Elizabeth C. Walker Anderson System Director Equitable Care, Cross Cultural Services HealthEast Care System Saint Paul, MN

Transcription

1 Diversity Rx Conference Quality Health Care for Culturally Diverse Populations: Achieving Equity in an Era of Innovation and Health System Transformation Promoting Health Equity- Two Organizational Perspectives (A8) March 12, 2013 Elizabeth C. Walker Anderson System Director Equitable Care, Cross Cultural Services HealthEast Care System Saint Paul, MN Sue Schlotterbeck Director, Cultural and Language Services Edward M. Kennedy Community Health Center Worcester, MA Funding for participation in this conference was partially funded by University of Massachusetts Medical School Prevention Research Center

2 Health Equity is attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities. Source: US Department of Health and Human Services, National Partnership for Action to End Health Disparities

3 1. Organizational Commitment 2. Training and Education 3. Workforce Diversity 4. Language Services 5. Community Engagement 6. Address Health Disparities

4 Community Health Center in Worcester, MA Founded in 1972 by 7 mothers from Great Brook Valley Staff speak 30 languages and represent 40 ethnic groups Patients speak 93 languages 73% of our staff are bilingual, of which 23% are trilingual We provide over 140,000 visits per year to over 24,000 patients At least 51% of board membership must be patients We help people live healthier lives.

5 Services include: Primary Medical Care Urgent Care Specialty Care HIV Counseling and Testing Dental Care Optometry Social and Behavioral Health Services Pharmacy Community Health Education and Prevention Refugee Health Assessments

6 HealthEast Care System HealthEast Care System The largest health care provider in the Twin Cities East Metro area: 4 Hospitals St. Josephs St. Johns Woodwinds Bethesda A Strategic Focus is on Employee Engagement and Equitable Care Yields Great Rewards: Best Places to Work Minneapolis/St. Paul Business Journal Top 100 Best Places to work Modern HealthCare Top 10 Health Care Systems Thompson Reuters Woodwinds Highest Nursing Engagement Scores in the US Gallup The Disparities Leadership Program Award 15 Clinics + OP Services + Medical Transportation 7000 Employees 1300 Physicians Milestone Goal: National leader in clinical quality, patient experience and cost effectiveness best value.

7 HealthEast Care System Organizational Commitment HealthEast Mission: Our Mission is high quality, compassionate, cost effective health care for the communities we serve. HealthEast Faith Based Philosophy: By sustaining HealthEast s Christian heritage and identity, we provide compassionate services that respects the dignity of each person and welcomes all faith traditions, cultures and communities. HealthEast Vision: Optimal health and well-being for our patients, our communities, and ourselves. Equitable Care Vision: Create an inclusive environment where all patients receive high quality, culturally responsive care and all employees are engaged in achieving quality outcomes. Milestone Goal: National leader in clinical quality, patient experience and cost effectiveness best value.

8 HealthEast Care System Organizational Commitment Legal /Regulatory The Joint Commission Nat l Committee for Quality Assurance Title VI of the Civil Rights Act-Americans with Disabilities Act Culturally and Linguistically Appropriate Services Minnesota Department of Human Rights Patient Protection and Affordable Care Act Market Share Changing Demographics Under 5 set in RC- majority/minority 30% compared to 17% MN population Significant Purchasing Power Operational Efficiency and Effectiveness Attract the best talent --- first choice employer Milestone Goal: National leader in clinical quality, patient experience and cost effectiveness best value.

9 HealthEast Care System Organizational Commitment Quality/Safety 6 IOM AIMS First Choice Employees Physicians Volunteers Milestone Goal: National leader in clinical quality, patient experience and cost effectiveness best value.

10 HealthEast Care System Organizational Commitment Equitable Care Governance Executive Team Champion strategic plans: equitable care/workforce diversity Equitable Governance Committee Promote equitable care vision promise; align operational strategies Equitable Care Action Teams Identify site-based projects to support vision and strategy Strategic Drivers Value Based Improvement New Enterprise - Wide Health Record (EPIC) Accountable Care Organization Milestone Goal: National leader in clinical quality, patient experience and cost effectiveness best value.

