Kaiser Permanente has seven decades of experience promoting diversity, inclusion and health equity — and the data to keep moving the needle.
In 2006, Kaiser Permanente implemented its electronic health record system for all of its patients, starting in ambulatory care and then expanding into its hospitals, says Berny Gould, R.N., Kaiser Permanente’s national senior director for quality and equitable care. Then, in 2007, the system launched its Member Demographic Data Collection system and methodology for collecting patients’ race, ethnicity and language preference, or "REaL," information. The following year, the equitable care view of Kaiser Permanente’s clinical effectiveness measure in its quality dashboard revealed that clinical disparity measures could be incorporated into the system’s broader quality agenda and systematically monitored with other quality metrics.
“The electronic health record is still just a technology, but when paired with an integrated health care delivery system, it has tremendous potential to follow people from birth to death,” says Winston Wong, M.D., medical director for Community Benefit and director of disparities improvement and quality initiatives at Kaiser Permanente. “The EHR allows us to follow health patterns of individuals and groups of individuals and see how many facets of their background apply to their illnesses. It goes to the core of how we intentionally use data and then plan forward to proactively address health disparities.”
It is because of work like this that Kaiser Permanente, headquartered in Oakland, Calif., is the winner of the 2017 American Hospital Association Equity of Care Award.
The use of EHRs for boosting equity of care turns out to be good for patients. “The electronic health record enables data sets that are more readily available to be stratified by race (and) ethnicity. This data stratification contributes to identifying and prioritizing vulnerable populations and health outcome disparities,” Gould says. “We have learned that combining evidence-based medicine with cultural responsiveness has the potential to reduce certain health care disparities. Self-reported race and ethnicity data provide a patient-centered focus to data stratification. We can focus by clinical diagnosis as well as community demographics. This puts the member in the driver’s seat when the health care team is able to develop trusting relationships to ensure improved clinical outcomes.”
As just one instance of the organization's targeted improvements, its Hypertension Program Improvement Process has bolstered blood pressure control rates among its members to nearly 90 percent — almost twice the national average.
A related effort, Kaiser Permanente’s Equitable Care Health Outcomes Program, began implementing clinical and culturally responsive strategies in 2010 to close health care disparity gaps for African-American patients with hypertension, as well as improve colorectal cancer screening rates among the system’s Hispanic members. REaL data were integrated into population health registries to provide actionable patient lists and decision-support tools. By the end of the fourth quarter of 2016, race and ethnicity data collection for more than 10 million Kaiser Permanente members had reached 87 percent systemwide.
Subsequently, hypertension control levels for Kaiser Permanente’s African-American members ages 18-85 have improved by 22 percent, and disparities between control rates for African-American and white patients with hypertension have decreased by 71 percent. Due to membership growth, the number of Hispanic members ages 51-75 who are eligible for colorectal cancer screening increased 44 percent from 308,000 in 2009 to 444,000 in 2016, and the colorectal cancer screening rate for Hispanic members improved 20 percent. The difference between colorectal cancer screening rates for Hispanic and white patients also decreased by 44 percent.
The larger goal in attaining these outcomes is inclusivity, Wong says. “Kaiser Permanente has a long history of inclusion — it’s part of our DNA. Inclusivity is not just diversity. We have to be open and mindful and flexible enough to incorporate the patient’s beliefs into the care we provide — we have to customize our care to wherever people come from.
“In our various programs, we ask: ‘What are the tenets of leadership that represent inclusivity values? What does it mean to be culturally humble? To work in a pluralistic community?'”
Kaiser Permanente’s numerous Community Health Initiatives tackle those questions on a sweeping scale: In 2015, the initiatives reached 665,000 regional Kaiser Permanente members in more than 50 communities, supporting healthy eating and active living through environmental and policy changes. A prime example is the Thriving Schools program, which reached more than 200,000 students in more than 300 schools last year. The program aims to make local schools safe, supportive settings that promote healthy eating, physical activity and mental health services, providing healthy lifestyle toolkits to teachers and PTAs, among other types of support. Kaiser Permanente also sponsors a touring educational theater program that presents plays in local schools on topics including bullying, nutrition and sexual health.
“We recognize that schools are critical to the future health of the community,” Wong says. “To make a long-standing contribution to community health, we need to improve the school environment.”
“The progress that Kaiser Permanente has made in closing disparities reflects the commitment of the health care team in addressing disparities,” Gould says. “Closing disparities gaps in clinical outcomes provides opportunities for each member to a healthier quality of life.”
“Against the current political backdrop, health inequity remains uncharted territory,” Wong says. “Access to quality, affordable health care and how the U.S. is addressing that affordability crisis has a disproportionate effect on the disadvantaged and people of color. [In addressing disparities], none of this happens by accident. You must focus on health equity constantly. In every decision you make, you must ask, ‘Are we contributing to health equity or accidently contributing to health disparities?’ We are always asking if we are helping everyone in our community lead a fulfilling life, unencumbered by the conditions of where they might have begun.”
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.