1. The presentation will begin shortly.

2. AnMed Health Disparities Dashboard Keeping it REaL: An Analysis of Health Care Quality Among Priority Patient Populations Juana Slade, CDM, CCF Director, Diversity and Language Services Suzanne Wilson, RN, MBA Director, Medical Resource Management Presented in partnership with the Institute for Diversity in Health Management Health Research Education Trust Affiliates of the American Hospital Association May 30, 2012

3. AnMed Health 578 Bed Acute Care System –461 AnMed Health Medical Center –72 AnMed Health Women’s and Children's Hospital –45 AnMed Health Rehabilitation Hospital 24,054 Inpatient admissions 205,400 Outpatient procedures 107,818 ED visits 400 Admitting physicians 2800 Employees

4. to passionately blend the art of caring with the science of medicine to optimize the health of our patients, staff and community. Our Mission Our Vision to be recognized and celebrated as the gold standard for healthcare quality and community health improvement.

5. The Joint Commission’s Stroke Center of Excellence The Joint Commission’s “Top Performer” on Key Quality Measures IHI Mentor Hospital for Acute Myocardial Infarction Healthgrades® Clinical Excellence and Patient Safety Awards 100 Most Wired Hospitals in Health Networks Magazine Institute for Diversity in Healthcare’s “Best in Class” and a “Promising Practices” Gold Standard Celebrations Healthgrades® America’s 100 Best Hospitals Award

6. Why this….why now?

7. Pursuit of Equitable Care National Direction: Culturally and Linguistically Appropriate Service Standards (CLAS) Joint Commission’s Roadmap Advancing Effective Communication, Cultural Competence and Patient- and Family-Centered Communication Standards American Hospital Association’s National ‘Call to Action’

8.  Applicable law or comprehensive vision  Executive authorization or executive leadership  Language access policy or cultural and linguistic competence  Functional accountability or system integration  Regulatory compliance or equitable care A Few Historical Realities ….

9. Our Project Disparities Leadership Program 2011-2012 AnMed Health: Disparities Dashboard

10. Goal The goal of our project is to research and develop a disparities dashboard to identify and strategically address AnMed Health’s most vulnerable, underserved and costly patient populations. The disparities dashboard will be adjunct to our system-wide quality management strategies.

11. Project Objectives I.Establish dashboard implementation team II.Establish dashboard framework III.Establish priority populations IV.System engagement V.Project Evaluation & Phase II Assessment

12. Project Status –Administrative /Executive Support –Competing organizational priorities Moving disparities ‘conversations’ forward –Established dashboard framework Methodology and Data Set –Physician Sponsor Matt Cline, MD, Assoc. Program Director, Family Medicine –Resources / Implementation Team Talent

13. Quality & Disparities Dashboard Components Quality Appropriate Care Scores –HF; AMI; CAP; SCIP Patient Satisfaction –H-CAHPS Readmissions Disparities Diversity Snapshot –Service Volumes –Business Line Analysis Language Services