11 Organizational Commitment Why is Health Equity important? Federal and State Standards (IOM, Affordable Care Act, Office of Civil Rights, Office of Management and Budget, Office of Minority Health) Included in Patient Centered Medical Home (PCMH) Standards Health Disparities Exist Health Equity is Connected to Quality and Safety Values, Vision, Strategic Action Plan

12 Organizational Commitment Culturally responsive care is part of the Kennedy Health Center s vision, organizational values and key strategic action plan. Vision includes: Understanding and respecting the cultures of our employees, patients and the communities we serve. Organizational values include: The healthcare and other services we offer reflect the diversity of our community and are responsive to the race, language, culture, sexual orientation, gender, age and disability of our patients and clients. We recognize our patients and clients as whole persons whose physical, social, emotional and cultural needs impact their overall health.

13 Organizational Commitment EMKCHC key strategic action plan includes: Provide care that is sensitive to the cultural and linguistic needs of our patients. Promote the concept of cultural competency in health care, reduce racial and ethnic disparities in health care outcomes and work toward elimination of racism. Strive to continue to hire staff that is reflective of the patients and communities we serve.

14 Organizational Commitment Policies and Procedures: Culturally Responsive Care Policy Limited English Proficiency Policy Interpreter Services Procedures Procedures for Translating Documents Language Testing Policy Patient Communication Policy Patient Education Policy Teach Back Procedures* * uploaded

15 Organizational Commitment 2002 Health Equity/Cultural Competence Committee to improve health equity and cultural competence Provider Champion(s) Diverse Team Work Plan Address CLAS Standards Pilot Ideas (PDSA cycle) Policies and Procedures Communicate

16 HealthEast Care System Cross Cultural Services Training and Education Interpreter Services Milestone Goal: National leader in clinical quality, patient experience, cost effectiveness-best value.

17 HealthEast Care System Training and Education Hardwiring Equitable Care Continuing Education Managing A Diverse Workforce (targeted to any leader) Instructor: David Hunt J.D. President and CEO of Critical Care Measures, LLC. Classes 2 Cross Cultural Care Training (targeted to all staff) Instructor: David Hunt President and CEO of Critical Care Measures, LLC. How To Work Effectively with Interpreters (targeted to all staff) Instructors: Mayly Lochungvu Donna Fowler LEARN- Mandatory Education On-line Training New Leader Orientation (targets new leaders) Segment: Hardwiring Equitable Care Instructors: HR Talent Development Subject Matter Experts Language Law Access and the Law (targets care providers and leaders) On-line Training Employment Law 101 (targets to any leader involved in managing employees) Instructor: Ugo A. Ukabam, Principal at Gray Plant Mooty in the Labor and Employment Law group. 3 6 On Going Monthly On Going 2 Hardwiring Equitable Care Continuing Education LINK TO SIGN-UP Questions? Contact Liz Anderson, System Director Equitable Care (2-2938) Milestone Goal: National leader in clinical quality, patient experience, cost effectiveness-best value.

18 HealthEast Care System Training and Education January 16, 2013 MLK Breakfast 10 Leaders Represented HealthEast from: Quality, St. Josephs, Physician Leadership, Human Resources & Materials Management January 31, New Classes New Conversations on Race and Racism New Conversations on White Privilege Serving our GLBT Patients and Families Milestone Goal: National leader in clinical quality, patient experience and cost effectiveness - best value.

19 HealthEast Care System Training and Education Hardwiring Equitable Care Continuing Education Managing a Diverse Workforce FY Classes 79 Participants 28% direct patient care 72% non-patient care 2012 Nine Classes Cross Cultural Care FY Classes 214 Participants 42%direct patient care 58% non-patient care EC: Practical Skills New Leader Understanding Race & Racism Understanding White Privilege How to Work Effectively with Interpreters FY 2009 Piloted the class in Participants 401 Staff Leaders & Employees Milestone Goal: National leader in clinical quality, patient experience, cost effectiveness-best value.

