Assessing Health Equity in Your Patient Population

Objectives Utilize resources within your institution or practice to better identify your particular patient population Identify resources within your community that identify health inequities or disparities provide services to combat health inequities or disparities Put your knowledge into action Develop projects or programs to combat health disparities for your patient population Assessing your patient population using what you have learned from the previous modules

Institutional and Practice Resources Outpatient Practice Query your EHR patient demographics: Age Ethnicity Zip code Insurance carrier (commercial, federal, self-pay) Common diagnoses Patient intake questionnaires

Institutional and Practice Resources Institutional/Hospital Resources Demographics Billing Office Registrar Institutional Officer on Diversity and Inclusion

Identifying Local Disparities I know who I am caring for, now where do I find what disparities may be affecting their care? Local government resources Health Department Reports Examples: https://louisvilleky.gov/government/center-health-equity/health-equity-report https://www.scottcountyiowa.com/sites/default/files/attachments/pages/2018%20Health%20Equity%20Assessment%20Report.pdf Web resources Community Health Needs Assessment (CHNA)(http://www.astho.org/Programs/Maternal-and-Child-Health/) http://www.countyhealthrankings.org/ Once you know who your providing care to, it is important to discover what particular social determinants of health that may be affecting them This is a good opportunity for you to brainstorm with your residents/audience to identify local disparities you think are affecting your patient population.

Identifying Local Disparities Your own experience – what are the unmet needs of your patients that adversely impact their health? Examples: Access to mental health care. Resources for substance abuse Nutritional counseling Healthy food options Transportation to appointments Limited English Proficiency Limited health literacy

Local Resource Identification Learn what resources are already available within your community to combat health disparities Nutritional Support WIC resources and offices SNAP programs Local Food banks/closets and free meal programs Insurance Program Incentives Gift cards for baby supplies if they attend a certain number of prenatal appointments and/or postpartum visits Transportation benefits for those without access to a vehicle Language/Translator Services Local Charitable Programs Clothes closets Free/reduced care seat programs Mother’s Day out or child care offerings Parenting/baby care programs Healthy eating and nutrition programs Mental Health and Addiction Resources

Local Resource Identification Who can help me learn about this? Hospital/Institutional Staff Social Workers Case Management Diversity and Inclusion officers Your own exploration and web searches Once you have collected this information, it is very helpful to make this an available resource for others in your program/institution for easy reference

Put your knowledge into action This new knowledge will allow you to: Improve your understanding of the barriers to care that your patients face and the system of resources in place within your community aimed to help improve health equity Increase referral and utilization to these local resources Recognize continued gaps in resources and your role in advocating for your patients Develop new practice patterns, projects, and programs that can improve the health care outcomes for your patients.

Projects and Programs Based upon what you have learned about your patient population what ideas do you have for a helpful initiative, project, or educational program?

Example: Small Group Activity for Resident Training to raise awareness surrounding local health disparities and resources This scenario is through the eyes of a newly identified pregnant patient with limited resources as she navigates the local healthcare system Participants identify barriers to care and social determinants that she faces. They will then identify local resources that are available in their community to help combat these potential barriers and disparities.

Another Example: A population health approach to stillbirths https://youtu.be/Kn5xyct4Hd0 http://www.ihi.org/education/IHIOpenSchool/resources/Pages/AudioandVideo/Jason-Leitch-What-If-You-Take-a-Complex-Clinical-Challenge-to-the-Community.aspx This video and the next slide are from the IHI module on the Triple Aim and is a great example how we apply the principles of population health in understanding and improving patient outcomes.

Discussion What were some of the factors affecting stillbirth rates that you heard in the video? Why couldn't obstetricians solve the problem on their own? Do you think it would be hard to convince staff and patients to participate in multidisciplinary rounds after a stillbirth? Why might people resist this, and how might you address their concerns? What other health care problems might be improved by addressing factors outside of health care, for example, living conditions? http://www.ihi.org/education/IHIOpenSchool/resources/Documents/Facilitator_Leitch_ComplexChallenge.pdf