AnMed Health Disparities Dashboard

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2 AnMed Health Quick Facts 588 Bed Acute Care System Level II Trauma Center Emergency Department visits: 112,329 Admissions: 23,489 Active Medical Staff: 455 Employees: 3,511 Source : CY2013

3 Setting the Gold Standard AnMed Health has earned numerous awards and accreditations for quality care, including recognitions from HealthGrades, U.S. News and World Report, and Becker s Hospital Review.

4 In Pursuit of Equitable Care 1964 Title VI of the Civil Rights Act 2000 Culturally and Linguistically Appropriate Service Standards (CLAS) 2002 IOM s Unequal Treatment 2003 Joint Commission s Hospitals, Language, Culture: A Snapshot of the Nation 2010 Joint Commission Roadmap Monograph 2011 JC s New and Revised Communication Standards 2013 Enhanced CLAS Standards

5 Call to Action! Addressing disparities is no longer just about morality, ethics and social justice: It is essential for performance excellence and improved community health. Association of Medical Colleges College of Healthcare Executives Hospital Association Catholic Health Association of the United States National Association of Public Hospitals and Health Systems

6 Now look who s talking! IOM Unequal Treatment Hospital Association Agency for Healthcare Research and Quality (AHRQ) National Association of Public Hospitals and Health System Associations of Medical Colleges Catholic Health Association of the United States College of Healthcare Executives

7 Social Determinants of Health The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. Religion or Spirituality Language Geography PATIENT Sociology Race & Ethnicity Biology Source: World Health Organization (WHO)

8 A Roadmap 1. Link quality and equity 2. Create a culture of equity 3. Diagnose the disparity 4. Design the activity 5. Secure buy-in 6. Implement change Source: Robert Wood Johnson Foundation

9 Fundamental Premise From the standpoint of hospitals it s really critical that they begin to measure quality by race and ethnicity. And to do that they will need to create race and ethnicity data, and that links to the communication piece. If you look at race and ethnicity, you can look at where the gaps are and where you might intervene. - Joseph Betancourt, MD, MPH Director, The Disparities Solution Center

10 Our Project Disparities Leadership Program AnMed Health: Disparities Dashboard Abstract The goal of our project was to research and develop a disparities dashboard to identify and strategically address AnMed Health s most vulnerable, underserved and costly patient populations. The disparities dashboard is adjunct to our system-wide quality measures and management strategies.

11 Considerations in Project Selection Moving disparities conversations forward Competing organizational focuses /priorities Clinical and Quality priorities Status of REaL Data collection REaL = Race, Ethnicity and Language data Organizational timing and resource availability

12 Project Implementation REal data at registration foundation Established dashboard framework data sources and metrics Executive Team and Physician Support Implementation Team /Multidisciplinary Collaboration Inpatient Focus Initially, Case Management Supported Physician Sponsor Matt Cline, MD, Assoc. Program Director, Family Medicine

13 Dashboard Components Quality & Disparities Quality Appropriate Care Scores Heart Failure; AMI; Pneumonia; SCIP; + VTE/IMM + Stroke Patient Satisfaction H-CAHPS Readmissions + COPD Disparities Diversity Snapshot Service Volumes Business Line Analysis Language Services

