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Abstract
Background In 2020 in response to national events, our hospital issued a “Declaration on Equity, Diversity and Inclusivity,” (EDI) which, in part, outlined a commitment to develop and track metrics related to EDI. This increased focus on EDI amplified challenges posed by the complexity of the patient demographic data as well as variations in methodologic approaches for identifying significant disparities in care and outcomes. Additionally, our institution did not have a regular, accountable process for assessing our highest priority safety and quality measures.
Objectives To develop institutional standard methods and tools for use by analysts across the organization to allow for standardized assessment of equity of care and to apply these methods to a board-level Health Equity Quality Report (HEQR).
Methods We developed an institutional standard operating procedure (SOP), which provides a common methodology for assessing the equity of care based on patient social determinants of health. The SOP specifies how to combine patients into broad categories based on race and ethnicity, language, and payor; and how to measure differences in performance between groups. We identified significant differences using criteria based upon both the magnitude of the difference and the p-value of the statistical test of comparison. We developed an annual Health Equity Quality Report that applies these methods to enterprise-wide quality measures as well as high priority local clinical quality measures (figure 1).
Results The SOP was distributed widely across the hospital through presentations at quality and analyst forums. The HEQR identified disparities in several measures (figure 2). Additional analyses are underway to understand drivers of these differences and design improvement interventions.
Health equity quality report framework
Heat map of selected health equity quality report measures stratified by race and ethnicity
Conclusions These resources greatly standardized our institution’s approach to measuring health disparities by lowering barriers to analysis. Application of the methods will drive improvements in care for our patients and families.