Outline
Efforts to Reduce Disparities:
Barriers, Innovation, Implementation and Evaluation
Joseph R. Betancourt, M.D., M.P.H.
‹ Barriers
to Change
Director, The Disparities Solutions Center
Director, RWJF’s Leading Change: Disparities Solutions Initiative
Senior Scientist, Institute for Health Policy
Director for Multicultural Education, Massachusetts General Hospital
Assistant Professor of Medicine, Harvard Medical School
‹ Innovations:
State, Health Plan, Hospital
‹ Implementation
Innovative Approaches:
State Government and Health Plans
Barriers to Change
‹
Absence of an action-oriented research agenda
‹
Little translation of research to policy/practice
– Many academic research centers, little funds for dissemination/translation
– Research may not meet stakeholder needs
‹
No coordinated political/policy strategy
– Scattered legislative response to IOM Report Unequal Treatment
‹
Minimal efforts focused on education, training, and leadership
– Little informed leadership; lack of leadership development
‹
Marginal involvement of community
– No centralized voice to inform process of change or encourage activism
Innovative Approaches: Hospital
‹
Massachusetts General Hospital
– Medical Policy
‹ All QI stratified by race/ethnicity
– Unit-Based Staff Quality Rounds
‹ Exploring disparities: main finding was concern about
language barriers over course of hospitalization
– Patient Satisfaction
‹ Stratifying results by r/e and have added questions
about respect for culture/race/religion
– CMS Core Measures
‹ Stratifying results by r/e with all Boston Hospitals
– Disparities Dashboard
‹ Above info plus other info (readmission, wait times)
presented to Leadership and Board routinely
State Legislation
– Massachusetts Health Care Reform
‹ Requires collection of r/e data
‹ Creates Disparities and Quality Council
‹ P4P to reduce disparities in hospital (MassHealth)
– Questions with policy/practice relevance
‹
& Evaluation: Leading Change
‹
Health Plans
– Aetna
‹ Collection
of r/e data; staff training (med directors, case
managers) in cult comp; incorporation of cult comp strategies
into diabetes disease management
– BCBS of Florida
‹ CC
Education part of RPE (P4P) program; points for taking
course; measures include clinical indicators and patient
satisfaction
‹ New
focus on health coaches in DM, customer service; other
regional health programs
Culturally Competent Disease Management:
The MGH Chelsea Diabetes Program
Systems Component:
Race/Ethnicity Data Collection, Diabetes Registry by R/E
Patient Component:
• Telephone outreach to increase rate of HbA1c testing
• Individual coaching to address patients’ needs and concerns
regarding diabetes self-management to improve HbA1c
• Group visits meeting ADA educational requirements
Provider Component:
Diabetes Monograph (EBG with prompts)
Coaching Feedback
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Cultural Competence, Quality and Disparities
A Multitiered Intervention
Goals of RWJF Leading Change:
Setting the Stage and Moving to Action
‹
-R/E Data Collection, Registries, QI
-Interpreter Services
Synthesize Results with Finding Answers (Evaluation)
– Examine evaluation results
System
– Develop into practical, usable forms that include key themes
and critical success factors
Culturally
Competent
Programs
‹
Disseminate Solutions to Stakeholders
‹
Create Leaders and Provide Technical Assistance to
Implement Disparities Solutions
– Broad Audience
Provider
Patient
-CC Education
-Screen for non-adherence
-Facilitate adherence to
guidelines
-Provide focused education,
activation, navigation
– Targeted Audience
‹
Maintain Clearinghouse of Disparities Solutions
– Web-based, interactive
-Feedback
Major Activities
‹
‹ Leaders
from QI, Disparities, Imp Science and Org Excellence
– Sounding Board
‹
Summary
Planning
– Strategy Forum
Broad Dissemination and Translation
– Annual National Meetings
– Public Web Seminars
– Website
‹
IOM Report Unequal Treatment—yet more to do
‹
Projects; Searchable Database; Case-Study Section;
New Interventions and Lit Search
Targeted Leadership Development and Technical Assistance
– Executive Disparities Institute (Implementation)
‹ Competitive
Application Process (20 Org’s); Organizational
Commitment to Project; Opening and Closing Meeting (1.5 Day
each); 2 Conf Calls per Year; 2 months of Tech Assistance Calls
Growing desire among key health care
stakeholders for concrete “what to do’s”
‹ Highlights
‹
There has been some progress since release of
‹
Leading Change—in collaboration with others—
hopes to fill void
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