14 AnMed Health Disparities Quality Dashboard CY 2013 Diversity Snapshot White Hispanic African Indian Asian Unknown/ Other National Hospital Quality Measures 1- White 1-Hispanic 2- African 3- Indian 4- Asian 7- UTD Total Setting Percent Heart Failure Inpatient Discharges 78.66% 0.82% 19.70% 0.29% 0.36% 0.15% Evaluation of LVS Function % % % % % % Emergency Department 70.04% 1.24% 28.05% 0.03% 0.15% 0.46% ACEI or ARB for LVSD % % % % % Child Health 48.00% 10.00% 33.00% 0.07% 0.40% 3.70% HF Appropriate Care Score (ACS) % % % % % % Family Medicine 49.00% 4.00% 33.00% 3.00% 11.00% AMI Type of Care White Hispanic African Indian Aspirin at arrival % % % % % Aspirin Prescribed at discharge % % % % % ACEI or ARB for LVSD % % % % % Beta Blocker prescribed at Discharge % % % % % Service Percent of Admissions Primary PCI received w ithin 90 minutes of hospital arrival % % % % % Inpatient Adult 79.23% 0.68% 19.38% 0.23% 0.28% 0.17% Statin at discharge % % % % % Inpatient Pediatrics (<18) 74.20% 1.90% 22.10% 0.70% 1.00% 0.00% AMI Appropriate Care Score (ACS) % % % % % AnMed Health Business Line 78.87% 0.88% 19.55% 0.27% 0.29% 0.14% Pneumonia Cardiac Surgery 87.36% 0.72% 11.19% 0.00% 0.00% 0.72% Blood cultures w /i 24 hours of hosp arrival-pts transferred/admitted to the ICU 99.40% % % 0.00% % 99.50% Cardiology 73.90% 0.98% 24.79% 0.13% 0.00% 0.20% Initial antibiotic selection for CAP in immunocompetent - ICU patient % 0.00% % 0.00% 0.00% % Cath & EP 85.16% 0.32% 14.29% 0.08% 0.00% 0.16% Initial antibiotic selection for CAP in immunocompetent - Non ICU patient 99.60% 0.00% % % % 99.60% Dentistry 64.71% 0.00% 35.29% 0.00% 0.00% 0.00% PN Appropriate Care Score (ACS) 99.20% % % % % 99.30% ENT 76.74% 3.49% 18.60% 1.16% 0.00% 0.00% Surgical Care Asian Unknown/ Other Gastroenterology 77.77% 1.15% 21.02% 0.06% 0.00% 0.00% On-time prophylactic antibiotic selection 99.80% % 99.10% 0.00% % 99.70% General Surgery 80.40% 0.75% 18.47% 0.19% 0.00% 0.19% Appropriate selection of prophylactic antibiotics 99.20% % % 0.00% % 99.30% Gynecology 72.78% 0.63% 26.58% 0.00% 0.00% 0.00% Discontinuation of prophylactic antibiotics w ithin 24 hours after surgery 99.70% 75.00% % 0.00% % 99.60% Internal Medicine 78.28% 0.69% 20.64% 0.13% 0.00% 0.26% Cardiac surgery patients w ith controlled 6 a.m. postop serum glucose 98.00% % % 0.00% % 98.20% Medical Oncology 70.92% 0.00% 29.08% 0.00% 0.00% 0.00% Appropriate hair removal % % % % % % Neonatology 71.75% 1.79% 26.01% 0.45% 0.00% 0.00% Urinary catheter removed on POD 1 or POD 2 w ith day of surgery being day zero 98.90% % % % 0.00% 99.00% Nephrology 70.65% 0.33% 28.44% 0.33% 0.00% 0.25% Beta blocker prior to admission and perioperative period 99.20% % 97.20% % 0.00% 98.90% Neurology 76.94% 0.93% 21.94% 0.09% 0.00% 0.09% Venous thromboembolism prophylaxis timely 99.70% % % % 0.00% 99.70% Neurosurgery 84.98% 0.32% 14.70% 0.00% 0.00% 0.00% SCIP Appropriate Care Score (ACS) 97.70% 83.30% 98.50% % % 97.70% Normal New born 76.19% 1.67% 21.25% 0.89% 0.00% 0.00% Stroke Obstetrics 75.36% 1.49% 21.97% 1.03% 0.00% 0.15% Stroke patients w ith VTE prophylaxis 99.30% % % % % 99.40% Opthalmology 82.35% 0.00% 17.65% 0.00% 0.00% 0.00% Discharged on antithrombotic therapy 99.60% % 98.50% % % 99.30% Orthopedics 87.27% 0.74% 11.63% 0.07% 0.00% 0.29% Anticoagulation for atrial fibrillation 97.60% 0.00% % 0.00% % 97.90% Psychiatric 87.09% 0.50% 11.92% 0.20% 0.00% 0.30% Thrombolytic therapy % % 66.70% 0.00% % 94.40% Pulmonary 81.80% 0.45% 17.52% 0.11% 0.00% 0.11% Antithrombotic therapy by end of hospital day % % % % % % Thoracic Surgery 79.76% 0.79% 19.44% 0.00% 0.00% 0.00% Discharged on statin medication 97.20% % % % % 97.90% Trauma & Burns 79.87% 0.65% 17.53% 1.30% 0.00% 0.65% Stroke education 97.20% % % 0.00% % 98.00% Urology 84.43% 0.00% 14.88% 0.69% 0.00% 0.00% Assessed for rehab 97.70% % % % % 98.20% Vascular Surgery 67.98% 0.00% 32.02% 0.00% 0.00% 0.00% Stroke Appropriate Care Score (ACS) 94.20% % 97.40% % % 95.00% VTE VTE prophylaxis 97.20% % 98.90% % % 97.60% Language Services Outpatient Services Inpatient Services Total ICU VTE prophylaxis 98.20% % 95.80% % % 97.80% Other 3.3% 9.5% 4.6% VTE patients w ith anticoagulation overlap therapy 93.10% % 84.30% 0.00% 0.00% 90.70% Spanish 86.6% 75.4% 84.3% VTE patients receiving unfractionated heparin w ith monitoring by protocol % % % 0.00% 0.00% % Vietnamese 1.0% 0.8% VTE discharge instructions 98.80% % % 0.00% 0.00% 99.20% Sign Language 6.6% 8.3% 7.0% VTE Appropriate Care Score (ACS) 96.60% % 94.00% % % 96.10% Arabic 0.5% 0.7% 0.5% Immunization Chinese/Mandarin 0.5% 1.2% 0.6% Influenza Rate 96.10% % 97.00% % 75.00% 66.70% 96.00% German Russian 0.03% 1.4% 4.9% 0.03% 2.1% Farsi (Persian) 0.03% 0.03% 30-Day African Unknown White Hispanic Asian Readmissions Indian / Other Overall Rate 18.57% 25.00% 19.89% 50.00% 0.00% 0.00% Overall 18.83% Overall Volume Patient Experiences with Care Hawaiian/ African Puerto Heart Failure Rate 23.57% 66.67% 25.37% 50.00% 24.22% White Hispanic Mexican Pacific Asian Indian Rican Islander Heart Failure Volume % of Responses in Best Category (9-10 Rating) AMI Rate 13.64% 0.00% 25.00% 15.19% H-CAHPS Experience 9-10 (Inpatient) AMI Volume Overall Rating 76.50% 74.30% 73.60% Pneumonia Rate 18.17% 0.00% 11.32% 17.15% 85.70% 66.70% % 85.70% 77.80% % 0.00% Pneumonia Volume COPD Rate 16.50% 0.00% 20.91% 0.00% 0.00% 16.99% 0.00% COPD Volume

