In June 2016, Rush University Medical Center changed its mission from being the “best in patient care” to “improving the health of individuals and communities we serve,” with an emphasis on improving health outcomes beyond its campus. No doubt a sobering contributor to that revised mission is the fact that just outside its walls, life expectancy on Chicago’s West Side is less than 69 years, while only a few miles away in the downtown Loop it is 85 years. To understand those disparities and determine how to change them, Rush started running the numbers.
“We decided several years ago that we needed to look at how our [electronic health record] data linked to our cost and geo-coded consumer data — and that’s now connected to public health data as well,” says David Ansell, M.D., Rush’s senior vice president of community health equity. Taking a standardized approach, Rush has begun to gather psycho-social data as well as race, ethnicity and language-preference information to create an inpatient and outpatient data mart named the Disparity Navigator. The tool allows improvement teams and university researchers to examine inequities within Rush’s delivery system by clinical condition, race, ethnicity, language, cost of care, gender/gender identity, sexual orientation and neighborhood characteristics.
Using the Disparity Navigator’s insights and public health data, Rush recently created a new community health needs assessment, as well as a community health implementation plan to improve the well-being of its West Side resident patients. These initiatives have made Rush an honoree in the American Hospital Association's Equity of Care Award.
“We’ve made community health equity a strategic priority,” Ansell says. “We’re taking an all-encompassing approach, asking ‘Who’s not thriving here, and why not?’ Working with our community, our patients and our employees, we’ve begun an effort to address this question on all fronts.”
Among the examples of its work, Rush’s CHNA identified a need to address community trauma from gun violence and other events and its consequences. Rush then started screening teens at its Adolescent Family Center and School-Based Health Center at Orr Academy High School, documenting and addressing adverse childhood events. Rush aims to offer telepsychiatric services in area schools next year to support children in need, Ansell says.
In partnership with University of Illinois Health, Rush is also starting to use a tool to screen for social and structural determinants of health, administered by patient navigators in its emergency department. “We’ve rolled it out on paper and, eventually, we’ll put it into the [EHR] and everyone who comes through the ED will be screened,” Ansell says.
In the community, Rush has committed to providing supportive housing to local, chronically ill homeless patients, based on a similar, successful program at UI Health. In response to the life expectancy outcomes in its surrounding neighborhoods, Rush, UI Health and the Cook County Health and Hospitals System convened health care leaders, the Chicago Department of Public Health and more than 50 community-based organizations to seek input from individuals and community partners on the area’s most pressing health concerns. Local hospitals, residents and community-based organizations will be joining Rush in a multisector, multipartner West Side Total Health Collaborative with the ultimate aim of improving life expectancy, well-being and economic vitality in these neighborhoods. As part of this effort, Rush and a number of other hospitals have committed to become anchor institutions — to hire, purchase and invest in local neighborhoods.
“We’re pursuing an all-in strategy that recognizes there have been deliberate, historic injustices,” Ansell says. “We don’t want to replicate that going forward.”
The American Hospital Association's Equity of Care Award is presented annually to hospitals or care systems that are noteworthy leaders and examples to the field in the area of equitable care. Honorees demonstrate a high level of success in reducing health care disparities and promote diversity in leadership and staff within their organizations.
The goals of this award are:
- Recognize outstanding efforts among hospitals and care systems to advance equity of care to all patients.
- Accelerate progress of the National Call to Action to Eliminate Health Care Disparities and its stated goals and milestones.
- Spread lessons learned and progress toward health care equity and the promotion of diversity.