1. Office of Health Equity Hepatitis C–Advanced Liver Disease Disparities Dashboard

2. News Release  VA Launches Hepatitis C–Advanced Liver Disease Disparities Dashboard o Tool will enhance VA efforts to treat all Veterans with Hepatitis C and advanced liver disease… Link here…. 2

3. Hepatitis C-Advanced Liver Disparities Disease Dashboard  The purpose of the HCV-ALD Dashboard is promote equitable diagnosis and treatment of underserved Veterans with hepatitis C and advanced liver disease.  The Hepatitis C-ALD Dashboard utilizes a set of criteria - age, gender, geography, service era, race/ethnicity - to characterize Veteran groups with ALD due to hepatitis C who may require targeted intervention to improve their health.  The dashboard advances the vision for quality care and improved access to care as identified in the VHA Blueprint for Excellence. 3

4. Office of Health Equity VA Core Values: Integrity+Commitment+Advocacy+Respect+Excellence =*I CARE*

5. Program Office Scope  Role of Program – Office of Health Equity (OHE) – OHE champions the advancement of health equity and reduction of health disparities through 5 key focal areas*: 1.Leadership 2.Awareness 3.Health Outcomes 4.Diversity and Cultural Competency of the Workforce 5.Data, Research, and Evaluation – Strategic Alignments  VHA Strategic Plan Objective 1(e)—Quality & Equity: Veterans will receive timely, high quality, personalized, safe, effective and equitable health care, irrespective of geography, gender, race, age, culture or sexual orientation  Blueprint for Excellence strategies 2.2a, 3.2a and 7.2b *VHA Health Equity Action Plan 5

6. Vulnerable Populations  Racial or Ethnic Group  Gender  Age  Geographic Location  Religion  Socio-Economic Status  Sexual Orientation  Military Era  Disability – Cognitive, Sensory, Physical  Other characteristics historically linked to discrimination or exclusion 6

7. Applying an Equity Lens The lens through which you view conditions, circumstances, and processes to understand who experiences the benefits and burdens of a program, policy, or practice. 7

8. Hepatitis C–Advanced Liver Disease Disparities Dashboard Dashboard Screen shots National Data

9. Dashboard Screen - Example 9

10. Hepatitis C-Advanced Liver Disease Dashboard 10

11. Hepatitis C-Advanced Liver Disease Dashboard 11

12. Hepatitis C-Advanced Liver Disease Dashboard 12

13. Hepatitis C-Advanced Liver Disease Dashboard 13

14. Hepatitis C-Advanced Liver Disease Dashboard 14

15. Dashboard Data  OHE Hepatitis C - Advance Liver Disease Dashboard depicts: OHE Hepatitis C - Advance Liver Disease Dashboard – VISN VISN – Facility Facility – Overall/National Overall/National – Facilities by VISN tables Facilities by VISN tables  The data is compared to FY14 VHA unique outpatient encounters to provide context as the demographics of the regions vary  No Personal Health Information (PHI) on the Dashboard 15

16. Dashboard –Disparities Exercise  The predominance of Veterans at the VA who have Hepatitis C and Advanced Liver Disease based on this data - refer Overall data on the Dashboard = o Born between 1945 and 1965 ( 89.1%) + male ( 97.8%) + white ( 50.4%) + Urban(73.9%)  BUT when you look at those percentages in comparison with the VA demographics as of FY 2014 (noted as Unique FY14) the top disparities are as follows: o Born between 1945 and 1965 (89.1 % Vs 45.6% = 43.5% difference) = mostly Vietnam Era Veterans o Black ( 33.5% Vs 14.7% = 18.3% difference)  At the VISN and facilities with higher population of racial/ethnic minorities the relative differences and therefore disparities may become more pronounced  These numbers are not the same for every VISN/Facility which is why OHE depicts the other sections on the Dashboard. A similar exercise in each section helps identify the differences and/or disparities. 16

17. What’s next?  The OHE will provide patient specific data directly to facility POCs for any of the vulnerable Veteran groups represented  The OHE will work directly and collaborate with VA offices, programs, medical centers and other stakeholders to address any identified disparities and refine the current dashboard 17

18. Related Collaboration in Progress  The Office of Health Equity-QUERI Partnered Evaluation Initiative, Principal Investigator Donna L. Washington, MD o A population health approach to examine the distribution of diagnosed health conditions, mortality, and healthcare quality across the entire VA healthcare system, as defined by Veterans’ membership, or not, in vulnerable population groups o Evaluate whether characteristics of the healthcare delivery settings (e.g., geography, treatment setting) and of the types of care that individuals use, including new models of care such as Telehealth, influence the quality of care that Veterans receive  The OHE plans to fund FY16 VISN- wide QI Project on Hepatitis C and liver disease led by the BRIDGE QUERI o Partnership with other VA program offices to explore additional steps in tackling Hepatitis C disparities among vulnerable Veterans 18

19. Collaboration - Outreach  Outreach efforts are underway–to those who work with vulnerable Veteran populations disparately impacted  If your organization works with vulnerable Veterans as defined by age, gender, geography, service era, race/ethnicity and is willing to support this project, please contact the VA Office of Health Equity: VHA 10A6ACTION@VA.GOVVHA 10A6ACTION@VA.GOV 19