15 Diversity Snapshot White Hispanic Setting African Percent Indian Asian Unknown/ Other Inpatient Discharges 78.66% 0.82% 19.70% 0.29% 0.36% 0.15% Emergency Department 70.04% 1.24% 28.05% 0.03% 0.15% 0.46% Child Health 48.00% 10.00% 33.00% 0.07% 0.40% 3.70% Family Medicine 49.00% 4.00% 33.00% 3.00% 11.00% CY 2013 Diversity Snapshot Type of Care White Hispanic Service Percent of Admissions African Indian Asian Diversity Snapshot White Hispanic Inpatient Adult 79.23% 0.68% 19.38% 0.23% 0.28% 0.17% Setting Unknown/ Other African Inpatient Pediatrics (<18) 74.20% 1.90% 22.10% 0.70% 1.00% 0.00% AnMed Health Business Line 78.87% 0.88% 19.55% 0.27% 0.29% 0.14% Cardiac Surgery 87.36% 0.72% 11.19% 0.00% 0.00% 0.72% Cardiology 73.90% 0.98% 24.79% 0.13% 0.00% 0.20% Child Cath & EP Health 85.16% 0.32% 14.29% 48.00% 0.08% 10.00% 0.16% 33.00% 0.07% 0.40% 3.70% Family Dentistry Medicine 64.71% 0.00% 35.29% 49.00% 0.00% 4.00% 0.00% 0.00% 33.00% 3.00% 11.00% ENT 76.74% 3.49% 18.60% 1.16% 0.00% 0.00% Gastroenterology 77.77% 1.15% 21.02% 0.06% 0.00% 0.00% General Surgery 80.40% 0.75% 18.47% 0.19% 0.00% 0.19% Gynecology 72.78% 0.63% 26.58% 0.00% 0.00% 0.00% Internal Medicine 78.28% 0.69% 20.64% 0.13% 0.00% 0.26% Medical Oncology 70.92% 0.00% 29.08% 0.00% 0.00% 0.00% Neonatology 71.75% 1.79% 26.01% 0.45% 0.00% 0.00% Nephrology 70.65% 0.33% 28.44% 0.33% 0.00% 0.25% Inpatient Neurology Pediatrics 76.94% (<18) 0.93% 21.94% 74.20% 0.09% 0.00% 1.90% 0.09% 22.10% 0.70% 1.00% 0.00% Neurosurgery 84.98% 0.32% 14.70% 0.00% 0.00% 0.00% Normal New born 76.19% 1.67% 21.25% 0.89% 0.00% 0.00% Cardiac Surgery 87.36% 0.72% 11.19% 0.00% 0.00% 0.72% Obstetrics 75.36% 1.49% 21.97% 1.03% 0.00% 0.15% Opthalmology 82.35% 0.00% 17.65% 0.00% 0.00% 0.00% Orthopedics 87.27% 0.74% 11.63% 0.07% 0.00% 0.29% Psychiatric 87.09% 0.50% 11.92% 0.20% 0.00% 0.30% Pulmonary 81.80% 0.45% 17.52% 0.11% 0.00% 0.11% Thoracic Surgery 79.76% 0.79% 19.44% 0.00% 0.00% 0.00% Trauma & Burns 79.87% 0.65% 17.53% 1.30% 0.00% 0.65% Urology 84.43% 0.00% 14.88% 0.69% 0.00% 0.00% Vascular Surgery 67.98% 0.00% 32.02% 0.00% 0.00% 0.00% Percent Indian Asian Unknown/ Other Inpatient Discharges 78.66% 0.82% 19.70% 0.29% 0.36% 0.15% Emergency Department 70.04% 1.24% 28.05% 0.03% 0.15% 0.46% Type of Care White Hispanic Service Percent of Admissions African Indian Asian Unknown/ Other Inpatient Adult 79.23% 0.68% 19.38% 0.23% 0.28% 0.17% AnMed Health Business Line 78.87% 0.88% 19.55% 0.27% 0.29% 0.14%

