Disparities Reduction Projects across the Public Health Care Systems
By June of 2017, public health care systems participating in PRIME (Public Hospital Redesign and Incentives in Medi-Cal) had collected granular Race, Ethnicity, and Language (REAL) data for more than 460,000 patients – an increase of nearly 200,000 over the baseline established in the first year of the program.
Public health care systems’ analyses of this data revealed disparities in the provision of care and health outcomes that previously may have been undetected, and/or confirmed the existence of disparities that were suspected but not yet measured.
By the end of PRIME, public health care systems will have been required to collect REAL data for at least 80% of its PRIME population and sexual orientation and gender identity (SOGI) data for 40% of its PRIME population, and to have closed the gap between current performance and a high performance benchmark by at least 10% in each of the final three program years.Each community served by one of California’s public health care systems has unique demographics, geography, and needs. Consequently, each public health care system developed its
disparity reduction plan tailored to those characteristics. Despite their differences, the disparity plans share a number of common themes. Race was commonly chosen as a defining factor for target populations, with some health systems choosing to refine further by also including factors such as age and health diagnosis. Overall, ten systems chose African Americans as their target population, and five selected Hispanics/Latinos as their target population. Two systems chose their target populations based on language.
With regard to the specific health disparities and health metrics being targeted, public health care systems often identified improved blood pressure control, improved colorectal cancer screening rates, and the delivery of comprehensive diabetes care.
Several common themes emerged across the interventions planned by health systems to address these disparities:
Developing culturally competent and linguistically appropriate materials
Many public health care systems are developing and disseminating culturally competent and linguistically appropriate education materials. For instance, Arrowhead Regional Medical Center is sharing its materials on the importance of colorectal cancer screening at its family health centers that serve a large Hispanic/Latino population, and is also utilizing social media and text-messaging to issue a “call-to-action” on the importance of testing. Natividad Medical Center is using messaging that targets specific barriers or knowledge gaps, as can occur when a patient is newly insured.
Public health care systems are also training staff to improve cultural competence. For example, Los Angeles County Department of Health Services’ disparity reduction plan targets improvements in colorectal cancer screening for African Americans. They are training providers to address specific concerns that have been raised in academic studies of this specific disparity, including patients’ fear of a bad result and providers’ reluctance to recommend the screening. Santa Clara Valley Health & Hospital System is developing training opportunities for Hispanic nursing students to receive diabetes education and become Certified Diabetes Educators.
Enhancing patient engagement
Patient engagement is also crucial to all disparity reduction plans, starting with direct outreach. Kern Medical is utilizing letters and personal phone calls from care coordinators to educate patients in its target population on the medical benefits of taking aspirin for heart disease, and UCLA Health is using an automated calling platform to assist patients with scheduling return office visits.
Seeking guidance from patients affected by these disparities
In addition, many public health systems are seeking direct input and guidance from patients who are directly affected by these disparities. For example, Contra Costa Health Services has recruited African American patients from their target population to be “patient partners,” who attend weekly staff planning meetings and help guide decision-making and interventions. UCSD leverages its patient portal to conduct surveys and questionnaires that can help identify barriers to care among different populations. Similarly, Riverside University Health System, is launching a promotora program to train community members to provide basic health education in the community. UC Davis Health is partnering with faith groups and schools, as well as farmers’ markets and grocery stores, to help patients learn about and manage their diabetes.
Improving change management strategies
Many plans also call for the use of change management techniques, and improvements to internal workflows and communications practices. San Mateo Medical Center, for example, is implementing workflow changes to help ensure that providers are aware of, and communicate in, a patient’s preferred language. UC San Francisco Health has created a health equity data dashboard that can be used to track progress in achieving their disparity reduction goals.