MGH Committee on RacialEthnic Disparities Annual Update

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MGH Committee on Racial/Ethnic DisparitiesAnnual
Update

• Joseph R. Betancourt, MD, MPH
• Joan Quinlan
• Co-Chairs, MGH Committee on Racial/Ethnic
  Disparities

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Overview of Presentation

• Recap and Key Events of 2004-5
• Current Efforts
• Quality Identifying and Addressing Disparities
• Disparities Dashboard, Diabetes, CRC Screening
• Pt Experience The Multicultural Advisory
  Committee
• Next Steps

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MGH Committee on Racial/Ethnic Disparities

• Recap and Key Events

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• Quality Health Care 2001
• Health care should be
• Safe
• Effective
• Patient-centered
• Timely
• Efficient
• Equitable

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Disparities in Health Care 2002 Racial/Ethnic
disparities consistently found across a wide
range of health care settings, disease areas, and
clinical services, even when various confounders
are controlled for. Mayors Effort 2002-3 Mayor
Menino calls hospital CEOs to help in addressing
disparities in Boston
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MGH Disparities Committee 2003

• Underlying Principle
• While data specific to disparities at MGH
  important, not necessary to begin to take action
  given IOM Report documented issue nationally
• Charge
• Coordinate with the Mayors Efforts
• Identify and address disparities in health and
  health care wherever they may exist at MGH
• Subcommittees Quality, Pt Experience,
  Education/Awareness
• Present plan and results to Board, GEC,MGPO, and
  other hospital leadership regularly

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• State Comm on Disps 2004
• State forms Committee on
• Disparities with plan to
• develop legislative strategy.
• Public hearing held in Spring
• of 2005 and Dr. Peter Slavin
• is first and only hospital CEO
• to Testify (and upon
• questioning cites several
• studies on disparities by
• memory)

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• Mayors Report 2005
• Mayor Menino releases Task
• Force Report and Hospital
• Group Report in June MGH
• plays a major leadership role
• in development of both
• reports and participates in
• press release

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Disparities Solutions Center 2005The Disparities
Solutions Center will develop and implement
strategies that advance policy and practice to
eliminate racial and ethnic disparities in health
care both locally and nationallyAccomplished
through1. Action-Oriented Service
Scholarship2. Leadership Development3.
Translation into Policy and PracticeMajor Focus
on Disparities at MGH Projects with BPHC, BCBS
Foundation of MA, Delaware, NCQA and 2.0M from
the Robert Wood Johnson Foundation
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Where we left offRecommendations for 2005

• Quality of Care
• Establish policies so that all quality
  initiatives are stratified by race/ethnicity and
  design quality improvement interventions
  accordingly
• Patient Access and Experience of Care
• Explore methods for routinely assessing these
  issues (i.e. via patient satisfaction surveying,
  Multicultural Advisory Committee) and develop
  strategies to address them
• Education and Awareness
• Continue current activities and explore new
  educational efforts

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MGH Committee on Racial/Ethnic Disparities

• Quality
• Identifying and Benchmarking Disparities

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Identifying and Benchmarking Disparities

• Unit-Based Staff Quality Rounds
• Exploring disparities main finding was concern
  about language barriers over course of
  hospitalization
• Patient Satisfaction
• Stratifying results by r/e and have added
  questions about respect for culture/race/religion
  (results pending)
• CMS Core Measures
• Stratifying results by r/e with all Boston
  Hospitals (results pending, low sample sizes to
  date)
• Disparities Dashboard
• Identifying possible indicators to be stratified
  by race/ethnicity (readmission, satisfaction,
  wait times)

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Disparities DashboardDeveloped under leadership
of Liz Mort and distributed by her office to all
who receive Quality Dashboard (approx 200 leaders)

• Welcome and Purpose
• Understanding race/ethnicity at MGH
• How data collected, categories, future models
• Snapshot of diversity of MGH patients
• Measures
• Wait times for appointments
• Communication with LEP patients (
  interpretations)
• Clinical quality indicators
• CMS Core Measures (inpatient)
• HEDIS Preventive Svcs and Diab (outpatients)
• Patient experiences
• Inpatient and outpatient satisfaction by r/e
• Lessons learned
• Areas for disparities targets for improvement

