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The National Call to Action to Eliminate Health Care
Disparities: Hospitals Answering the Call
Cincinnati Expecting Success
November 16, 2011
Nancy Strassel
Senior Vice President
Greater Cincinnati Health Council
Cincinnati Expecting Success
Acknowledgements
The Greater Cincinnati Health Council is leading
the work of Cincinnati Expecting Success as
part of Cincinnati Aligning Forces for Quality, an
initiative of the Health Collaborative and the
Robert Wood Johnson Foundation.
Marcia Wilson, Vickie Sears, Marsha Regenstein
AF4Q Program Office, George Washington University
Lisa R. Sloane, MHA
Project Consultant
Lisa R. Sloane, LLC – Health Care Insights
Cincinnati Experience
Background
Data Collection Approach
Early Findings
Lessons and Challenges
What’s on the Horizon
Greater Cincinnati Health Council
•Representing area hospitals since 1957
•Long history of collaboration
•33 diverse members in 14 counties
•SW Ohio, Northern Kentucky, Southeastern Indiana
•290,000 discharges
Mission:
High quality/high value
health care; improved
health status
Climate for Change
 Health transformation in full gear
 $40 million in investments
 Beacon Collaborative and Regional Extension
Center (HealthBridge)
 Aligning Forces for Quality (Health
Collaborative)
 Chartered Value Exchange (Health Collaborative
and HealthBridge)
Cincinnati Expecting
Success
Embracing early opportunity
Health disparities as priority
Engage as many hospitals as possible
Work collaboratively
Assess current state as first step
Getting Buy In
Do you know who your patients are?
Support and leadership
Upfront about how we would use
hospital data
Opportunity to be a leader and benefit
from help of national experts
Survey of Hospitals
Goal: Assess current R/E/L data
collection practices
 Survey based on national Expecting Success
led by GWU
 Hospital characteristics, data collection
practices, barriers to collection, use of data,
language services, and more
Participating Hospitals
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Adams County Regional Medical
Center
Atrium Medical Center
Bethesda North Hospital
Brown County General Hospital
CMH Regional Health System
Cincinnati Children's Hospital Medical
Center
Deaconess Hospital
Dearborn County Hospital
Drake Center
Fort Hamilton Hospital
Good Samaritan Hospital
Highland District Hospital
The Jewish Hospital – Mercy Health
Lindner Center of Hope
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Margaret Mary Community Hospital
McCullough-Hyde Memorial Hospital
Mercy Health – Anderson Hospital
Mercy Health – Clermont Hospital
Mercy Health - Mt. Airy Hospital
Mercy Health - Western Hills Hospital
Mercy Health – Fairfield Hospital
Regency Hospital Company of
Cincinnati
St. Elizabeth Health Care (5)
Select Specialty Hospital
The Christ Hospital
University Hospital
Veteran Affairs Medical Center
West Chester Medical Center
Where We Were
One-third use standard categories
Most include Hispanic/Latino category in
race information
A few include bi- or multi-racial category
Method of collection –self-report,
observation, combination, referral, driver’s
license
12
Where We Were
Race: majority were at or near 100%
Ethnicity: some not collecting at all
More than one- third had 100% of patient
language data
Some very confident in data – others
much less confident
Variance in registration staff training
Use REL Data by Number of Survey Respondents
Compare utilization
3
Compare satisfaction
3
Market for special programs
5
Compare health outcomes
6
Research purposes
8
Comply with regulations
9
Identify need for interpreter
15
0
2
4
6
8
10
12
14
16
Disparities?