20 Training and Education Training for New Hires: Definition Cultural Code of Ethics* Health disparities Racism Ouch video and discussion of racism. Attitudinal Training Attitudes Towards Differences Training History and demographics of populations we serve Health Literacy* Lesbian, Gay, Bisexual, Transgender (LGBT) Working with Interpreters* Refugees (in process) Substance Use and Recovery (in process) *uploaded

21 Training and Education Annual required training for all staff Rotating Cycle: Cultural Competence Overview, LGBT Refugees, Working with Interpreters Racism, CLAS Standards, Substance Use and Recovery Department specific training Other trainings/activities (Stand Against Racism Day): What Makes Me White s to Staff (unnatural causes) Guidelines for Challenging Racism and other forms of oppression

22 Training and Education Examples of Evaluation: Health Literacy: 91% staff state they are using teach back 88% staff report teach back increased patients participation in their care Stand Against Racism Event for Dept Heads Evaluation: Over 90% said they reflected on their own views about racism and discussed racism with others 66% were more likely to discuss racism with their staff Patient and Staff Experience Surveys Surveys to Determine Needs- AHRQ toolkit, LGBT survey Health Outcomes

23 HealthEast Care System Workforce Diversity Milestone Goal: National leader in clinical quality, patient experience and cost effectiveness - best value.

24 Populations of Color Twin Cities 7-County Region ( ) 35% 30% 25% 20% 15% 10% 5% Ramsey Hennepin Twin Cities Dakota Scott Anoka Washington Carver 0% Milestone Goal: National leader in clinical quality, patient experience and cost effectiveness - best value.

25 HealthEast Hospital Patient Population White 84.0% Black/ African American 7.0% Other 0.1% Asian 5.0% Hispanic/ Latino 2.0% American Indian/ Alaskan Native 0.4% Native Hawaiian/ Pacific Islander 0.0% Two or More Races 0.3% % Patient Population EEO = 14.8% - June 2012 Milestone Goal: National leader in clinical quality, patient experience and cost effectiveness - best value.

26 FY2011 Employee EEO HealthEast System Black/ African American 7.0% Asian 5.1% White 83.5% % Employee Population EEO = 15.8% Two or More Races 1.1% Hispanic/ Latino 1.7% American Indian/ Alaskan Native 0.9% Milestone Goal: National leader in clinical quality, patient experience and cost effectiveness - best value.

27 HealthEast Care System Workforce Diversity Equitable Action Teams ECATS Succession Development Leadership HealthEast Aspiration Discussions Talent Review October 18 Employees Attend YWCA ITT Tuition Reimbursement Milestone Goal: National leader in clinical quality, patient experience and cost effectiveness - best value.

28 HealthEast Care System Workforce Diversity Management Improvement Fund Award Dedicated to strengthening the internal operations of organizations; may be used to finance programs that improve service to the greater community. How the funds will be use $20,000 awarded to conduct a Workforce Diversity and Inclusion Assessment and Gap Analysis for the HR Team; and to increase the capacity of the HR team to work more effectively with employees and communities of color for sourcing, recruitment and retention. Partner Organizations The St. Paul Foundation Cincinnatus Milestone Goal: National leader in clinical quality, patient experience and cost effectiveness - best value.

29 Workforce Diversity What does diversity mean to your organization? Diversity of: Your Staff Your Board The Population You Serve The Population You Would Like to Serve Learning About the Diversity of Your Community: Your Data (granular) Census Department of Education Office for Refugees and Immigrants Zip Skinny Department of Public Health vital statistics YRBSS youth risk behavior surveillance system (CDC)

30 Workforce Diversity Strategic actions include: Strive to continue to hire staff that is reflective of the patients and communities we serve.

31 How to Define Race or Ethnicity? Slide from Bruce Cohen, Ph.D., Bureau of Health Statistics, MA Department of Public Health

32 Workforce Diversity Race: group or groups that an individual identifies with because they share similar characteristics or social and geographic origins. examples: Asian, Black, White physical Ethnicity: a person s background, heritage, culture, ancestry, country of birth examples: Brazilian, Haitian, Vietnamese Slide from Bruce Cohen, Ph.D., Bureau of Health Statistics, MA Department of Public Health