16 National Hospital Quality Measures 1- White 1- Hispanic 2- African 3- Indian 4- Asian 7- UTD Total Heart Failure Evaluation of LVS Function % % % % % % ACEI or ARB for LVSD % % % % % HF Appropriate Care Score (ACS) % % % % % % AMI Aspirin at arrival % % % % % Aspirin Prescribed at discharge % % % % % ACEI or ARB for LVSD % % % % % Beta Blocker prescribed at Discharge % % % % % Primary PCI received w ithin 90 minutes of hospital arrival % % % % % Statin at discharge % % % % % AMI Appropriate Care Score (ACS) % % % % % Pneumonia Blood cultures w /i 24 hours of hosp arrival-pts transferred/admitted to the ICU 99.40% % % 0.00% % 99.50% Initial antibiotic selection for CAP in immunocompetent - ICU patient % 0.00% % 0.00% 0.00% % Stroke Initial antibiotic selection for CAP in immunocompetent - Non ICU patient Stroke patients w ith 99.60% VTE prophylaxis 0.00% % VTE prophylaxis % 99.30% % % 99.60% New % measures % % 99.40% PN Appropriate Care Score (ACS) Discharged on antithrombotic 99.20% therapy % % % 99.60% % % 99.30% 98.50% % % 99.30% Surgical Care Appropriate Care Score Populations: Heart Failure (HF) Acute Myocardial Infarction (AMI) Pneumonia (CAP) Surgical Care (SCIP) Stroke Immunizations Anticoagulation for atrial fibrillation 97.60% 0.00% % 0.00% % 97.90% On-time prophylactic antibiotic selection Thrombolytic therapy99.80% % 99.10% 0.00% % % % 99.70% 66.70% 0.00% % 94.40% Appropriate selection of prophylactic antibiotics Antithrombotic therapy 99.20% by end of hospital % day % 0.00% % % % 99.30% % % % % Discontinuation of prophylactic antibiotics w ithin 24 hours after surgery Discharged on statin medication 99.70% 75.00% % 0.00% 97.20% % % % 99.60% % % 97.90% Cardiac surgery patients w ith controlled 6 a.m. postop serum glucose Stroke education 98.00% % % 0.00% 97.20% % % % 98.20% 0.00% % 98.00% Assessed for rehab 97.70% % % % % 98.20% Appropriate hair removal % % Stroke Appropriate Care Score (ACS) % % % % 94.20% % 97.40% % % 95.00% Urinary catheter removed on POD 1 or POD 2 w ith day of surgery being VTE day zero 98.90% % % % 0.00% 99.00% Beta blocker prior to admission and perioperative period VTE prophylaxis 99.20% % 97.20% % 97.20% 0.00% % 98.90% 98.90% % % 97.60% Venous thromboembolism prophylaxis timely ICU VTE prophylaxis99.70% % % % 98.20% 0.00% % 99.70% 95.80% % % 97.80% SCIP Appropriate Care Score (ACS) VTE patients w ith anticoagulation 97.70% overlap 83.30% therapy 98.50% % 93.10% % % 97.70% 84.30% 0.00% 0.00% 90.70% VTE patients receiving unfractionated heparin w ith monitoring by protocol % % % 0.00% 0.00% % VTE discharge instructions 98.80% % % 0.00% 0.00% 99.20% VTE Appropriate Care Score (ACS) 96.60% % 94.00% % % 96.10% Immunization Influenza Rate 96.10% % 97.00% % 75.00% 66.70% 96.00%

