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More than ten years ago,the Institute of Medicine (IOM) sounded an alarm when its report “Unequal Treatment” concluded that racial and ethnic disparities in health care exist and are associated with worse outcomes. In the wake of that report, Massachusetts General Hospital President Peter Slavin, MD, immediately focused the hospital’s attention on reducing health disparities.
One response was the formation of an action-oriented Disparities Solutions Center (DSC). Since 2005, the DSC has used Mass General’s successes in reducing health disparities as a model in engaging others nationally in the effort.
“With great certainty, we can say today that every patient at Mass General, no matter what their background, gets the best care we have to offer,” says Joseph Betancourt, MD, MPH, director of Mass General’s Disparities Solutions Center. Dr. Betancourt leads a team of experts that is tackling disparities, improving quality and fostering equity in health care. He also serves on committees such as the one that produced the IOM report.
Collecting Health Disparities Data
The leaders of Mass General know their patients receive equal care because since 2004, they have collected data and monitored patient care through the Annual Report on Equity in Healthcare Quality (or “disparities dashboard”). The dashboard, an easy-to-read display of data comparing the care received by patients of various races/ethnicities, was developed by Dr. Betancourt and and his team at the DSC, in conjunction with the MGH Center for Quality and Safety.
Data collection pointed to problem areas and to strategies for improvement, Dr. Betancourt explains.
“We found that Latino patients weren’t getting colonoscopies at the same rates as their white counterparts,” he says. DSC partnered with Mass General’s Committee on Racial and Ethnic Disparities to develop a program using outreach workers as “navigators” to educate patients, identify why they weren’t getting tested, and accompanying patients to have it done, if necessary. “That disparity has now been eliminated,” he says.
They also learned that there were racial and ethnic disparities among patients in keeping their diabetes under control. Those health disparities too have been reduced through more individual and group coaching sessions.
A Critical Step
Language barriers can result in medical errors if, for example, medical recommendations are not followed or misunderstandings arise about medications. As one way to address this, hospital interpreters are now trained to not only interpret, but also to monitor for quality and safety of care.
In 2014, the American Hospital Association awarded Mass General its first Equity of Care award, recognizing the hospital’s achievements in dealing with health disparities.Few other organizations are at the point of developing interventions related to health disparities, Dr. Betancourt says. But this data gathering and monitoring to reveal inequities is a critical step in that direction.
Living Labs for Intervention
Besides sponsoring webinars and producing informational tools, a key way the DSC translates what’s known about health disparities into solutions is through their year-long Disparities Leadership Program. Since 2007, they’ve trained more than 250 healthcare executives from about 121 hospitals, health plans or other health care organizations across the country, including Puerto Rico, Canada and Switzerland. The program helps leaders incorporate the latest information about how to reduce disparities into strategies that can they take back to their institutions.
“Our focus at the Disparities Solutions Center is to spread our lessons nationally,” Dr. Betancourt says. One result is that 10 to 20 other organizations have built dashboards to monitor for health disparities too. The Centers for Medicare and Medicaid Services has also contracted with the DSC to review its data collection for race and ethnicity.
These executive alumni of the program stay in contact as a network and continue to share progress and ideas. “By getting all these organizations pointed in the right direction, supporting each other, and being a sounding board for each other, the Disparities Solutions Center’s impact is magnified twenty-fold,” Dr. Betancourt says.
Organizations in the alumni network have been “living labs for testing interventions too,” he adds. For example, DSC developed a guide for how to prevent medical errors for those with limited English proficiency. They piloted it at Mass General and three other organizations in their alumni network with successful results.
Creating A Movement
We’re creating momentum, says Dr. Betancourt. “We’re trying to magnify the spread of this work and create a movement.”
Dr. Betancourt is also program director of multicultural education at Mass General and teaches cross-cultural medicine to Harvard Medical School students. He says he’s extremely encouraged about the future.
“I’m very hopeful the young professionals coming up noware committed to creating a health system that is more equitable for all,” he comments. He strongly believes that by improving care for minority patients, care for everybody improves.
The Disparities Solutions Center received seed money from Mass General, but now relies on grants, contracts and philanthropy. Please contact us for more information on how you can help the center expand its programming and more quickly foster change nationally.