33 Workforce Diversity Language(s) Percentages* Spanish Portuguese English Arabic Nepali Albanian Other Unknown Total Staff All Sites 61% 23% 100% 1% 1% 1% 15% PATIENTS- ALL SITES FY11 34% 26% 26% 3% 2% 1% 6% 2% Our staff speak 30 languages. 73% of our staff are at least bilingual and of those 23% are trilingual. Staff languages include: Albanian, Arabic, Armenian, Dzongkha, Cape Verdean, Chinese, English, Farsi, French, Ga, Fante(Fanti), Hebrew, Hindi, Italian, Kikuyu, Malayalam, Nepali, Persian, Polish, Portuguese, Punjabi, Romanian, Russian, Spanish, Telugu, Kannada, Twi, Wanda (Vanda), Vietnamese, and Zulu. * Patient Languages are Primary Language Only. Staff languages include 1 st, 2 nd or 3 rd language so there are duplicates in these counts and percentages do not add up to 100%. Staff Data as of 5/2012; % based on # patients and staff who responded.

34 Workforce Diversity ALL SITES-HISPANIC/LATINO* % Hispanic / Latino % Non Hispanic /Latino TOTAL TOTAL RESPONSES All Staff 56% 44% Dept Heads 8% 92% Supervisors 45% 55% Supervisors and Dept Heads 24% 76% PATIENTS- ALL SITES CY11 41% 59% 24,087 23,931 ALL SITES- HISPANIC/LATINO/BRAZILIAN % Hispanic / Latino/Brazilian % Non Hispanic /Latino/Brazilian TOTAL TOTAL RESPONSES All Staff 57% 43% PATIENTS- ALL SITES CY11 63% 37% 24,087 23,931 * Staff Data as of 5/2012; % based on # patients and staff who responded. Please note 92% of our Brazilian staff selected Hispanic/Latino and 95% of our Brazilian patients selected White (Non- Hispanic/Latino).

35 Workforce Diversity Our staff come from 39 countries and represent 40 ethnic groups Summary Ethnicities- All Sites* STAFF All Staff % Staff Sup/Dept PATIENTS %Sup/Dept All Pts FY11 % Patients Latin American/Carribean (Except Brazilian and Puerto Rican) % 3 8.3% 5, % Brazilian % 2 5.6% 5, % Puerto Rican % % 3, % North American % % 3, % African 8 2.8% 0 0.0% 1, % Middle Eastern 5 1.8% 0 0.0% % Asian % 2 5.6% % European % 2 5.6% % Pacific Islander 1 0.4% 0 0.0% % Unknown (Declined & No Response) ,129 TOTAL ,594 TOTAL (Not Including Declined and No Response (NR)) ,465 * Staff Data as of 5/2012; % based on # patients and staff who responded.

36 Percent (%) Breastfeeding by Race and Ethnicity Massachusetts: % 90% 80% 88.1%* 84.5%* 83.6%* 84.5%* 78.7%* 80.8% 70% 60% 50% 40% 30% 20% 10% 0% Whites Blacks Hispanics Asians Other Total MA * Statistically different from state rate (p<0.05) Slide from Bruce Cohen, Ph.D., Bureau of Health Statistics, MA Department of Public Health

37 Breastfeeding by Ethnicity Massachusetts: 2008 Honduran Asian Indian Salvadoran Brazilian Korean African South American Guatemalan Haitian Dominican Chinese Cape Verdean European State Total Vietnamese African-American American Puerto Rican Cambodian Portuguese 60.3% 57.4%* 97.2%* 96.9%* 95.9%* 95.3%* 95.2%* 94.8%* 93.7%* 92.5%* 91.9%* 90.6%* 90.5%* 86.3%* 86.0%* 80.8% 78.5% 75.0%* 74.5%* 71.9%* 0% 20% 40% 60% 80% 100% 120% Statistically different from state rate (p<0.05) Slide from Bruce Cohen, Ph.D., Bureau of Health Statistics, MA Department of Public Health

38 HealthEast Care System Language Services Preferred Language The Challenge Interpreter Services commitment statement: Interpreters contribute to best practice, equitable care by making important connections between patients, families and providers. These connections promote dignity, safety, quality and patient satisfaction. As a member of the larger health care team, we are committed to creating a patient-centered experience that delivers exceptional outcomes for our changing community Milestone Goal: National leader in clinical quality, patient experience and cost effectiveness best value.

