Equity
We Ask Because We Care
The five major health systems in Cincinnati are asking patients to identify their race, ethnicity, and preferred language (R/E/L). The Institute of Medicine’s 2002 report Unequal Treatment detailed consistent evidence of disparities of care provided in the United States. By collecting patient R/E/L data, hospitals can pinpoint possible differences in care and areas for improvement.
“We as a nation are aware...
Updates from Finding Answers: Disparities Research for Change, a national program of the Robert Wood Johnson Foundation, suggest promising strategies for reducing racial and ethnic disparities in care for depression, diabetes, and cardiovascular disease. Since 2005, Finding Answers has awarded and managed research grants totaling $8 million to health care organizations implementing interventions aimed at reducing disparities. The funds have been used to...
To ensure that patients who need medical interpreter services are served as quickly as possible, Steward St. Elizabeth's Medical Center, part of the Boston AF4Q alliance, has replaced beeper dispatching with an innovative use of hand-held technology. Staff medical interpreters now carry iPod Touch devices which alert them each time new requests for language services are made. The interpreters take cases from a digital queue while the intranet-net based dispatching system tracks their work flow in real time. Requests are sent only to the appropriate interpreters – for example,...
Impact
Patients with limited English proficiency may have more medical errors and less patient satisfaction when they do not get care in a language they can understand. That is why Ashland Community Hospital in Oregon moved towards higher quality care for their patients when they improved rates for screening preferred spoken language and preferred written language from 1.4 percent to 100 percent in a seven month period. This improvement is attributed to standardizing the collection of self-reported language data from patients during the registration process as part of their work in an AF4Q hospital effort.
Voices
The University of New Mexico Hospital (UNMH) has found a disparity with their Hispanic heart failure patients, much to their amazement. Over 40 percent of residents in Albuquerque, NM are Hispanic in a state that has the highest proportion in the country. As one of the major hospitals that serves the region, UNMH understands the community. But despite previous efforts to collect data, it was not until the hospital's participation in the AF4Q Hospital Quality Network Reducing Readmissions and Improving Language Services programs that problem became more clear. As a result of, UNMH is exploring programs and interventions that aim to improve cardiac care for their Hispanic...
Although the quality of health care is poor for many Americans, specific racial and ethnic groups, as well as patients with limited English proficiencies, continue to experience lower quality health care.
By collecting care measures that are stratified by race, ethnicity and language (R/E/L), providers and consumers can pinpoint where inefficiencies lie and develop strategies to correct them.
AF4Q Alliances are incorporating equity and R/E/L into their efforts. Hospitals in AF4Q communities are also participating in language improvement and equity initiatives, implementing strategies to improve the quality of hospital care.
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A September 1 study in the New England Journal of Medicine by the AF4Q Alliance in Cleveland found that the quality of diabetes care, across insurance types including Medicaid and uninsured patients, was improved by the meaningful use of electronic health records (EHRs). “We were not surprised by these results,” said Randall D. Cebul, MD, director of Better Health Greater Cleveland and the study’s lead author, “but they were influenced by several factors, including our public reporting on agreed-upon standards of care and the willingness of our clinical partners to share their EHR-based best practices while simultaneously competing on their execution.”
“I am especially pleased that the benefits reported in this investigation spanned all insurance types, including Medicaid and uninsured patients, since it is essential that the modern information technologies improve care for all Americans, including our most vulnerable citizens,” said David Blumenthal, M.D., M.P.P., professor of Medicine and Health Policy at Harvard Medical School and past National Coordinator for Health Information Technology.
The research involved more than 500 primary care physicians in 46 practices that are partners in Better Health Greater Cleveland. EHR sites were associated with significantly higher achievement of care and outcome standards and greater improvement in diabetes care.