14. FY2011 Diversity Snapshot Diversity SnapshotWhiteHispanic African American American Indian Asian Unknown/ Other SettingPercent Inpatient Discharges78.63%0.91%19.83%0.25%0.31%0.08% Emergency Department70.64%1.17%23.59%0.01%0.12%4.47% Child Health42.23%7.52%27.09%0.00%0.01%23.14% Family Medicine65.26%1.85%20.97%0.00% 11.91% Type of CareWhiteHispanic African American American Indian Asian Unknown/ Other ServicePercent of Admissions Inpatient Adult59.61%0.72%19.36%0.19%0.24%0.09% Inpatient Pediatrics (<17)73.33%2.19%23.04%0.63%0.78%0.04% AnMed Health Business Line78.63%0.91%19.83%0.25%0.31%0.08% Cardiac Surgery88.68%0.75%9.43%0.75%0.38%0.00% Cardiology74.71%0.40%24.55%0.00%0.27%0.07% Cath & EP83.37%0.59%15.32%0.13%0.53%0.07% Dentistry53.85%7.69%38.46%0.00% ENT77.25%1.20%20.96%0.00%0.60%0.00% Gastroenterology79.93%0.88%18.85%0.20%0.14%0.00% General Surgery81.05%1.24%17.22%0.33%0.08% Gynecology72.18%0.70%26.06%1.06%0.00% Internal Medicine78.48%0.54%20.43%0.23%0.27%0.05% Medical Oncology69.39%0.00%30.16%0.23% 0.00% Neonatology73.16%2.25%23.77%0.41% 0.00% Nephrology76.10%0.73%22.96%0.10%0.00%0.10% Neurology77.02%0.62%21.49%0.00%0.25%0.62% Neurosurgery85.63%0.00%13.22%0.57% 0.00% Normal Newborn73.34%2.04%22.98%0.72%0.85%0.07% Obstetrics72.67%2.10%23.75%0.62%0.72%0.14% Opthalmology25.00%0.00%75.00%0.00% Orthopaedics87.27%0.29%12.22%0.00%0.22%0.00% Psychiatric84.08%0.57%15.06%0.00%0.10%0.19% Pulmonary81.03%0.55%18.19%0.08%0.12%0.04% Thoracic Surgery82.70%0.00%17.30%0.00% Trauma & Burns82.54%0.79%15.08%0.79% 0.00% Urology85.27%0.63%14.11%0.00% Vascular Surgery68.69%1.22%29.79%0.30%0.00% Diversity SnapshotWhiteHispanic African American American Indian Asian Unknown/ Other SettingPercent Inpatient Discharges78.63%0.91%19.83%0.25%0.31%0.08% Emergency Department70.64%1.17%23.59%0.01%0.12%4.47% Child Health42.23%7.52%27.09%0.00%0.01%23.14% Family Medicine65.26%1.85%20.97%0.00% 11.91% Type of CareWhiteHispanic African American American Indian Asian Unknown/ Other ServicePercent of Admissions Inpatient Adult59.61%0.72%19.36%0.19%0.24%0.09% Inpatient Pediatrics (<17)73.33%2.19%23.04%0.63%0.78%0.04% AnMed Health Business Line78.63%0.91%19.83%0.25%0.31%0.08% Cardiac Surgery88.68%0.75%9.43%0.75%0.38%0.00% Cardiology74.71%0.40%24.55%0.00%0.27%0.07% Cath & EP83.37%0.59%15.32%0.13%0.53%0.07%

15. National Hospital Quality Measures 1-White1-Hispanic2-Black 3-American Indian 4-Asian7-UTDTotal Heart Failure Discharge instructions 97.71%100.00%96.90%0.00% 100.00%97.51% Evaluation of LVS Function 100.00% 0.00%100.00% ACEI or ARB for LVSD 99.29%0.00%100.00%0.00% 99.51% Adult smoking cessation advice/counseling 100.00%0.00%100.00%0.00% 100.00% HF Appropriate Care Score (ACS) 98.06%0.00%97.37%100.00%0.00% 97.90% AMI Aspirin at arrival 100.00% Aspirin Prescribed at discharge 100.00% ACEI or ARB for LVSD 100.00%0.00%100.00% 0.00%100.00% Adult smoking cessation advice / Counseling 100.00%0.00%100.00% Beta Blocker prescribed at Discharge 100.00% Inpatient Mortality *Not tracked in 2011 4.76%0.00%6.67% 0.00%5.06% Primary PCI Received Within 90 Minutes of Hospital Arrival 100.00%0.00%100.00% AMI Appropriate Care Score (ACS) 100.00% 98.04% 100.00%99.67% AMI-T1a LDL Cholesterol Assessment AMI-T2 Lipid-Lowering Therapy at Discharge (Test) Pneumonia Pneumococcal vaccination 99.79%100.00% 0.00%100.00%0.00%99.81% Blood Cultures Performed in the ED Prior to Initial Abx Received in Hospital 99.62%100.00%98.68%100.00% 0.00%99.50% Adult smoking cessation advice / counseling 100.00%0.00%100.00%0.00%100.00%0.00%100.00% Influenza vaccination 100.00% 0.00%100.00%0.00%100.00% Blood cultures w/i 24 hours of hosp arrival-pts transferred/admitted to the ICU 100.00%0.00%100.00% 0.00% 100.00% Initial antibiotic received within 8 hours of hospital arrival 96.89%100.00%97.14%100.00% 0.00%96.98% Initial antibiotic selection for CAP in immunocompetent - ICU patient 95.65%0.00%100.00%0.00% 96.08% Initial antibiotic selection for CAP in immunocompetent - Non ICU patient 97.58%100.00%97.06%0.00% 97.52% Initial Antibiotic Received Within 6 Hours of Hospital Arrival 96.89%100.00%97.14%100.00% 0.00%96.94% PN Appropriate Care Score (ACS) 96.78%100.00%96.40%100.00% 0.00%96.75% Surgical Care Prophylactic abx within 1 hr prior to surgical incision-Overall Rate 98.35%100.00%99.19% 0.00% 98.49% Prophylactic abx selection surgical patients-Overall Rate 98.22%100.00%97.58% 0.00% 98.13% Prophylactic abx discontinued within 24 hrs after surgery end time-Overall Rate98.41%100.00%99.17% 0.00% 98.54% Cardiac Surgery Patients With Controlled 6 A.M. Postoperative Serum Glucose99.15%100.00%93.33% 0.00% 98.52% Surgery Patients with Appropriate Hair Removal 100.00% Surgery Pt on BB Therapy Received BB During Perioperative Period 96.23%100.00%97.67% 100.00% 96.53% Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered99.18%100.00% 0.00% 99.32% Rcvd Appropriate VTE Prophylaxis w/n 24 Hrs Prior to thru 24 hrs after Surg98.57%100.00%97.94% 0.00% 98.47% SCIP Appropriate Care Score (ACS) 91.99%100.00%91.98% 100.00% 92.05% Urinary Catheter Removed on POD 1 or POD 2 With Day of Surgery Being Day Zero93.75%100.00%95.45% 0.00% 94.09% Surgery Patients with Perioperative Temperature Management 100.00% 0.00% 100.00% Appropriate Care Score Populations: Heart Failure (HF) Acute Myocardial Infarction (AMI) Pneumonia (CAP) Surgical Care (SCIP)

