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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 BackgroundData Collection ApproachEarly FindingsLessons and Challenges What’s on the Horizon

Greater Cincinnati Health Council Mission: High quality/high value health care; improved health status Representing area hospitals since 1957 Long history of collaboration 33 diverse members in 14 counties SW Ohio, Northern Kentucky, Southeastern Indiana 290,000 discharges

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  Survey based on national Expecting Success led by GWU  Hospital characteristics, data collection practices, barriers to collection, use of data, language services, and more Goal: Assess current R/E/L data collection practices

Participating Hospitals 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 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

12 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

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

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: White Black or African American Asian American Indian or Alaska Native Native Hawaiian or Pacific Islander Declined Unavailable (or Unknown) Ethnicity: 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 Q  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 self- reported 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

Where We Are Now Integrating with quality improvement efforts across 19 hospitals Reviewing data by quarter Sharing hospital-specific results Heart failure readmissions 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 REL community scorecard Data integrity standards developed Engage affiliated physician practices On-line training tool developed

Questions? Nancy Strassel Greater Cincinnati Health Council

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.Definition of Health and Health Care Disparities B.Health Disparities: The Basics C.Drivers of Disparities D.What steps should CEO’s take to make meaningful progress? E.Lessons Learned from Several Initiatives 1.Hispanocare at Advocate Illinois Masonic Medical Center, Chicago, Illinois 2.Korean Concierge Program at Advocate Lutheran General Hospital and Children’s Hospital, Park Ridge, Illinois 3.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 Office: Executive Assistant: Joanna Werling