STRATEGIC PLANNING

In the Pursuit of Health Equity, Data Are Key  

Despite health equity being a long-standing concept, it was the COVID-19 pandemic, with its stark differences in hospitalizations and mortality rates, that really underscored its importance as a primary goal for health care organizations.

Megan Trosko, director of Care Improvement at the Arizona Hospital and Healthcare Association (AzHHA), and Lee Ann Lambdin, former senior principal consultant of Syntellis Performance Solutions and current president of StrategyHealth, discussed health equity—its importance and impact on patients and organizations—during the SHSMD23 Connections annual conference. They also shared details of a recent collaborative program conducted by their organizations and 12 hospitals to reduce disparities in rural areas in Arizona.

A Renewed Focus on Health Equity

In 2001, the Institute of Medicine (IOM) published “Crossing the Quality Chasm,” which outlined the following six aims of health care:

1. Safety
2. Effectiveness
3. Patient-centeredness
4. Timeliness
5. Efficiency
6. Equity

Although two of these aims—patient-centeredness and health equity—speak directly to reducing disparities and improving equity in care access and delivery, health equity was largely overshadowed by the other aims in the years since the IOM’s publication.

However, the COVID-19 pandemic in 2020 reignited an industrywide focus on health equity as it accentuated disparities in hospitalizations and mortality rates between different populations. The data and disparities led to larger discussions on inequities in other areas of health care, such as cancer research and maternal morbidity and mortality, according to Trosko and Lambdin.

The pandemic's impact was particularly severe on the Black, Indigenous and people of color (BIPOC) group, exacerbating long-standing disparities in life expectancy and access to care. As Trosko notes, rural areas also saw higher COVID-related death rates compared with urban neighborhoods.

“The Navajo Nation, Arizona, which is the largest and most populous reservation in the United States, was one of the hardest hit areas during the COVID-19 pandemic,” she notes. “Limited access to running water and basic infrastructure—wells and indoor plumbing—placed the members at a heightened risk of disease. It is no coincidence that the Navajo nation had some of the highest COVID-19 infection rates in the nation.”

Collaboration Is Key

The AzHHA Health Equity Collaborative was born from the COVID-19 pandemic, but its mission is much broader: to mobilize partners and collaborators to advance health equity and address social determinants of health for high-risk and underserved populations.

Funded in part by the Arizona Department of Health Services, with funding from the Centers for Disease Control and Prevention through the COVID-19 Health Disparities Grant, the AzHHA Health Equity Collaborative is focused on assisting rural and critical access hospitals and rural health clinics outside the state’s two most urban counties—Maricopa and Pima—to reduce health disparities in those communities.

Participating in the collaborative were 12 rural critical access and safety-net hospitals and 29 clinics that support rural and underserved areas, from nine of 15 counties.

One of the first steps taken by AzHHA was to contract with Syntellis Performance Solutions for advanced healthcare data analytics. Thus, the “collaborative” launched in August 2022.

Participating hospitals and health clinics initiated their work by completing the Centers for Medicare & Medicaid Services Health Equity Organizational Assessment (HEOA). One-on-one coaching calls were held with each facility to discuss data, identify gaps and create action plans. Monthly learning group calls were also organized for all participants to learn more about health equity and data; various resources, such as podcasts, articles, guest speakers and videos, were used for this purpose.

A significant part of the collaborative project involved instructing participants about different perspectives on health equity before they could even identify a gap and create an action plan.

 “We had a hospital tell us that they were not sure that they needed to be a part of the collaborative because they treat everybody the same,” Lambdin explains. “Yet, if you treat everybody the same, not everyone is going to achieve health. … Imagine that I am a healthy, white, male, Protestant, and I get what I need for my health. Now, imagine that I am all of those things, but I am also visually impaired—don’t forget about the disability population in health equity. Now, I may need large print or Braille materials or audio-based resources. I have more challenges and I need more resources. So, equity is not about treating everyone the same; it is about giving everybody the equal chance to reach health.”

Challenges and Lessons

The AzHHA Health Equity Collaborative, which "started the equity conversation with how to accurately collect data on sexual orientation, gender identity and social determinants of health by organization, quickly learned that the ability to collect these data can be a barrier to success,” Trosko says.

However, having prepared responses to questions can help ease patient concerns about privacy and information use, she adds.

Accurate data collection, validation and stratification in assessing health equity are essential, she says.

“Data make health equity a tangible concept by allowing organizations to see their market and patient demographics,” Lambdin adds.

Insights, Actions and Takeaways

After reviewing the stratified data, the participating facilities were asked to identify a gap shown by the data and create an action plan to address it. The projects chosen by the participants varied widely, with many focusing on collecting and stratifying data on sexual orientation, gender identity and social determinants of health. Other projects focused on cultural education and community partnerships.

Examples include:

• a hospital using community data to diversify its board;
• a clinic increasing its social determinants of health screenings;
• a small critical access hospital stratifying its data on falls to identify potential links to certain ethnic groups or income levels; and
• a rural hospital working to decrease health disparities and increase staff education for the LGBTQ+ population.

From August 2022 to May 2023, the AzHHA Health Equity Collaborative saw a 47% improvement in HEOA scores across the board, according to Trosko. This result confirmed that collaborative efforts are what is needed to achieve health equity and all organizations should work collectively (not competitively) in reviewing health disparities and promoting health equity, she says.

For more information please visit https://www.azhha.org/azheoa