39 HealthEast Care System Language Services Preferred Language-Culturally Competent Patient Centered Care The Process Interpreters: staff, vendors, telephone, video, bilingual, admin. Committees: patient rights, patient & family education, HR leadership, quality institute council, honoring choices, HEI Milestone Goal: National leader in clinical quality, patient experience and cost effectiveness best value.

40 HealthEast Care System Policies and procedures Language Services The Results Preferred Language Policies and Procedures Policy & procedure -Limited-English Proficiency Policy & procedure-deaf, deaf-blind or hard of hearing Guidelines for working with patients who are blind, deaf-blind or visually impaired HealthEast hospital agency interpreter guidelines Permissibility of vaccines memo FAQs-compliance forms and hearing loss How to Arrange for an Interpreter HealthEast agency in-person telephone - guidelines Milestone Goal: National leader in clinical quality, patient experience and cost effectiveness best value.

41 100% 90% 80% 0.8% 7.5% 15.1% HealthEast Staff Interpreter Performance Variables 0.3% 0.3% 1.5% 1.0% 0.8% 0.0% 0.3% 5.8% 4.6% 3.7% 2.5% 0.5% 1.1% 0.3% 3.9% 2.5% 1.9% 6.9% 10.7% 11.0% 12.9% 70% 60% 48.1% 47.1% 47.5% 49.0% 50.4% 49.0% 49.6% 50% 55.8% 40% 30% 20% 44.3% 47.1% 37.0% 41.6% 44.9% 34.5% 37.5% 10% 20.8% 0% Arrive on Time (n=385) Demonstrate Courtesy/Respect (n=395) Wear Appropriate Attire (n=393) Don't Conduct Personal Business (n=381) Excellent Listening Regard for Privacy Skills (n=363) (n=383) Impartial and Objective (n=365) Trust in Accuracy (n=373) Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Milestone goal: National leader in clinical quality, patient experience, cost effectiveness-best value.

42 Health Literacy Language Services Languages of populations you serve and want to serve Interpreter qualifications Recruitment and Collaboration In Person and Telephonic Track Language Needs, Quality, Productivity, Costs Feedback from Providers and Patients Translations Working with Interpreters

43 Language Services TIPS FOR WORKING WITH INTERPRETERS Always look at the patient (not the interpreter) when you are speaking or the interpreter is speaking. Use simple language and short sentences. Pause after a full thought for interpretation to be accurate and complete. Avoid asking multiple questions without breaks. Speak in the first person rather than asking the interpreter to tell something to the patient. Remember that everything you say will be interpreted. Use teach back to confirm patient understanding. Repeat yourself in different words if your message is not understood.

44 Language Services Health Literacy: The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Institute of Medicine, Consensus Report, Health Literacy: Prescription to End Confusion National Priority: CLAS Standards PCMH Healthy People 2010 National Action Plan to Improve Helath Literacy National Partnership for Action to End Health Disparities AHRQ Health Literacy Universal Precautions Toolkit

45 HealthEast Care System Community Engagement DRAGON FESTIVAL Annual Twin Cities Pride Festival Milestone Goal: National leader in clinical quality, patient experience, cost effectiveness - best value.

46 HealthEast Care System Community Engagement Milestone Goal: National leader in clinical quality, patient experience, and cost effectiveness - best value.

47 Community Health Needs Assessment Why? Affordable Care Act Passed in March 2010 with new reporting requirements for private non-profit hospitals to maintain 503(c)3 tax exempt status. For tax years beginning after March 2012, each hospital must: Title Slide Conduct a Community Health Needs Assessment at least once every three years. Must include public health and community voice. Develop action plans to address unmet community needs and obtain Board of Director approval of the plan. Report the process and plan to the community and on IRS 990 s. HealthEast formally launched the project in September 2011.

48 Establish the Assessment Infrastructure Define the Purpose and Scope Title Slide HE Community Health Needs Assessment (CHNA) Process Collect and Analyze Data Plan for Action and Monitor Progress Obtain Board Approval and Communicate Results Select Priorities and Develop Implementation Plan

49 CHNA: Purpose and Scope Purpose: To identify community health needs. To inform strategic initiatives. To focus and prioritize program planning. Scope: Title Slide HealthEast Primary Service Area (Ramsey, Dakota, Washington Counties) Expand to State of Minnesota for Bethesda service area. Filtered by: Diverse populations. Payers health plans, government, uninsured End Users: IRS 990, Schedule H; Community; Public Health Depts., and HealthEast senior leaders.

