efforts to reduce disparities: barriers, innovation, implementation and evaluation joseph r....
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Efforts to Reduce Disparities: Barriers, Innovation, Implementation and Evaluation
Joseph R. Betancourt, M.D., M.P.H.
Director, The Disparities Solutions Center
Director, RWJF’s Leading Change: Disparities Solutions InitiativeSenior Scientist, Institute for Health Policy
Director for Multicultural Education, Massachusetts General Hospital
Assistant Professor of Medicine, Harvard Medical School
Outline
Barriers to Change
Innovations: State, Health Plan, Hospital
Implementation & Evaluation: Leading Change
Barriers to Change
Absence of an action-oriented research agenda– Questions with policy/practice relevance
Little translation of research to policy/practice– Many academic research centers, little funds for dissemination/translation
– Research may not meet stakeholder needs
No coordinated political/policy strategy
– Scattered legislative response to IOM Report Unequal Treatment
Minimal efforts focused on education, training, and leadership
– Little informed leadership; lack of leadership development
Marginal involvement of community
– No centralized voice to inform process of change or encourage activism
Innovative Approaches: State Government and Health Plans
State Legislation– Massachusetts Health Care Reform
Requires collection of r/e data Creates Disparities and Quality Council P4P to reduce disparities in hospital (MassHealth)
Health Plans– Aetna
Collection of r/e data; staff training (med directors, case managers) in cult comp; incorporation of cult comp strategies into diabetes disease management
– BCBS of Florida
CC Education part of RPE (P4P) program; points for taking course; measures include clinical indicators and patient satisfaction
New focus on health coaches in DM, customer service; other regional health programs
Innovative Approaches: Hospital
Massachusetts General Hospital– Medical Policy
All QI stratified by race/ethnicity– Unit-Based Staff Quality Rounds
Exploring disparities: main finding was concern about language barriers over course of hospitalization
– Patient SatisfactionStratifying results by r/e and have added questions
about respect for culture/race/religion – CMS Core Measures
Stratifying results by r/e with all Boston Hospitals– Disparities Dashboard
Above info plus other info (readmission, wait times) presented to Leadership and Board routinely
Culturally Competent Disease Management:The MGH Chelsea Diabetes Program
Systems Component:
Race/Ethnicity Data Collection, Diabetes Registry by R/E
Patient Component:
• Telephone outreach to increase rate of HbA1c testing
• Individual coaching to address patients’ needs and concerns regarding
diabetes self-management to improve HbA1c
• Group visits meeting ADA educational requirements
Provider Component:
Diabetes Monograph (EBG with prompts)
Coaching Feedback
Cultural Competence, Quality and DisparitiesA Multitiered Intervention
System
Provider Patient
-Screen for non-adherence
-Provide focused education, activation, navigation
-CC Education
-Facilitate adherence to guidelines
-Feedback
-R/E Data Collection, Registries, QI
-Interpreter Services
Culturally Competent Programs
Goals of RWJF Leading Change:Setting the Stage and Moving to Action
Synthesize Results with Finding Answers (Evaluation)– Examine evaluation results
– Develop into practical, usable forms that include key themes and critical success factors
Disseminate Solutions to Stakeholders– Broad Audience
Create Leaders and Provide Technical Assistance to Implement Disparities Solutions– Targeted Audience
Maintain Clearinghouse of Disparities Solutions– Web-based, interactive
Major Activities Planning
– Strategy Forum Leaders from QI, Disparities, Imp Science and Org Excellence
– Sounding Board Broad Dissemination and Translation
– Annual National Meetings– Public Web Seminars– Website
Highlights Projects; Searchable Database; Case-Study Section; New Interventions and Lit Search
Targeted Leadership Development and Technical Assistance
– Executive Disparities Institute (Implementation) Competitive Application Process (20 Org’s); Organizational Commitment to Project; Opening and
Closing Meeting (1.5 Day each); 2 Conf Calls per Year; 2 months of Tech Assistance Calls
Summary
There has been some progress since release of
IOM Report Unequal Treatment—yet more to do
Growing desire among key health care
stakeholders for concrete “what to do’s”
Leading Change—in collaboration with others—
hopes to fill void