Introducing a Lens of Equity Into Healthcare Measurement Systems - HIMSS
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Introducing a Lens of Equity Into
Healthcare Measurement Systems
Se s s ion # HA15, Augus t 12, 20 21
Na t ha n Da la lo, MS
Senior Business Intelligence Analyst, NorthShore University HealthSystem
DISCLAIMER: The views and opinions expressed in this presentation are solely those of the author/presenter and do not necessarily represent any policy or position of HIMSS.
1
Welcome
Na t ha n Da la lo
Senior Business Intelligence Analyst, NorthShore University HealthSystem
#HIMSS21 2
Conflict of Interest
Nathan Dalalo, MS
Has no real or apparent conflicts of interest to report.
#HIMSS21 3
Agenda
• NorthShore University HealthSystem’s mission
• Learning objectives
• What is health equity? …and other definitions
• Motivation: Why is health equity important?
• Diversity, equity & inclusion at NorthShore
• Four areas of focus
• What data do we need and how do we organize it?
• Lens of equity tools
• Identifying care gaps
• How we communicate to patients matter
• A technology-enhanced approach to engagement
• Opportunities to improve data collection
• What is NorthShore doing to work toward health equity?
#HIMSS21 4
Learning Objectives
• Develop a measurement system strategy that incorporates a lens of equity
stratification into existing metrics
• Create a governance and implement structure that brings multiple key
stakeholders in an organization, to provide guidance, navigate challenges,
and create accountability for new equity metrics
• Build data visualizations and geographic maps that help explain social equity
across our healthcare system’s market area
#HIMSS21 5
NorthShore University HealthSystem
MISSION: Preserve and Improve Human Life
HOW: SERVICE AREA:
• Superior clinical care, academic excellence, innovative • Chicago Metropolitan Area
research
REVENNUE:
• Top quality and patient safety scores
• $2.6 Billion
• 6 hospitals, 140+ locations
KEY AFFILIATIONS:
• 3,100+ Primary Care Physicians and Specialists
• Principal Teaching Affiliate of the University
• 12,500+ Employees of Chicago Pritzker School of Medicine
• 5 Institutes
• Advanced Primary Care
• System enabled through technology
(EMR), Informatics
• Research Institute
• Foundation
#HIMSS21 6
What is Equity?
Tony Ruth’s Giving Tree art of justice/equality/equity #HIMSS21 7
Health Equity vs Inequity
• Health equity: “…is the assurance of conditions for optimal health for all
people. [It] requires valuing all individuals and populations equally,
recognizing and rectifying historical injustices, and providing resources
according to need.” (NACCHO 2016)
• Health inequity: “Differences in population health status and mortality rates
that are systemic, patterned, unfair, unjust and actionable, as opposed to
random or caused by those who become ill.” (Whitehead 1992)
#HIMSS21 8
Additional Definitions
• Social determinants of health (SDoH): “…the conditions in which people are born,
grow, live and age. These circumstances are shaped by the distribution of
money, power and resources at global, national and local levels. [SDoH] are
mostly responsible for health inequities (WHO 2014)
• Structural racism: “…macrolevel systems, social forces, institutions, ideologies and
processes that interact with one another to generate and reinforce inequities
among racial and ethnic groups…[does] not require the actions or intent of
individuals. (Gee 2002)
• REAL: race, ethnicity and language data
• SOGI: sexual orientation and gender identity data
#HIMSS21 9
CDPH: Chicago Life Expectancy Gap
#HIMSS21 10Where are the
COVID Hot Spots?
Census Tract
11N= 876
Hospitalization
Comparisons
N= 272
N= 154
N= 278
12What Makes Us Healthy
vs. What We Spend on
Being Healthy
13
Bipartisan Policy Center1 2
Create Greater Drive Employment and
Diversity, Equity, &
To Be the Most Inclusion at NorthShore
Economic Growth for
Underserved Groups
Trusted and
Indispensable
Health Partner to
the Communities We Diversity, Equity & Inclusion Action Group
Serve, We Have the
3
Opportunity To: Impact Health Inequity
in our Communities
Health Equity Impact Team
14“
To reduce healthcare disparities in the care that NorthShore
provides access across the continuum to serve as a critical
healthcare partner with community organizations whose work are
aligned with the goals of improving equitable heath outcomes.
