Efforts to Reduce Disparities: Barriers, Innovation, Implementation and Evaluation Joseph R. Betancourt, M.D., M.P.H. Director, The Disparities Solutions Center Director, RWJF’s Leading Change: Disparities Solutions Initiative Senior Scientist, Institute for Health Policy Director for Multicultural Education, Massachusetts General Hospital Assistant Professor of Medicine, Harvard Medical School

Outline  Barriers to Change  Innovations: State, Health Plan, Hospital  Implementation & Evaluation: Leading Change

Barriers to Change  Absence of an action-oriented research agenda –Questions with policy/practice relevance  Little translation of research to policy/practice –Many academic research centers, little funds for dissemination/translation –Research may not meet stakeholder needs  No coordinated political/policy strategy –Scattered legislative response to IOM Report Unequal Treatment  Minimal efforts focused on education, training, and leadership –Little informed leadership; lack of leadership development  Marginal involvement of community –No centralized voice to inform process of change or encourage activism

Innovative Approaches: State Government and Health Plans  State Legislation –Massachusetts Health Care Reform  Requires collection of r/e data  Creates Disparities and Quality Council  P4P to reduce disparities in hospital (MassHealth)  Health Plans –Aetna  Collection of r/e data; staff training (med directors, case managers) in cult comp; incorporation of cult comp strategies into diabetes disease management –BCBS of Florida  CC Education part of RPE (P4P) program; points for taking course; measures include clinical indicators and patient satisfaction  New focus on health coaches in DM, customer service; other regional health programs

Innovative Approaches: Hospital  Massachusetts General Hospital –Medical Policy  All QI stratified by race/ethnicity –Unit-Based Staff Quality Rounds  Exploring disparities: main finding was concern about language barriers over course of hospitalization –Patient Satisfaction  Stratifying results by r/e and have added questions about respect for culture/race/religion –CMS Core Measures  Stratifying results by r/e with all Boston Hospitals –Disparities Dashboard  Above info plus other info (readmission, wait times) presented to Leadership and Board routinely

Culturally Competent Disease Management: The MGH Chelsea Diabetes Program Systems Component: Race/Ethnicity Data Collection, Diabetes Registry by R/E Patient Component: Telephone outreach to increase rate of HbA1c testing Individual coaching to address patients’ needs and concerns regarding diabetes self-management to improve HbA1c Group visits meeting ADA educational requirements Provider Component: Diabetes Monograph (EBG with prompts) Coaching Feedback

Cultural Competence, Quality and Disparities A Multitiered Intervention System Provider Patient -Screen for non-adherence -Provide focused education, activation, navigation - CC Education -Facilitate adherence to guidelines -Feedback -R/E Data Collection, Registries, QI -Interpreter Services Culturally Competent Programs

Goals of RWJF Leading Change: Setting the Stage and Moving to Action  Synthesize Results with Finding Answers (Evaluation) –Examine evaluation results –Develop into practical, usable forms that include key themes and critical success factors  Disseminate Solutions to Stakeholders –Broad Audience  Create Leaders and Provide Technical Assistance to Implement Disparities Solutions –Targeted Audience  Maintain Clearinghouse of Disparities Solutions –Web-based, interactive

Major Activities  Planning –Strategy Forum  Leaders from QI, Disparities, Imp Science and Org Excellence –Sounding Board  Broad Dissemination and Translation –Annual National Meetings –Public Web Seminars –Website  Highlights Projects; Searchable Database; Case-Study Section; New Interventions and Lit Search  Targeted Leadership Development and Technical Assistance –Executive Disparities Institute (Implementation)  Competitive Application Process (20 Org’s); Organizational Commitment to Project; Opening and Closing Meeting (1.5 Day each); 2 Conf Calls per Year; 2 months of Tech Assistance Calls

Summary  There has been some progress since release of IOM Report Unequal Treatment—yet more to do  Growing desire among key health care stakeholders for concrete “what to do’s”  Leading Change—in collaboration with others— hopes to fill void