Gathering and stratifying data on adverse events ("harm events") by race, ethnicity and other key socioeconomic factors can make health inequities visible and create the opportunity to correct them.
Collecting and using safety data segmented by sociodemographic characteristics is the third focus area of the “Advancing Equity through Quality and Safety Peer Network Series,” an AMA Ed Hub™ Health Equity Education Center resource, which explores in detail how this can be accomplished and offers a total of 11.5 CME credits.
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“These modules are designed to support health care professionals who play a role in quality and safety in health care institutions in understanding how they can integrate equity considerations into the operational DNA of their organizations,” said Emily Cleveland Manchanda, MD, MPH, director of social justice education and implementation at the AMA Center for Health Equity.
Along with race and ethnicity, other characteristics to consider when collecting and using harm event data include age, language preference, sexual orientation and gender identity, disability, and socioeconomic status—as identified by insurance type.
The modules are designed to show “ not just the nuts and bolts of how do you stratify data by sociodemographic characteristics like race and gender, which are crucial to ensuring equitable care—but also how do you address the inequities revealed by the data and prevent it from recurring?" said Tam Duong, MSPH, director of health systems transformation at the AMA Center for Health Equity, and director of the Peer Network program.
That can involve answering questions such as: “Are there patterns that indicate certain groups within our health system are experiencing inequitable outcomes? Beyond individual performance and behaviors, what are the systems, social, and structural contributors that led to these inequities?”
“This is a comprehensive curriculum for health systems that are looking for a how-to guide to embed equity into their quality and safety practices,” she added.
In the first module, emergency physician Nadia Huancahuari, MD, noted that a common theme that emerges when health systems get started on this work is that “racism, explicit or implicit, will come out,” including harms caused by language barriers.
Seeing gap between intent, action
One example of this was provided by internist Esteban Gershanik, MD, MPH, MSc, who detailed breastfeeding rates at discharge for patients who had their babies delivered at the hospital where he works.
The breastfeeding rate for white patients was 55%, compared with 35% for Black patients, 30% for English-speaking Hispanic patients, and 10% for Hispanic patients who did not speak English.
“There was a large gap between intent and what we were doing,” Dr. Gershanik said, adding that one way this was addressed was to add more diversity to the hospital’s staff of lactation specialists.
Representatives from Ochsner Health spoke in one of the modules, noting how they used data to ensure that patients with transportation barriers were able to get rides to their appointments—reducing the system’s no-show rate and improving care for patients’ chronic conditions.
Lindsey White, director of Ochsner Health’s tobacco-cessation program, also helped integrate services between the state Medicaid program and a national ride-sharing service. Ochsner Health also was one of the first health systems to integrate the ride service into its EHR.
Ochsner Health has done the same with the Unite Us platform, a program that identifies social needs in a community, manages enrollment to services and provides outcomes data and analytics on these efforts.
“From the second we refer a patient to the second there’s an outcome, we’re able to see if the referral needs to be rerouted, if it’s been rejected because an organization is out of funding, or if it’s been accepted and there’s a successful connection,” said Stephanie Most, BSN, MPH, Ochsner’s population health manager.
Ochsner Health is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Recognizing community health needs
“Health systems around the country are recognizing the ways in which social determinants of health, whether that's access to safe housing or healthy food or transportation, shape people's ability to access health care and to lead healthy lives,” Dr. Cleveland Manchanda said.
“As health systems take a more expansive view of their role in keeping patients and communities healthy, we end up looking more broadly at what types of interventions or supports health systems can and should provide,” she added.
The series also highlights inequities in four specific areas:
- Critical test results reporting.
- Pain assessment.
- Suicide prevention.
- Restraint use.
“These are each areas where health inequities have been identified by sociodemographic characteristics, such as race or gender,” Dr. Cleveland Manchanda said. “Proactively exploring these areas can help health systems to identify and tailor solutions to address those inequities.”
It’s noted that the stratification of data for these particular domains allows for the creation of systems that structure clinical decision-making to provide more equitable care.
“We can't fix what we don't see,” Dr. Cleveland Manchanda said.
“So if you are not stratifying your data, you will miss inequities that mirror patterns that show up in essentially every health system in many different areas around the country,” she explained. “By stratifying data, you can see the problems that you then need to fix.”