Most said they did not know, whether by
race, ethnicity or language
Categories
Adopted by Cincinnati Area Hospitals
(Consistent with OMB categories - March 2010)
Race:
Ethnicity:
• White
• Black or African
American
• Asian
• American Indian
or Alaska Native
• Native Hawaiian
or Pacific Islander
• Declined
• Unavailable (or
Unknown)
• Hispanic or Latino
• Non-Hispanic or
Latino
• Declined
• Unavailable (or
Unknown)
Language:
• English
• Spanish
• Other, Please
Specify
• Declined
• Unavailable (or
Unknown)
Call to Action
Hospitals across the region will collect
standardized REL data by Q3 2010
This applies to categories (OMB) and
methods (self-report) of collection
Q3 2009: CES representatives nominated
by CEOs
Q4 2009: gap analysis (determine what
hospital/system needs to do; provide tools)
Q1 2010: registration systems adjusted
Q2 2010: registration staff trained in
patient self-reporting
Q3 & Q4 2010: community relations plan
implemented
Action Areas
Embracing local recommendations for
REL categories & hospital IT system
revisions to accommodate categories
Train admissions staff to collect selfreported data
Educate patients so they understand
why they are being asked REL
questions
Sample Materials
Where We Are Now
Percent of inpatient discharges with indicator present
by quarter
CASES PER CEN T CASES PER CEN T
IN D ICAT OR Q42010 W IT H IN D Q12011 W IT H IN D
RACE
56865
68.88%
57627
90.25%
ETHN
56865
40.79%
57627
69.38%
LANG
56865
59.10%
57627
60.54%
Where We Are Now
Integrating with quality
improvement efforts
across 19 hospitals
Reviewing data by
quarter
Heart failure
readmissions
Sharing hospital-specific
results
Mortality for AMI,
Pneumonia, COPD,
Heart Failure,
Respiratory Failure,
Stroke
Challenges and Lessons
Learned
Training and data collection are ongoing
processes
Better training gets better results
Train and retrain
Data flow “rules” can help and hinder
Prepare staff and community for REL
data collection
Challenges and Lessons
Learned
Ensure administrative systems crosswalk
to clinical data systems
Work alongside your quality teams
Monitor data integrity
Find opportunities to keep in front of
leadership
On the Horizon
Deep-dive
with
champion
hospitals
On-line
training tool
developed
Engage
affiliated
physician
practices
REL
community
scorecard
Data
integrity
standards
developed
Questions?
Nancy Strassel
Greater Cincinnati Health Council
513 878-2854
nstrassel@gchc.org
Thank You!
The National Call to Action to Eliminate
Health Care Disparities: Hospitals Answering
the Call
HRET Educational Webinar Presentation
November 16, 2011
Anthony A, Armada, FACHE
President
Advocate Lutheran General Hospital and Children’s Hospital
Park Ridge, Illinois
Learning Objectives
A.
B.
C.
D.
E.
Definition of Health and Health Care Disparities
Health Disparities: The Basics
Drivers of Disparities
What steps should CEO’s take to make meaningful progress?
Lessons Learned from Several Initiatives
1.
2.
3.
Hispanocare at Advocate Illinois Masonic Medical Center,
Chicago, Illinois
Korean Concierge Program at Advocate Lutheran General Hospital
and Children’s Hospital, Park Ridge, Illinois
Stroke Program at Advocate Trinity Hospital, Chicago, Illinois
F. Question and Answer
Definition of Health and
Health Care Disparities
• Health Disparities are differences in health
status between people that are related to
social or demographic factors such as race,
gender, income or geographic region
• Disparities in health care are differences in the
preventative, diagnostic and treatment
services offered to people with similar
conditions
Driver of Disparities
•
•
•
•
Racial or Ethnic Health Disparities
Socioeconomic Health Disparities
Gender Health Disparities
Rural Health Disparities
Statement for the Record of the American College of Physicians
“Addressing Disparities in Health and Healthcare”
• Timely access to appropriate health care is critical to improving health
outcomes
• Effective patient-provider communications increases patient
understanding and is a critical component of patient-centered care.
• Language is one aspect of an individual’s culture that may affect patient –
provider communication, quality of the encounter and patient outcome.
Physicians and other health care providers must realize the impact of
culture on health status
• Eliminating health disparities will require an adequate supply of culturally
competent health care providers
• A diverse workforce of health professionals is also an integral part of
eliminating disparities among racial and ethnic minorities
• Eliminating health disparities and improving quality of care requires
evidence-based policies and programs.
What steps should CEO’s take to
make meaningful progress?
1. Cultivate a clinical leader who can champion the cause of
patient equity.
2. Conduct a CLAS-based organizational assessment.
3. Collect patient race, ethnicity and language data.
4. Focus on improving the quality and safety of hospital
language access systems
5. Place culture within the context of an interwoven network
of community relationships – between language and
traditions, etc.
6. Keep racial and ethnic disparities on your hospital’s
management dashboard.
Lessons Learned
• Hispanocare at Advocate Illinois Masonic
Medical Center, Chicago, Illinois
• Korean Concierge Program at Advocate
Lutheran General Hospital and Children’s
Hospital, Park Ridge, Illinois
• Stroke Program at Advocate Trinity Hospital,
Chicago, Illinois
THANK YOU
QUESTIONS AND ANSWER ?
Anthony A. Armada FACHE
President
Advocate Lutheran General Hospital and Children’s Hospital
1775 Dempster Street
Park Ridge, Illinois 60068
E-mail: anthony.armada@advocatehealth.com
Office: 847-723-8446
Executive Assistant: Joanna Werling