Measuring Health Equity in TC LHIN We’ve Come a Long Way: Measuring Health Equity in TC LHIN Caroline Bennett-AbuAyyash Human Rights and Health Equity Office 13 May 2014

Background on TC LHIN Mandate TC LHIN mandated the collection of patient demographic data across 17 hospitals starting April 2013 CHCs started with pilot on demographic data collection using TC LHIN items in 2014 First point: Using the same set of 8 standardized demographic items and being led by Mount Sinai Hospital Second point: With vision that pilot findings will be used to roll out standardized data collection all TC LHIN CHCs

What makes up a “Demographic Data Collection Plan” The privacy legislation piece The staff training The IT solution(s) The communication strategy If demographic data collection were a mystery, these would be the clue to get us to the solution The privacy legislation piece: How does existing legislation govern how we use, store, and disclose the data? A The staff training: Whether training people who have never asked for those who were asking in different ways The IT solution: Being a Microsoft Windows Package user created some illusions about how easy this piece would be: Where to put it in, how to pull it out, and how to put it where people can see it. How to report it. The Communication strategy: Within organization, with staff doing the work, bottom up and top to bottom ** Demographic data collection is about anything but the data collection itself. The real challenge is not asking, which is what a lot of organizations first reactions were, but about all these other pieces that created a labyrinth.

Year 1: 2012-2013 Here are the organization that were involved in the first year. As you can see, we were quite a mix of settings, with a wide range of patients and care. What were some common themes that first year? As I said, the first question was ‘are the patients going to be ok with it’ and soon expanded to include questions on: Who needs to be part of this conversation? How can this be incorporated into ongoing operations? The key was often a solution that considers ‘what is best’ and ‘what is feasible’. Take the question of: Who are the best people to ask this? Social workers seemed a great fit, and have now taken on part of this work in few number of organizations. However, the best practice, particularly when a significant proportion of patients do not see a social worker or do so too late into the visit, admission and registration has now been adopted. IT first with asking questions, getting what we need early on, and putting it directly into the system. That is no surprise, since it’s widely acknowledged as a gold standard.

Year 2: 2013-2014 Hospitals: Progressing well Expansion Data reporting Data quality Community Health Centres: Piloting 8 demographic items Becoming leaders This year has been about looking at patient and staff reactions- the common theme has been a sigh of relief Laying out plans for reporting data: CIHI Once data is collected, we’ve seen hospitals look at it and try to plan for doing better Half of our hospitals already started expanding on their own Toronto is becoming a leader in demographic data collection in Canada and internationally, the ideas, solutions, approaches have all been a source of interest from a number of health care systems in north america

Year 3: 2014-2015 - Expansion of demographic data across hospitals - Adoption of TC LHIN questions by CHCs Continued focus on data quality Data reporting structure in place Understanding how to use the data for everything ranging from bedside care to program planning