QI and the EMR: Identifying and Addressing Disparities in Chronic

Report
Tools for Measuring and Monitoring
Equity in Quality: The Hospital
Perspective
Thursday, January 27, 2010
3:00-4:30pm EST
2:00-3:30pm CST
1:00-2:30pm MST
12:00-1:30pm PST
This web seminar will begin momentarily.
Tools for Measuring and Monitoring Equity in
Quality: The Hospital Perspective
James Walton, DO, MBA
Vice 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
Susana Rinderle, MA
Manager, Diversity,
Equity & Inclusion
(DEI) at University of
New Mexico Hospitals,
Albuquerque, NM
Joseph R. Betancourt,
MD, MPH
Director, The Disparities
Solutions Center at MGH
Moderator
Health Equity Improvement:
The Baylor Health Care System
Vision and Experience
Jim Walton, DO, MBA
Vice President & Chief Health Equity Officer
Baylor Health Care System
Dallas, Texas
“Tools for Measuring and Monitoring Equity in Quality:
The Hospital Perspective”
January 27, 2-3:30 pm CST
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)
3/4/05
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©2009 Baylor Health Care System
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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George W. Truet t
(In His World War I Uniform)
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©2009 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
3/4/05
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©2009 Baylor Health Care System
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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©2009 Baylor Health Care System
Office of Health Equity:
Goals
•
•
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
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8
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©2009 Baylor Health Care System
BHCS Health Equity
Improvement Model
Collect Data
Intervene & Improve
Health Equity
Improvement
Access to
Services
Convene Workgroups
& Design Intervention
Equity
Analyze for Disparities
Care
Delivery
Health Outcomes
Report
Socialize Data
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©2009 Baylor Health Care System
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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©2009 Baylor Health Care System
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 NonHispanic
AMI=Acute Myocardial Infarction; HF=Heart Failure; PNE=Pneumonia;
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SCIP=Surgical Complication Infection Prevention
©2009 Baylor Health Care System
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.
3/4/05
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©2009 Baylor Health Care System
Health Equity Performance:
ED Patient Satisfaction-Race
Persisting
Racial
Inequity
Observed
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©2009 Baylor Health Care System
Health Equity Performance:
ED Patient Satisfaction-Race
First Qtr. Patient
Responses
Baylor Hospitals
3/4/05
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©2009 Baylor Health Care System
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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©2009 Baylor Health Care System
Conclusions
 Health Equity must be a shared value;
 Disparities in health outcomes exist as do
inequities in health care
access and delivery: find
Module 3:
Health Equity Performance Improvement Exercise
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
3/4/05
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16
©2009 Baylor Health Care System
Diversity, Equity & Inclusion (DEI)
at UNM Hospitals:
Tools for Measuring & Monitoring Equity
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?
QUALITY
COMPLIANCE
COMPETENCE
COMMUNITY
CARE
DISPARITIES
Diversity is a driver of quality
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
You have a right to an interpreter. UNM Hospitals will provide one free of charge – just ask us!
Please place
patient’s registration
sticker here.
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.
1. Please select the language you would like to receive services in.
Other Languages:
Most Common at UNM Hospitals:
 Arabic
 English
 Chinese (Mandarin)
 Spanish/Español
 Dutch/Nederland
 Vietnamese
 Farsi
 Sign Language/ASL
 French/Français
 Keresan
 German/Deutsch
 Navajo
 Italian/Italiano
 Tiwa, Tewa or Towa (circle)







Japanese
Portugese/Portugais
Russian
Swahili
Turkish
Zuni
Other ___________________
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.
 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.
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 indicators
Clinical:
•
•
•
•
•
•
•
•
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 Force
UNM Hospitals
933 Bradbury Drive SE, Suite 3057
Albuquerque, NM 87106
tel (505) 272-1698
pager (505) 951-3927
fax (505) 272-5477
http://hospitals.unm.edu/dei/index.shtml
Question and Answer Period
Thank you for your participation.

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