17 National Hospital Quality Measures Heart Failure AMI 1- White 1-Hispanic 2- African 3- Indian Evaluation of LVS Function % % % % % % ACEI or ARB for LVSD % % % % % HF Appropriate Care Score (ACS) % % % % % % Aspirin at arrival % % % % % Aspirin Prescribed at discharge % % % % % ACEI or ARB for LVSD % % % % % Beta Blocker prescribed at Discharge % % % % % Primary PCI received w ithin 90 minutes of hospital arrival % % % % % Statin at discharge % % % % % AMI Appropriate Care Score (ACS) % % % % % Pneumonia Blood cultures w /i 24 hours of hosp arrival-pts transferred/admitted to the ICU 99.40% % % 0.00% % 99.50% Initial antibiotic selection for CAP in immunocompetent - ICU patient % 0.00% % 0.00% 0.00% % Initial antibiotic selection for CAP in immunocompetent - Non ICU patient 99.60% 0.00% % % % 99.60% PN Appropriate Care Score (ACS) 99.20% % % % % 99.30% Surgical Care On-time prophylactic antibiotic selection 99.80% % 99.10% 0.00% % 99.70% Appropriate selection of prophylactic antibiotics 99.20% % % 0.00% % 99.30% Discontinuation of prophylactic antibiotics w ithin 24 hours after surgery 99.70% 75.00% % 0.00% % 99.60% Cardiac surgery patients w ith controlled 6 a.m. postop serum glucose 98.00% % % 0.00% % 98.20% Appropriate hair removal % % % % % % Urinary catheter removed on POD 1 or POD 2 w ith day of surgery being day zero 98.90% % % % 0.00% 99.00% Beta blocker prior to admission and perioperative period 99.20% % 97.20% % 0.00% 98.90% Venous thromboembolism prophylaxis timely 99.70% % % % 0.00% 99.70% SCIP Appropriate Care Score (ACS) 97.70% 83.30% 98.50% % % 97.70% Stroke National Hospital Quality Measures Heart Failure AMI Stroke patients w ith VTE prophylaxis 99.30% % % % % 99.40% Discharged on antithrombotic therapy 99.60% % 98.50% % % 99.30% Anticoagulation for atrial fibrillation 97.60% 0.00% % 0.00% % 97.90% Thrombolytic therapy % % 66.70% 0.00% % 94.40% Antithrombotic therapy by end of hospital day % % % % % % Discharged on statin medication 97.20% % % % % 97.90% 4- Asian 7- UTD Total 1- White CY 2013 Appropriate Care Scores 1-Hispanic 2- African Evaluation of LVS Function % % % ACEI or ARB for LVSD % % % HF Appropriate Care Score (ACS) % % % Aspirin at arrival % % % Aspirin Prescribed at discharge % % % ACEI or ARB for LVSD % % %

