Hospitals, for the most part, aren't making full use of demographic data to reduce health disparities among ethnic and racial patient populations, but organizations like Better Health Greater Cleveland can offer an outline about how providers can do more.
Better Health Greater Cleveland, a regional health care improvement collaborative that has been collecting quality data since 2007, is working to improve blood pressure control among black patients after it uncovered related differences between patient racial populations in the region.
As part of the Robert Wood Johnson Foundation's Aligning Forces for Quality program, Better Health Greater Cleveland was highlighted as a success story in a recent update from the foundation for its work in that area.
The collaborative, which was created in 2007 with funding by RWJF, identified the disparity through its review of data it collects every six months from members. (The collaborative reports selected data on its website.)
The collaborative then tried to find a best practice for reducing that type of disparity, and decided to rely on an intervention used by what was then Kaiser Permanente Ohio, says Shari Bolen, M.D., an assistant professor of medicine, biostatistics and epidemiology in the Center for Health care Research and Policy at MetroHealth System. (The Kaiser system is now part of HealthSpan.)
"Locally, they had shown large improvements in blood pressure over two years, and that was in both their African-American and their white patients," Bolen says. "They didn't have a lot of disparity in their practices to start with, but whatever was there disappeared," she says.
Better Health Greater Cleveland adapted the curriculum to its own needs, delivering training to providers and staffers at member primary care clinics. It includes strategies to improve provider-patient communication with black patients by focusing on the beginning and end of the visit, alleviating patient concerns and demonstrating empathy, according to the case study. "It was a nice best practice to share," Bolen says.
While just one example, it is a step in the right direction, given hospitals' current stage in reducing disparities, and their growing need to improve population health management. While 97 percent of hospitals are collecting racial data from their patients, only 30 percent are using the data to reduce disparities, according to a recent survey conducted by the Institute for Diversity in Health Management. Similarly, 94 percent are collecting data on ethnicity and 29 percent are using it.
Bolen says hospital quality executives are getting pulled in so many directions that disparities reduction sometimes gets left on the back burner. Even Better Health's effort moved forward because Bolen had the interest and time to pursue it, she says. Other organizations may not have the resources or champion to get such an effort going, she says.
"It's really hard to find time to do quality improvement, and that's a real problem at a health system level," Bolen says. "Docs are seeing patients every 20 minutes, or quicker, and you're just endlessly doing tasks. There's no built-in time to do quality improvement projects and they do take time."