The IOM Report
“Unequal Treatment”
Translating Research & Recommendations
into Policy and Practice
A Hospital Case Study
Joseph R. Betancourt, M.D., M.P.H.
Senior Scientist, Institute for Health Policy
Director for Multicultural Education, Massachusetts General Hospital
Assistant Professor of Medicine, Harvard Medical School
Outline
• Background: National and Local Context
• Process: Developing an Approach
• Key Lessons Learned
Background:
Efforts Underway Prior to 2002
• MAO: Minority Recruitment, Retention, Prof Dev
• Interpreter Services: Increasing Volume
• Cultural Competence Education: Mandatory in Med
• Race/Ethnicity Data Collection: Active deliberations
at systems level; QI in place at hospital level
Background:
Timeline of Key Events
• March 2002: IOM Report “Unequal Treatment”
• July 2002: Dr. Satcher presents in Boston
• December 2002: Boston Mayor Menino convenes
hospital CEO’s re role in eliminating disparities
• December 2002: Dr. Satcher presents at MGH
• April 2003: Mayor’s Hospital Working Group
formed: 12 month plan to address disparities
• April 2003: MGH appoints Disparities Committee
MGH Disparities Committee
Underlying Principle
• While data specific to disparities at MGH important,
not necessary to begin to take action given IOM
Report documented issue nationally
Charge
• Identify and address disparities in health and health
care wherever they may exist at MGH
• Coordinate with the Mayor’s Efforts
• Present Plan to Board in Jan ‘04; Results Sept ’04
– Also to GEC and President’s Advisory Council
Translating Research into
Policy and Practice
Committee will base work on IOM
Report “Unequal Treatment”
IOM’s Unequal Treatment
www.nap.edu
Recommendations
• Increase awareness of existence of disparities
among key health care stakeholders
• Address systems of care
– Support race/ethnicity data collection* and QI
– Encourage use of evidence-based guidelines
– Improve workforce diversity*
– Facilitate interpretation services*
*Efforts underway at MGH
IOM’s Unequal Treatment
www.nap.edu
Recommendations
• Provider education (mechanisms of
decisionmaking, cultural competence)*
• Patient education (health care system navigation,
activation in the medical encounter)
• Research (identifying sources, promising
strategies, barriers to eliminating disparities)
*Efforts underway at MGH
MGH Disparities
Subcommittees Form
Based on 4 months of deliberations:
• Education and Awareness
• Quality
• Patient Access and Experience
*Budget provided for each group’s efforts
Education and Awareness Subcommittee
Charge: Raise awareness at MGH of disparities
and contributing factors
2004 Goals:
• At least two major presentations at grand
rounds/leadership meetings
– To Date: Byrd and Hill present in May 2004
• Comprehensive communication strategy
developed and underway
– To Date: MGH Hotline, Fruit St MD, FYI Posters
• Message on disparities incorporated into
orientations
– Under development
Quality Subcommittee
Charge: Stratify outcomes of QI initiatives by race
and ethnicity, and design improvement
activities based on findings
2004 Goals:
• Data on outcomes of asthma and diabetes QI
initiatives stratified by race and ethnicity; plan and
develop interventions based on findings
• Patient Satisfaction Data – inpatient and
outpatient data stratified by race and ethnicity
• Embed Disp’s Questions into Quality Rounds
• Demographic Profile of the Hospital – who are
our patients and what services do they use
Patient Experience of Care and
Access to Care Subcommittee
Charge – Assess the experience of care for MGH
patients and develop and implement action
plan based on findings
2004 Goals:
• Conduct inpatient and outpatient survey
• Create Multi-Cultural Advisory Committee and plan
initial meeting
• Develop inventory of existing disparities research
Crossing the Quality Chasm
Institute of Medicine, 2001
Quality can be achieved if health care systems are:
»Safe
»Effective
»Patient Centered
»Timely
»Efficient
»Equitable
*Consider Disparities for all strategic planning
Key Lessons Learned
Challenges
• Race/Ethnicity Data Collection: Categories,
Standardization, Ease, IT
• Quality: …versus research; Challenges of current data
systems
• Satisfaction: Do we have correct tools?
• Expanding buy-in
Key Ingredients:
• Leadership; Commitment; Mainstreaming; Plunge In