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MGH Committee on Racial/Ethnic Disparities

• Quality
• Addressing Disparities When Found

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Culturally Competent Disease Management
The Chelsea Latino Diabetes Project

• The Problem
• Diabetics at MGH Chelsea doing poorly on several
  quality indicators - Latinos worse than whites
• Of 1402 diabetics nearly 1/3 of Latinos and gt1/4
  of Whites had no HbA1c measured in past 9 months
• 41 of Latinos and 23 of Whites had HgbA1c gt 8
• Key groups involved
• MGH leadership, DSC, MGH Chelsea, CBO, MGPO

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The MGH Chelsea Diabetes Program

• A quality improvement / disparities reduction
  program with 3 primary components
• Telephone outreach to increase rate of HbA1c
  testing
• Individual coaching to address patients needs
  and concerns regarding diabetes self-management
  to improve HbA1c
• Group visits meeting ADA educational requirements

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A New Issue CRC Screening By Race/Ethnicity,
Linkage to MD, and Site of Care
Aged 52-69
Non-Chelsea
Chelsea
P
TOTAL 25729 65.1 2035 49.3 lt.0001 White
23111 65.6 1105 55.5 lt.0001 Black 1127
64.5 98 53.1 0.02 Asian 690 61.4 32 43.8
0.05 Hispanic 397 54.9 744 41.5
lt.0001 Other 404 56.4 56 26.8 lt.0001
n 27764 MD Linked Only Data is as of May
2004 CRC 1)FOBT- 1 yr 2) Sigmoidoscopy or
DCBE - 5 yrs or 3)Colonoscopy (7tsi) 10 yrs
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Moving Forward

• July 2005 meeting of Chelsea leadership,
  Disparities center, Community Benefits, PCOI
• September 2005 meetings with GI service
• September 28, 2005 meeting with Chelsea, GI,
  Community Benefits, PCOI representatives
• Goals
• Increase colonoscopy completion rates
• Use established programs at Chelsea
• Simplify scheduling with GI service
• Improve patients procedure experience

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MGH Committee on Racial/Ethnic Disparities

• Patient Experience
• and
• Education and Awareness

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Multicultural Advisory Committee

• Multicultural Advisory
• Committee Members
• Ali Abdullahi, International Inst
• Ruby Blake, patient
• Vanessa Calderon-Rosada, IBA
• Anicha Chablani, ROCA
• Tione Chilambe, Cambridge Cares About AIDS
• Niurka Giron, employee
• Howard Koh, Harvard School of Public Health
• Rev. Martin McLee
• Bountay Phath Reth, N. Suffolk MH
• Jovita Fontanez, community activist
• Azzie Young, Mattapan Health Center
• Juan Vega, Centro Latino, Chelsea
• Sandra Walker, patient/family member
• Darnell Williams, Urban League

• Multicultural Advisory Committee (MAC) charged
  with advising MGH on minority patients
  experiences of care and perceptions of hospital
• Chaired by Peter Slavin and Jeanette Ives
  Erickson
• Has met 4 times
• Results of patient phone survey presented key
  themes
• The treatment, satisfaction and training of front
  line staff have a large impact on patients
  perceptions and experiences of care.
• It is not just language that is important, but
  the overall sensitivity and compassion
  demonstrated to patients.

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Education and Awareness

• Sponsored forum attended by 200 faculty and staff
  on disparities in renal transplantation
• Published stories in Hotline, Caring and Fruit
  Street Physician
• Language on disparities in New Employee Resource
  Guide

MGH forum on disparities brings patients' voices
to the forefront
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Next Steps Plans for 2006

• Quality of Care
• Continue all current activities
• Obtain data on Chelsea Diabetes Project
• Develop CRC Screening Project
• Work with additional clinical services to
  identify opportunities to stratify quality
  measures by race and ethnicity
• Patient Access and Experience of Care
• Develop methods to embed phone survey questions
  into current patient satisfaction measurement
• Identify additional recommendations from MAC
• Education and Awareness
• Continue PR and develop strategies to further
  educate front-line staff