16. National Hospital Quality Measures 1-White1-Hispanic2-Black 3-American Indian 4-Asian7-UTDTotal Heart Failure Discharge instructions 97.71%100.00%96.90%0.00% 100.00%97.51% Evaluation of LVS Function 100.00% 0.00%100.00% ACEI or ARB for LVSD 99.29%0.00%100.00%0.00% 99.51% Adult smoking cessation advice/counseling 100.00%0.00%100.00%0.00% 100.00% HF Appropriate Care Score (ACS) 98.06%0.00%97.37%100.00%0.00% 97.90% AMI Aspirin at arrival 100.00% Aspirin Prescribed at discharge 100.00% ACEI or ARB for LVSD 100.00%0.00%100.00% 0.00%100.00% Adult smoking cessation advice / Counseling 100.00%0.00%100.00% Beta Blocker prescribed at Discharge 100.00% Inpatient Mortality *Not tracked in 2011 4.76%0.00%6.67% 0.00%5.06% Primary PCI Received Within 90 Minutes of Hospital Arrival 100.00%0.00%100.00% AMI Appropriate Care Score (ACS) 100.00% 98.04% 100.00%99.67% AMI-T1a LDL Cholesterol Assessment AMI-T2 Lipid-Lowering Therapy at Discharge (Test) Pneumonia Pneumococcal vaccination 99.79%100.00% 0.00%100.00%0.00%99.81% Blood Cultures Performed in the ED Prior to Initial Abx Received in Hospital 99.62%100.00%98.68%100.00% 0.00%99.50% Adult smoking cessation advice / counseling 100.00%0.00%100.00%0.00%100.00%0.00%100.00% Influenza vaccination 100.00% 0.00%100.00%0.00%100.00% Blood cultures w/i 24 hours of hosp arrival-pts transferred/admitted to the ICU 100.00%0.00%100.00% 0.00% 100.00% Initial antibiotic received within 8 hours of hospital arrival 96.89%100.00%97.14%100.00% 0.00%96.98% Initial antibiotic selection for CAP in immunocompetent - ICU patient 95.65%0.00%100.00%0.00% 96.08% Initial antibiotic selection for CAP in immunocompetent - Non ICU patient 97.58%100.00%97.06%0.00% 97.52% Initial Antibiotic Received Within 6 Hours of Hospital Arrival 96.89%100.00%97.14%100.00% 0.00%96.94% PN Appropriate Care Score (ACS) 96.78%100.00%96.40%100.00% 0.00%96.75% Surgical Care Prophylactic abx within 1 hr prior to surgical incision-Overall Rate 98.35%100.00%99.19% 0.00% 98.49% Prophylactic abx selection surgical patients-Overall Rate 98.22%100.00%97.58% 0.00% 98.13% Prophylactic abx discontinued within 24 hrs after surgery end time-Overall Rate98.41%100.00%99.17% 0.00% 98.54% Cardiac Surgery Patients With Controlled 6 A.M. Postoperative Serum Glucose99.15%100.00%93.33% 0.00% 98.52% Surgery Patients with Appropriate Hair Removal 100.00% Surgery Pt on BB Therapy Received BB During Perioperative Period 96.23%100.00%97.67% 100.00% 96.53% Surgery Patients with Recommended Venous Thromboembolism Prophylaxis Ordered99.18%100.00% 0.00% 99.32% Rcvd Appropriate VTE Prophylaxis w/n 24 Hrs Prior to thru 24 hrs after Surg98.57%100.00%97.94% 0.00% 98.47% SCIP Appropriate Care Score (ACS) 91.99%100.00%91.98% 100.00% 92.05% Urinary Catheter Removed on POD 1 or POD 2 With Day of Surgery Being Day Zero93.75%100.00%95.45% 0.00% 94.09% Surgery Patients with Perioperative Temperature Management 100.00% 0.00% 100.00% National Hospital Quality Measures 1-White1-Hispanic2-Black Heart Failure Discharge instructions 97.71%100.00%96.90% Evaluation of LVS Function 100.00% ACEI or ARB for LVSD 99.29%0.00%100.00% Adult smoking cessation advice/counseling 100.00%0.00%100.00% HF Appropriate Care Score (ACS) 98.06%0.00%97.37% AMI Aspirin at arrival 100.00% Aspirin Prescribed at discharge 100.00% ACEI or ARB for LVSD 100.00%0.00%100.00% Adult smoking cessation advice / Counseling 100.00%0.00%100.00% Beta Blocker prescribed at Discharge 100.00% Inpatient Mortality *Not tracked in 2011 4.76%0.00%6.67% Primary PCI Received Within 90 Minutes of Hospital Arrival 100.00%0.00%100.00% AMI Appropriate Care Score (ACS) 100.00% 98.04% FY2011 Appropriate Care Scores