Health Equity Impact Team (HEIT) Charter Purpose
#HIMSS21 15September 2020
Health Equity
Milestones December 2020
January through May 2021
Corporate Scorecard
June 2021
#HIMSS21 16HEIT Journey
• Data analytics utilized the ‘Lens of Equity Tool’ and Vizient data to create
a HEAT map that helped to identify care gaps in the non-white
population
• The HEIT Team separated into two sub-groups to analyze the Ambulatory
and Inpatient population
• We created a scoring rubric to help prioritize attributes of the data
• Team identified need to fill in gaps in knowledge in order to make a
better informed decision
#HIMSS21 17Four Areas of Focus
Benchmarking study deliverables:
Social • Electronic survey
Determinants of • Report provided by Vizient provides current state and
comparative analytics vs cohorts
Health • Identifies actionable opportunities based on data tool
Helps organizations to:
Health Equity
• Understand health equity efforts
Organizational • Address potential gaps/disparities in care
Assessment • Focus efforts and technical assistance
Partner with Community Relations to
Voice of the • Co health equity efforts
Understand existing
Community • Listen to priorities of the community
Learning from Gain knowledge from those institutions/experts that are ahead
of us on this journey
the Experts
#HIMSS21 18Area of Focus –
Social Determinants of
Health
Purpose
19Area of Focus –
Health Equity Next Steps
Organization Legacy NorthShore Swedish
Assessment • With Epic transition, looking for
• Current state of data
o Incomplete data opportunities for data
Purpose
o Inaccurate data optimization
• Establish community • Re-invigorate community
partnerships partnerships and reassess
community needs
• Current state of
training practices and • Continue to drive staff
look for opportunities engagement as data is collected
for improvement and validated and enhance
training opportunities
20Pilot Meeting
Area of Focus – “Take Aways” Next Steps
Voice of the • Supportive, engaged and • Outreach Caucus
interested • Leverage energy and
Community • Willing to partner and help momentum of internal
bridge the gap with champions/groups
communities • Avoid duplication
• Interested in data for • Development of diverse
Purpose specific stakeholder list
communities/service • Small group listening sessions
areas
• Interested in transparency
and sharing of data
externally, where possible
• Additional interest in heart
disease metric -
intersection between diet
and culture
21Area of Focus – Speakers
Learning from the • Darlene Hightower (Rush University Medical Center)
Experts – “Move The Crowd: 5 Strategies for Authentic
Community Engagement”
• Mary Kate Selling (University of Chicago Medical
Center) – “Using Clinical Data to Improve Equity in
Purpose Healthcare”
• Lou Hart (NYC Health and Hospitals) – “Ingraining
Equity in Healthcare”
22But First…
What Data Do We Need and How Do We Organize It?
1 2
Clinical and demographic data about our patients Data about the communities they live in
Can tell us what our metrics look like Can tell us what our metrics look like
across minority groups across census tract median income
communities
#HIMSS21 23Lens of Equity
Tool
24Care Gap Metric: Minority vs Non-Minority
and High MFI vs Low MFI
#HIMSS21 25How are We Communicating with Our Patients?
• NorthShore Connect (NSC) serves
as our primary tool to engage with
our patients for preventative care
• Is it surprising, given NSC is our
primary engagement tool, that we
also see inequities in the
mammography screening metric?
#HIMSS21 26When We Look at Those Active on NSC Broken by
Race and Ethnicity We See a Stark Difference
• Not only are minority populations less likely to be engaging with us on NSC, non-active
patients are a lot less likely to be compliant
• The confounder could be that the same barriers that are making it harder for people
to get screening also make it harder to sign up for and stay active on NSC. We need
to think more broadly about how to engage in a way that is equitable.
Screening Median Age
Compliance
Active and Registered 82% 62
Not Active 59% 64
Grand Total 80% 62
% of total number of patients
#HIMSS21 27A/B Testing: Breast Cancer Screening Outreach
This study will help us better understand the most effective communication
modality when reaching out to our patients. Population: Female, 52-74 y/o, all
payors, Epic listed PCP
NSC
NorthShore Connect
vs CRM Email
A prior NorthShore study showed that
the content of the NSC message
makes a difference in read rate
#HIMSS21 28A Technology -Enhanced Approach to Engagement
What if we can learn about how we engage with our patients through segmentation
and experimentation?
A learning-based process would:
• Segment our population using multiple risk models that identify patients likelihood (or risk) for multiple outcomes that can
segment them in to different categories
• Using our CRM platform we would run experiments on these segments in order to study the optimal mode, content, and
frequency of communication
• This would be enhanced by boots on the ground workers to provide patients with support
#HIMSS21 29How Are We Receiving Feedback From Patients?
• HCAHPS stands for Hospital Consumer Assessment of Healthcare Providers and Systems. [It is] an instrument to measure patient
perceptions of care. The goal is to provide consumers with information that might be helpful in choosing a hospital.
• NorthShore works with Press Ganey to send out surveys to patients after an inpatient stay.
#HIMSS21 30There Are Opportunities To Improve Data
Collection
#HIMSS21 31Increase the collection of race, ethnicity and
1
language data in order to better identify health
disparities and improve health outcomes for
patients
2022 Aims and
Identified Metrics 2 Increase the number of breast cancer screenings
performed within our underserved communities
Recap
Increase patient feedback from NS Legacy Inpatients
3 (Black and Latinx) by 50% by the end of FY 2022
#HIMSS21 32Partnership with Blue Cross Blue Shield
• Positions hired and under development to
Blue Cross Blue Shield’s 3-year program support program:
established to support hospitals that are most o Director of Healthcare Equity
likely to treat the highest concentrations of Community Outreach Liaisons
BCBS-IL members who face health inequities Communication and Education Specialist
and disparities o HIT/ Data Analytics roles
o GME Physician leadership
They will provide $9M over 3 years to health
systems who will be accountable for reducing • Engaged with BCBS Institute for Physician
identified health inequities in all payer Diversity
populations with $1MM annual incentive
• Goals developed by HEIT will support
achievement of incentive
#HIMSS21 33Questions
?
#HIMSS21 34Thank you!
Nathan Dalalo
ndalalo@northshore.org
linkedin.com/in/nathandalalo
#HIMSS21 35You can also read
