Photo Credit: Ipopba
Health inequities pervade the healthcare system, making it crucial for physicians to reevaluate what data is being collected and who is collecting the data.
One of the American Medical Association’s (AMA’s) most pressing missions is to address the US healthcare system’s systemic and community-wide inequities to deliver health equity to marginalized, minority community members. Founded in longstanding structural components that have not evolved, health inequities pervade the nation’s healthcare system. Based on data obtained from an AMA National Health Equity Grand Rounds event, physicians must reevaluate what data is being collected and who is collecting the data.
Elena Mendez-Escobar, PhD, co-executive director of the Boston Medical Center (BMC) Health System Health Equity Accelerator, spoke at the event. The Health Equity Accelerator’s mission is to transform healthcare by eliminating disparities in life expectancy and quality of life amongst people of varying ethnicities. Dr. Mendez-Escobar noted that, historically, some researchers and healthcare professionals have used data to hide from change rather than to prove its necessity. As such, while the Health Equity Accelerator’s work is rooted in data, the group uses data in conjunction with qualitative, descriptive data.
For example, upon examining statistics on pregnancy complications at BMC, Dr. Mendez-Escobar and colleagues found the data inconclusive. However, knowing that health inequities affect health outcomes by prompting delayed treatment, the Health Equity Accelerator team returned and dove deeper into the data. They saw a significant correlation between severe pregnancy complications and preeclampsia, which was the impetus for poorer outcomes for black patients. In response to the team’s findings, BMC instituted interventions, like providing patients with a remote blood pressure measurement device for their initial prenatal appointment. The organization also educated patients regarding the risks and symptoms associated with preeclampsia, encouraging them to schedule an appointment if they see a rise in blood pressure. Furthermore, BMC arranges for childcare should the need for an emergency appointment arise.
The Health Equity Accelerator team also measured the lag time between deciding on a cesarean section (C-section) and the actual start of surgery. While white patients averaged a 78-minute lag time, black patients averaged a 98-minute lag time. Dr. Mendez-Escobar emphasizes that increased time lapses are affiliated with a greater risk for complications like hemorrhages. As a result, the team created a goal to universally reduce C-section lag time to one hour. The ensuing interventions helped BMC meet that goal, exhibiting the power of a structural change in a healthcare process.
Another panel representative at the AMA event was the president of the Lown Institute, Vikas Saini, MD, whose team zeroes in on equity, value, and accountability with tools like their Hospital Index for Social Responsibility. Upon evaluating the success of a hospital’s Medicare-patient population mirroring its local community, the index ranks the inclusivity of 3200 hospitals via examination of claims data. For example, Dr. Saini and his team found that one hospital in Chicago with a largely white patient population did not accurately reflect the local community, which consisted of significantly more black and Hispanic residents. Those minority patients were either seeking care elsewhere or, worse, not seeking any care. According to Dr. Saini, this glaring discrepancy indicates “residential and labor-market segregation.” Healthcare systems nationwide must employ barometers like this to identify inequities and use findings to implement initiatives and enact change.