17. FY2011 H-CAHPS Readmissions Language Services Outpatient ServicesInpatient ServicesTotal Spanish 92.73%86.31%91.21% Russian 1.66%1.34%1.58% Sign Language 2.05%2.17%2.08% Other 1.78%6.62%2.92% Chinese / Mandarin 1.21%2.84%1.59% Arabic 0.12%0.45%0.20% Vietnamese 0.38%0.17%0.33% Polish 0.03% Farsi (Persian) 0.03% German 0.00% Greek 0.11%0.03% Patient Experiences with CareWhite African American American Indian HispanicMexican Puerto Rican Hawaiian/Pacific Islander Asian % of Responses in Best Category (9-10 Rating) H-CAHPS (Inpatient) Overall Rating78.70%74.50%80.11%71.43%70.00%71.43%53.85%50.00% 30-Day ReadmissionsWhiteHispanic African American American IndianAsianUnknown/ OtherOverall Overall Rate10.85%5.76%11.54%3.85%6.15%5.88%10.90% Overall Volume1796114822412296 Heart Failure Rate22.08%33.33%22.09%0.00% 21.94% Heart Failure Volume106138000145 AMI Rate11.76%0.00%37.04%0.00% 15.65% AMI Volume3402000054 Pneumonia Rate14.18%0.00%13.61%0.00% 14.02% Pneumonia Volume133020000153

18. Progress and Challenges –Strategic alignment Family Medicine Residency Program REaL data collection at registration –Trending and Data Analysis –Intervention Team Inpatient Focus –Collaborative and Benchmark Opportunities

19. Interventions Case Management Involvement –Real Time Patient Alerts –Readmission Interview –Post Discharge Phone Calls Cultural Competency Education –Skills Fair –Ongoing Relevance Training –Dashboard Presentations

20. Questions

21. Contact Information Pamela J. Janniere, MBA Senior Membership Specialist Institute for Diversity in Health Management pjanniere@aha.org 312-422-2691 Barrett Ludley, MBA barrett.ludley@anmedhealth.org 864-512-1846 Juana Slade, CDM, CCF juana.slade@anmedhealth.org 864-512-2361 Suzanne Wilson, RN, MBA suzanne.wilson@anmedhealth.org 864-512-1767