The U.S. healthcare system continues to perform poorly in health equity. For example, in New Orleans, life expectancy of babies varies drastically by zipcode.¹ While many physicians are aware of the vast inequities in health outcomes by race and socioeconomic status across the healthcare system, physicians don’t usually have much visibility into health equity for their own patients.² Addressing health inequality requires action in many arenas, including public health, housing, education, and healthcare. Within the healthcare ecosystem itself, there are a few steps that should be taken across providers to help detect and minimize disparities in health outcomes.

Root cause analysis needs to derive insights on how socioeconomic or other non-medical risk factors impact health outcomes and patients’ abilities to follow care plans suggested by their physicians. The AHQR Root Cause Analysis tool could be applied to the problem of patients not adhering to care plans. In many cases, actions such as preventive testing might not be available in a patient’s neighborhood or be affordable. Furthermore, interventions for patients with conditions such as diabetes are to exercise more and eat healthy. In the U.S., nearly all healthy food is much more expensive than unhealthy, processed foods. Additionally, cultural or language barriers can also prevent patients from fully understanding their doctors’ recommended procedures or tests. These are factors that can impact patients’ abilities to follow the advice from their physicians. Thus, non-medical factors like income, employment status, and first language should be collected in order to tailor care plans to match patient’s lives better. The root cause analysis exercise can help to identify areas of healthcare processes that could help to mitigate disadvantages of certain populations or ensure that care is tailored to each patient’s unique circumstances.

Sometimes, health equity data is not available because patients are not required to provide it, and often refuse to provide information on their race/ethnicity or other sociodemographic information. This may be due to a lack of understanding on why registration forms ask these questions. One way to potentially encourage patients to provide responses to questions about race, ethnicity, income, or other sociodemographic questions, would be to explain in the form that the data will be used for data analysis in the pursuit of providing a more equitable healthcare system. Physicians can also ask patients for this information face-to-face to provide better understanding. Social determinants of health (SDOH) have huge impact on patients’ access to care and health outcomes. Rather than collecting this data as optional registration information, some healthcare organizations have added SDOH as vital signs. This data can be used as part of the root cause analysis on health equity.

Based on findings from SDOH data and health outcomes, equity dashboards or reports can be displayed to physicians and care teams showing KPIs on health equity for their patients. Examples could include health outcomes by race and health outcomes by income or major diseases like heart disease, diabetes, and cancer. The root cause analysis can determine the most relevant SDOH for different health conditions in order to identify potential interventions to address inequities. Providing these equity dashboards can help physicians and care teams to understand which patients may need additional resources.

In terms of language barriers, a human factors approach can provide some workflow adjustments to improve equity problems for patients who aren’t fluent in English. For patients who have a first language besides English, all communications from healthcare providers should be in their native language. A device with apps like Google Translate or Microsoft Translator can be used during appointments to help patients communicate better with the nurses and physicians. Beyond language barriers, culture can also impact attitudes towards healthcare services. The Joint Commission and National Quality Forum have released quality measures and accreditation standards in cultural competency.³  One workflow modification providers could make would be to pre-load cultural literacy guides and prompt a pop-up in the EMR for patients who have other languages or nationalities documented in their EMR records. That way, providers could be reminded of the best practices for understanding and treating patient of diverse backgrounds.

Improvements in health equity depend upon providers looking beyond the purely medical factors of their patients’ care to consider social, demographic, and economic experiences. By addressing these nuances with a personal and system-wide approach, we can identify and make advancements in providing equitable care for all populations.

References:

1. Schoonover, H. (2018, March 6). Health Equity: Why it Matters and How to Achieve it. Health

     Catalyst. https://www.healthcatalyst.com/health-equity-why-it-matters-how-to-achieve-it

2. Cook, S., PhD, Mahadevan, R., BS, MA, Clarke, A., MPH, & El-Shamaa, M., MPH. (2015, April).

Reducing Health and Health Care Disparities: Implementation Lessons and Best Practices forHealth Care Organizations [PDF] https://www.chcs.org/media/Resource-13-058_reducing_health_and_health_care_disparities_-_final.pdf

3. Health Research and Educational Trust. Improving Health Equity Through Data Collection AND Use: A Guide for Hospital Leaders. Chicago: Health Research & Educational Trust, 2011.