50 Cultural diversity among HealthEast patients HealthEast serves a growing number of Hmong, Somali, and Karen patients Hmong: 7,719 visits in 2000, 8,646 visits in 2011 Somali: 182 visits in 2008, 1,014 visits in 2011 Karen: 1,737 visits in 2011 Source: HealthEast Community Health Needs Assessment Talking Points and Secondary Data Analysis Report (2011). wilderresearch.org

51 Our region Population by is select getting age groups older Minnesota, ,000, wilderresearch.org Sources: MN Compass, from: Minnesota State Demographic Center and U.S. Census Bureau, Decennial Census

52 More residents are living in poverty Twin Cities region Dakota County Ramsey County Washington County Total population 1,145, , , ,136 Percent living in poverty Percent of cost-burdened households Homelessness rate (per 10,000) 11% 6% 36% 24% 10% 7% 32% 21% 13% 11% 38% 26% 6% 3% 30% 21% Source: MN Compass, 2010 wilderresearch.org

53 What are the implications of these trends? Increased diversity Greater need for interpreter services, culturallyappropriate care Increased heterogeneity within cultural communities Aging population Growing demand for caregiving services Increased prevalence of chronic diseases Greater economic disadvantage Residents forced to make difficult choices Potential for widening disparities wilderresearch.org

54 GOAL: Impact the Health & Well-Being of the East Metro Community with Pre-Diabetes Analyze Progress Target Population: Passport members; Faith Communities Title Slide Potential Partners: Public Health; YMCA; Cultural Brokers; Act Plan Lion s Clubs Check Do CDC s program outcomes (Weight change, # minutes physical activity, # sessions.) Implement evidencebased prevention program, i.e. CDC s National Diabetes Prevention Program

55 Example: Refugee Groups and Presentations Community Engagement

56 HealthEast Care System Addressing Health Disparities What brought you to Health Care? Of all the forms of inequality, injustice in health care is the most shocking and inhumane. ---Dr. Martin Luther King Jr. What's your story? Milestone Goal: National leader in clinical quality, patient experience and cost effectiveness best value.

57 HealthEast Care System Addressing Health Disparities AIM: Develop standardized and consistent data collection of patient race, ethnicity, and preferred language (REaL) as a foundational first step to identifying and reducing health care disparities among patient populations. PROCESS MEASURES Train 100% of admitting/registration staff in three emergency departments by 9/1/09 Revise department policy and procedures for more efficient and accurate data collection Staff are able to articulate why collecting REaL patient data links to health disparities Staff will report increased comfort level with asking patients for REaL data Establish a system-wide action plan by 9/30/2009 OUTCOME MEASURES Metrics for improvement: Patient fields (1) race; (2) ethnicity; (3) preferred language Fields: Other/Unknown --- Patient Declined --- Patient Not Interviewed Quarterly review based on comparing data to corresponding quarter of previous FY Milestone Goal: National leader in clinical quality, patient experience, cost effectiveness - best value.

58 HealthEast Care System Addressing Health Disparities DLP Award Recipients Milestone Goal: National leader in clinical quality, patient experience, cost effectiveness-best value.

59 HealthEast Care System Addressing Health Disparities Rajen Rayan - Health Equity Project Manager Three Principle Responsibilities: 1. Lead and Manage HealthEast REaL (Race/Ethnicity, Country of Origin & Language) Patient Demographic Data Collection Process. 2. Support and Participate in ECAT (Equitable Care Action Teams) Activities at the Sites. 3. Develop and Manage Health Equity Outreach in the Community. Milestone Goal: National leader in clinical quality, patient experience and cost effectiveness best value.

