and diversity,” Dr. Knudsen said.

Massachusetts General Hospital

In November, Boston-based Mass General Brigham launched United Against Racism to address structural racism.

The comprehensive, systemwide plan “invests in leadership teams and leverages a multimillion-dollar commitment with goals, timelines, accountability and metrics of success,” said Joseph Betancourt, MD, senior vice president of equity and community health at Massachusetts General Hospital, part of Mass General Brigham.

“The plan focuses on diversity of leadership and governance, training, and creating an anti-racist culture; equity in patient care via data collection, performance measurement, digital access, clinical interventions and the removal of race from clinical guidelines; and a broad new strategy on community health focused on addressing the social determinants of health, the deployment of community health workers, a mobile health initiative, advocacy and anchor investments,” he said.

Massachusetts General Hospital has also launched its Structural Equity 10-Point Plan to support, complement and build on United Against Racism at the hospital. 

Dr. Betancourt said the initiatives involve all four pillars of the hospital’s mission — care, training, research and community health, and will significantly affect the organization’s people, culture and care. 

“While we are early in our implementation, we are making steady progress and are already seeing gains and achievements, with many more expected in the short and long-term,” he said.

UCSF Health 

At San Francisco-based UCSF Health, the health system has expanded its work on health equity since 2020, said Joshua Adler, MD, executive vice president and chief clinical officer. It deployed a comprehensive system for collecting race, ethnicity, sexual orientation and gender identity data from its patients. This has allowed the system to identify and address disparities in a number of important measures of health and health outcomes. 

Over the past year, UCSF focused on hypertension control, in which its Black patients were not achieving the same level of blood pressure control as its patients overall. The health system engaged with its patients to determine who best to help them to achieve control, including directed outreach to patients to provide visits (video or in person) to evaluate blood pressure control; use of medications; any challenges they faced, provision of home blood pressure measuring devices; input from pharmacists on medication choices, side effects and mitigation efforts; and a focus on non-medication-based interventions that can lower blood pressure. 

This also included straightforward approaches by nurse managers to standardize workflows during video visits, to make sure that clinicians captured blood pressure during those visits and outreach to patients to make sure they attended their scheduled physician visits. “By June 2021, the disparity had been completely eliminated in our primary care population,” Dr. Adler said.    

In another intervention, the system found that its Latino patients have a lower rate of completed advance care directives. With interventions that included improved language concordant documents, use of interpreters and timing the discussions so that family members could participate, UCSF was able to eliminate this disparity as well.   

Since UCSF’s data infrastructure was in place, it was able to recognize an emerging disparity in real time. Patients with limited English proficiency were using video visits at a lower rate than patients overall. This was particularly relevant during the early months of the pandemic when video visits were the preferred method of care. The health system implemented an on-demand interpreter program for video visits recently and hope that this intervention will help patients utilize this technology when desired.

NYU Langone Health

New York City-based NYU Langone Health launched the Institute of Excellence in Health Equity in 2020. The goal of the institute is to make sure patient outcomes are comparable, regardless of whether a patient is in Brooklyn or Manhattan, said Fritz Francois, MD, chief…

[ad_2]

Read More:How health disparity initiatives at US News’ top hospitals are faring a year later