18 Patient Experiences with Care H-CAHPS Experience 9-10 (Inpatient) White African Indian % of Responses in Best Category (9-10 Rating) Hispanic Mexican Puerto Rican Hawaiian/ Pacific Islander Overall Rating 76.50% 74.30% 73.60% 85.70% 66.70% % 85.70% 77.80% Asian 30-Day Readmissions White Hispanic African Indian Asian Unknown / Other Overall COPD readmission rates added in Q Overall Rate 18.57% 25.00% 19.89% 50.00% 0.00% 0.00% 18.83% Overall Volume Heart Failure Rate 23.57% 66.67% 25.37% 50.00% 24.22% Heart Failure Volume AMI Rate 13.64% 0.00% 25.00% 15.19% AMI Volume Pneumonia Rate 18.17% 0.00% 11.32% % 0.00% 17.15% Pneumonia Volume COPD Rate 16.50% 0.00% 20.91% 0.00% 0.00% 0.00% 16.99% COPD Volume Language Services Outpatient Services Inpatient Services Total Other Spanish Vietnamese Sign Language Arabic Chinese/Mandarin German Russian Farsi (Persian) 3.3% 86.6% 1.0% 6.6% 0.5% 0.5% 0.03% 1.4% 0.03% 9.5% 75.4% 8.3% 0.7% 1.2% 4.9% 4.6% 84.3% 0.8% 7.0% 0.5% 0.6% 0.03% 2.1% 0.03%

19 Project Interventions / Tactics Implementation Team /Multidisciplinary Collaboration Inpatient Focus Initially, Case Management Supported Assessed overall utilization of African AMI readmission population Real Time alerts based on medical record number Patient interviews related to readmission Geocoding by zip codes

20 4 Steps to Population Health Management 4. Population Health Management 3. REaL Data and Infrastructure 2. Multidisciplinary Collaboration 1. Diversity relevance and ROI

21 Emerging Opportunities Healthy Outcomes Program South Carolina Department of Health and Human Services Medicaid Expansion Strategy Participating hospitals proposing service delivery models to coordinate care for chronically ill, uninsured, high utilizers of emergency department (ED) services Critical Success Factors and Benefits:» Care Coordination, Population Management, Coaching» Improved Outcomes, Lower Care Costs

22 Emerging Opportunities (cont.) Physician Engagement Physician Diversity Advisory Council Physician Network Language Services

23 Interventions Ongoing assessment Continuum opportunities Maintain a focus Leadership updates Continued data trending Assess Cost Impact Next Steps

24 Questions?

25 Contact Information Juana Slade, CDM, CCF Director, Diversity and Language Services J. Suzanne Wilson, RN, MBA Director, Medical Resource Management

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