The IOM Report Unequal Treatment Translating Research

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The IOM Report Unequal Treatment Translating
Research Recommendations into Policy and
PracticeA Hospital Case Study

• Joseph R. Betancourt, M.D., M.P.H.
• Senior Scientist, Institute for Health Policy
• Director for Multicultural Education,
  Massachusetts General Hospital
• Assistant Professor of Medicine, Harvard Medical
  School

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Outline

• Background National and Local Context
• Process Developing an Approach
• Key Lessons Learned

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Background Efforts Underway Prior to 2002

• MAO Minority Recruitment, Retention, Prof Dev
• Interpreter Services Increasing Volume
• Cultural Competence Education Mandatory in Med
• Race/Ethnicity Data Collection Active
  deliberations at systems level QI in place at
  hospital level

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Background Timeline of Key Events

• March 2002 IOM Report Unequal Treatment
• July 2002 Dr. Satcher presents in Boston
• December 2002 Boston Mayor Menino convenes
  hospital CEOs re role in eliminating disparities
  
• December 2002 Dr. Satcher presents at MGH
• April 2003 Mayors Hospital Working Group
  formed 12 month plan to address disparities
• April 2003 MGH appoints Disparities Committee

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MGH Disparities Committee

• Underlying Principle
• While data specific to disparities at MGH
  important, not necessary to begin to take action
  given IOM Report documented issue nationally
• Charge
• Identify and address disparities in health and
  health care wherever they may exist at MGH
• Coordinate with the Mayors Efforts
• Present Plan to Board in Jan 04 Results Sept
  04
• Also to GEC and Presidents Advisory Council

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Translating Research into Policy and Practice
Committee will base work on IOM Report Unequal
Treatment
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IOMs Unequal Treatmentwww.nap.edu

• Recommendations
• Increase awareness of existence of disparities
  among key health care stakeholders
• Address systems of care
• Support race/ethnicity data collection and QI
• Encourage use of evidence-based guidelines
• Improve workforce diversity
• Facilitate interpretation services
• Efforts underway at MGH

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IOMs Unequal Treatmentwww.nap.edu

• Recommendations
• Provider education (mechanisms of decisionmaking,
  cultural competence)
• Patient education (health care system navigation,
  activation in the medical encounter)
• Research (identifying sources, promising
  strategies, barriers to eliminating disparities)
• Efforts underway at MGH

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MGH Disparities Subcommittees Form

• Based on 4 months of deliberations
• Education and Awareness
• Quality
• Patient Access and Experience
• Budget provided for each groups efforts

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Education and Awareness Subcommittee

• Charge Raise awareness at MGH of disparities
• and contributing factors
• 2004 Goals
• At least two major presentations at grand
  rounds/leadership meetings
• To Date Byrd and Hill present in May 2004
• Comprehensive communication strategy developed
  and underway
• To Date MGH Hotline, Fruit St MD, FYI Posters
• Message on disparities incorporated into
  orientations
• Under development

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Quality Subcommittee

• Charge Stratify outcomes of QI initiatives by
  race
• and ethnicity, and design
  improvement
• activities based on findings
• 2004 Goals
• Data on outcomes of asthma and diabetes QI
  initiatives stratified by race and ethnicity
  plan and develop interventions based on findings
• Patient Satisfaction Data inpatient and
  outpatient data stratified by race and ethnicity
• Embed Disps Questions into Quality Rounds
• Demographic Profile of the Hospital who are our
  patients and what services do they use

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Patient Experience of Care and Access to Care
Subcommittee

• Charge Assess the experience of care for MGH
• patients and develop and
  implement action
• plan based on findings
• 2004 Goals
• Conduct inpatient and outpatient survey
• Create Multi-Cultural Advisory Committee and plan
  initial meeting
• Develop inventory of existing disparities
  research

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Crossing the Quality ChasmInstitute of Medicine,
2001

• Quality can be achieved if health care systems
  are
• Safe
• Effective
• Patient Centered
• Timely
• Efficient
• Equitable
• Consider Disparities for all strategic planning

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Key Lessons Learned

• Challenges
• Race/Ethnicity Data Collection Categories,
  Standardization, Ease, IT
• Quality versus research Challenges of current
  data systems
• Satisfaction Do we have correct tools?
• Expanding buy-in
• Key Ingredients
• Leadership Commitment Mainstreaming Plunge In