60 HealthEast Care System Addressing Health Disparities Milestone Goal: National leader in clinical quality, patient experience, and cost effectiveness - best value

61 HealthEast Care System Addressing Health Disparities HealthEast Health Equity - REaL Data Collection To better understand the composition of HealthEast patient population in order to address health disparities and to improve the quality of care and services provided. All patients are asked of their Race/Ethnicity, Country of Origin and Preferred Language of Choice. REaL patient data collected is standardized, verified for accuracy with the goal of 100% compliance. Milestone Goal: National leader in clinical quality, patient experience and cost effectiveness best value.

62 Patient Population in Percentage HealthEast Care System Addressing Health Disparities 90 HealthEast Hospitals Patient Demographic Data* White (82.9) Af Am/Black (7.1) Asian (4.9) Hispanic /Latino (1.9) * HBI :HOS02-Cross Cultural Data Milestone Goal: National leader in clinical quality, patient experience and cost effectiveness best value.

63 Population in Percentage HealthEast Care System Addressing Health Disparities HealthEast Hospital Demographic 2011 * (HBI : HOS02 Cross Cultural Data) Compared to US 2010 Census** Ramsey County** HealthEast* City of St. Paul** St. Joe's Hospital* White Af Am/Black Asian Hispanic/Latino Milestone Goal: National leader in clinical quality, patient experience and cost effectiveness best value.

64 Benefit of working with an academic institution Address Health Disparities What do we want to know? How will this benefit our patients/our community? Example: Partnered with University of Massachusetts Medical School Prevention Research Center to look at BMI and blood pressure of refugee populations

65 Address Health Disparities Internal Evaluation of Data Example: Well Child Visit Disparity PDSA- to increase well child visits with children from Bhutan, Iraq, Burma Importance of Well Child Visit Outreach to families with children from Bhutan, Burma and Iraq Discuss with VOLAGS and other local organizations Track Outcomes

66 Making CLAS Happen- 6 Areas for Action CLAS Standards A New Way of Talking About Social Determinants of Health Robert Wood Johnson Foundation Unnatural Causes International Medical Interpreters Association Diversity Rx General Resources Think Cultural Health Cross Cultural Healthcare Program

67 LGBT Resources Joint Commission LGBT Field Guide IOM Report on The Health of LGBT People Bisexual-and-Transgender-People.aspx National LGBT Health Education Center

68 Attitudes Toward Differences- PROGROUP White Privilege: Unpacking the Invisible Backpack by Peggy McIntosh Wellesley College for Research on Women, Wellesley, MA p f Ouch Videos Training Resources What Makes Me White The Peoples Institute for Survival and Beyond-Undoing Racism Activities Toward Becoming an Antiracist Organization from Racism in the United States: Implications for the Helping Professions by Joshua Miller and Ann Marie Garran

69 Health Literacy Resources AHRQ- health literacy toolkit AMA Foundation- health literacy toolkit programs/public-health/health-literacy-program/health-literacy-kit.shtml Pharmacies: Is Our Pharmacy Meeting Patients Needs? American Academy of Pediatrics Culturally Effective Care Toolkit Health Environment Activity Packet First Impressions and A Walking Interview by Rima E. Rudd Quick Guide to Health Literacy National Action Plan to Improve Health Literacy

70 Health Literacy Resources Center of Disease Control (CDC) Information on Health Literacy Harvard School of Public Health (HSPH) Information on Health Literacy North Caroline Program on Health Literacy Free Online Courses with CMEs or CEUs HRSA online course with free CEU s The interactive training course, Unified Health Communication: Addressing Health Literacy, Cultural Competency, and Limited English Proficiency, aims to raise the quality of provider-patient interactions by teaching providers and their staff how to gauge and respond to their patients' health literacy, cultural background, and language skills. The course's five modules take five hours to complete. Up to five free CMEs/CEUs are available to participants who successfully complete the course. CDC online course with free CEU, CME, CPE, CNE

71 Uploaded Community Assessment: HealthEast Community Health Improvement Customer Survey: HealthEast Interpreter Services Department Policy: Language Preference and Interpreter Services Documentation Flyer: Equitable Care Continuing Education Teach Back Procedures Cultural Code of Ethics Health Literacy Working with Interpreters

72 HealthEast Care System Equitable Care One Patient s Definition. Milestone Goal: National leader in clinical quality, patient experience and cost effectiveness best value.