Measuring Equity of Care in Hospital Settings: From Concepts to Indicators. March 5, 2009

Transcription

1 Measuring Equity of Care in Hospital Settings: From Concepts to Indicators March 5, 2009

2 Research Team CRICH Gilbert Gallaher Sophie Kim Maritt Kirst Aisha Lofters Kelly Murphy Patricia O Campo Carlos Quiñonez Nicole Schaefer- McDaniel Ketan Shankardass Hospital Collaborative Partners Alexis Dishaw Rick Edwards Linda Gardner Jim O Neill Rosalie Steinberg

3 Background: The Problem Disparities among language, racial and ethnic minority groups have been shown to lead to increased medical errors, prolonged length of stay, avoidable hospitalizations and readmissions, as well as over- and under-utilization of procedures Ash and Brandt 2006; Jiang et al. 2005; Rathore et al. 2003; Alexander et al. 1999; Divi et al. 2007, Cohen et al. 2005, Carbone et al. 2003

4 Background Knowledge about how to monitor and report on equity is a relatively new and evolving area Measuring equity in hospitals is new in Canada

5 Momentum for Measuring Equity in Hospitals Ontario Ministry of Health and Long-Term Care has identified equity of access to care as a strategic priority In 2009, the Toronto Central LHIN for the first time required hospitals to report on equity initiatives

6 Our Task At the request of the GTA Hospital Collaborative on Marginalized Populations, we completed a review of scholarly and grey literature to: 1. Find existing approaches for operationalizing and measuring equity of care in the hospital 2. Assess the applicability of these measures for reducing inequities in care for marginalized populations

7 Equity and the Hospital Setting Defining equity Health disparities or inequities are differences in health outcomes that are avoidable, unfair and systematically related to social inequality and disadvantage (Gardner 2008)

8 Hospital s relationship to health and social services environment Catchment Area Hospital ED In-Patient Primary Health Care Long-Term Care Social Services

9 Quality improvement cycle for achieving equity in the hospital Problem identification via measurement Continued measurement Measurement of the magnitude of the problem Evaluation of solution and its effects on the problem Implementation of solutions

10 Literature search: Process and rational Search Strategy Academic and grey literature English, 1980s onward Keywords: access, equity, measure, hospital, healthcare Articles 4,262 academic 219 grey Screened title and abstract Master Indicator List 706 indicators Indicator selection by principle jurisdiction and priority population Articles 251 academic 111 grey

11 Final indicator selection: Process and rationale Master Indicator List 706 indicators Limited to measures with some relevance to equity within hospitals + Priority populations 541 Indicators

12 Final indicator selection: Process and rationale 706 Indicators Grouped similar concepts and indicators Good first-step indicator for HC/TC LHIN 1. Evidence of previous use 2. Endorsed 3. Feasibility 4. Adaptability 5. Applicability to equity 6. Transferability 10 Indicators

13 Indicator Table Domain Cultural Competency Quality Of Care Mental Health Diabetes Mellitus Elderly Title Cultural diversity of hospital Provision of interpretation services Patient satisfaction Perforated appendix rate Minimally invasive cholecystectomy rate Use of analgesics in ED Rate of death within 30 days of hospital admission for AMI Hours of physical restraint use Lower extremity amputations among patients with DM Post-operative in-hospital pressure ulcer rate

14 Conclusions & Recommendations Equity is an essential component of hospital performance and quality Institute of Medicine, Agency for Healthcare Research and Quality, Joint Commission, National Quality Forum are all linking equity with quality of care Equity indicators should be selected strategically Equity measurement in Toronto hospitals is possible now

15 Strategies Table Strategy LINKING EXISTING DATA Advantages Disadvantages Develop partnerships with ICES and others to facilitate data linkages and data sharing CHANGE EXISTING HOSPITAL DATA SYSTEMS Individual hospitals change internal data systems to collect socio-demographic information - Existing infrastructure and expertise - Spreads momentum - Relatively inexpensive - Ability to specify variables and modes of collection - Ability to collect individual-level data - Aggregated sociodemographic data - Limited individuallevel data - Labour intensive -Costly

16 Conclusions & Recommendations Any indicator can be a potential measure of equity if stratified by socio-demographic attributes Better equity measurement will happen when Toronto hospitals collect patient socio-demographic data Language, socioeconomic status, race, ethnicity

17 Conclusions & Recommendations Recommendations on action steps to achieve equity in the hospital: Hospitals should conduct an initial assessment of data capabilities Hospitals should start by using existing data, stratified by socio-demographic characteristics Hospitals should begin to collect language, socioeconomic status, race and ethnicity data Hospitals should monitor equity data over time Evaluate, redesign, reevaluate Hospitals should take action on disparities revealed through measurement

18 Quality improvement cycle for achieving equity in the hospital Problem identification via measurement Continued measurement Measurement of the magnitude of the problem Evaluation of solution and its effects on the problem Implementation of solutions

19 Using measurement to improve hospital equity Expecting Success: Excellence in Cardiac Care Program piloted by the Robert Wood Johnson Foundation in 10 hospitals to improve cardiovascular care for African Americans and Latinos Hospitals reported on 23 care performance measures stratified by language, race, ethnicity on a monthly basis Each hospital designed interventions to ensure patients received full set of recommended care After only 2 years, the all-hospital median heart failure Measure of Ideal Care increased from 41 percent to 78 percent

20 Summary Equity is a key component of quality; addressing disparities will help achieve this goal Measurement related to equity is possible now in Toronto hospitals Any indicator can be a potential measure of equity if stratified by socio-demographic attributes Better equity measurement will happen when Toronto hospitals collect patient socio-demographic data Language, socioeconomic status, race, ethnicity

21 Discussion