20. What can you do?  Learn the facts –Fact sheet & VHA sites http://vaww.hepatitis.va.gov/  Share the facts  Outreach to increase engagement- o Screening o Treatment linkage o Support to achieve treatment completion o Empower to take action 20

21. More Information…  Interactive Dashboard Available via VA intranet https://vaww.vha.vaco.portal.va.gov/sites/OHE/Pages/ALD- VISN%20Dashboard.aspx  Office of Health Equity (OHE) – Intranet -> http://vaww.pdush.med.va.gov/programs/ohe/oheDefault.aspx http://vaww.pdush.med.va.gov/programs/ohe/oheDefault.aspx – SharePoint -> https://vaww.vha.vaco.portal.va.gov/sites/OHE/Pages/Default.aspx https://vaww.vha.vaco.portal.va.gov/sites/OHE/Pages/Default.aspx – Internet –> Coming Soon  To learn more about VA Health Equity Efforts - Visit the Links on the Appendix Slides ->>NEXT 21

22. Appendix 1 Health Equity Action Plan (HEAP) – https://vaww.vha.vaco.portal.va.gov/sites/OHE/Pages/HEAP.aspx https://vaww.vha.vaco.portal.va.gov/sites/OHE/Pages/HEAP.aspx – http://www.hsrd.research.va.gov/news/video/heap.cfm ( Video) http://www.hsrd.research.va.gov/news/video/heap.cfm Healthcare Equality Index (HEI) – https://vaww.vha.vaco.portal.va.gov/sites/OHE/CCC/SitePages/HEI.aspx https://vaww.vha.vaco.portal.va.gov/sites/OHE/CCC/SitePages/HEI.aspx Hepatitis C – Advanced Liver Disparities Dashboard 2015 – https://vaww.vha.vaco.portal.va.gov/sites/OHE/Pages/ALD- VISN%20Dashboard.aspx https://vaww.vha.vaco.portal.va.gov/sites/OHE/Pages/ALD- VISN%20Dashboard.aspx Health Equity Environmental Scan 2015 – https://vaww.vha.vaco.portal.va.gov/sites/OHE/Pages/HEScan.aspx https://vaww.vha.vaco.portal.va.gov/sites/OHE/Pages/HEScan.aspx – VAntage Blog http://www.blogs.va.gov/VAntage/23168/23168/http://www.blogs.va.gov/VAntage/23168/23168/ 22

23. Appendix 2 American Journal of Public Health (AJPH) Supplemental Issue 2014 – http://ajph.aphapublications.org/toc/ajph/104/S4 http://ajph.aphapublications.org/toc/ajph/104/S4 https://vaww.vha.vaco.portal.va.gov/sites/OHE/Pages/VA_AJPH.aspx AJPH Veterans Health Equity Collection Page 2015 – http://ajph.aphapublications.org/topic/vaheathequity http://ajph.aphapublications.org/topic/vaheathequity Health Equity Coalition – http://vaww.pdush.med.va.gov/programs/ohe/oheCoalition.aspx http://vaww.pdush.med.va.gov/programs/ohe/oheCoalition.aspx Clinical Look at Unconscious Biases (CLUB) – https://vaww.vha.vaco.portal.va.gov/sites/OHE/Pages/UB.aspx https://vaww.vha.vaco.portal.va.gov/sites/OHE/Pages/UB.aspx 23

24. Appendix 3 Health Disparities Evidence-based Synthesis Reviews – Evidence Brief: Update on Prevalence of and Interventions to Reduce Racial and Ethnic Disparities within the VA http://www.hsrd.research.va.gov/publications/esp/HealthDisparities.cfm http://vaww.hsrd.research.va.gov/publications/esp/HealthDisparities.cfm – Health Disparities in Quality Indicators of Healthcare Among Adults with Mental Illness http://www.hsrd.research.va.gov/publications/esp/health_disparities.cfm http://www.ncbi.nlm.nih.gov/books/NBK299084/ Health Equity Presentation – Special Feature - National Rural Health Association Reilly Address 2015 – http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1748-0361 http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1748-0361 24

25. Appendix 4 Health Equity Cyberseminars – Internet & Intranet: – Disparities in Healthcare Quality Indicators among Adults with Mental Illness: A systematic review: http://www.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/video_archive.cfm?SessionID =965 http://vaww.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/video_archive.cfm?Sessio nID=965 – Partnership in Pursuit of Health Equity: Focus on Minority Veterans http://www.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/video_archive.cfm?SessionID =889 http://vaww.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/video_archive.cfm?Sessio nID=889 – ACA-Health Equity/Disparities Connection http://www.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/video_archive.cfm?SessionID =807 http://vaww.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/video_archive.cfm?Sessio nID=807 – VHA Office of Health Equity- What is it all about? http://www.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/video_archive.cfm?SessionID =769 http://vaww.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/video_archive.cfm?Sessio nID=769 25

26. GET INVOLVED!  The pursuit of Health Equity should be everyone’s business.  It is a journey that takes time and sustained effort.  What can you do today in your area of influence to improve health equity?  At a minimum - in all your actions - do not increase the disparity.  Thank you! 26