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Diagnostic errors (DE) and medication safety in the home (MSH) are two emerging health care issues receiving increasing attention for their impact on patient safety. Whereas hospital-based patient safety efforts have become quite advanced, medication safety in the home is an important area to better understand. Strategies to prevent DE and MSH for an increasingly diverse population are critical to ensuring equitable care and outcomes for all patients. This report highlights key issues related to disparities in diagnostic errors and medication safety in the home and the objectives were to:
- Understand the current state of knowledge in the areas of DE and MSH.
- Solicit input from subject matter experts to determine: (a) if any work has been done at the intersection of disparities and DE and MSH; (b) how communication difficulties (included limited health literacy, limited English proficiency, cultural beliefs, and mistrust, among other areas) might impact DE and MSH; and (c) what are areas of study, exploration, and intervention that address disparities in DE and MSH.
- Provide overall recommendations on key areas that require further exploration and funding to advance the field of disparities in DE and MSH.
This Guide was developed as part of the CMS Equity Plan for Improving Quality in Medicare and is designed to assist hospital leaders and stakeholders focused on quality, safety, and care redesign, as well as HIINs, QIN-QIOs, and other stakeholders engaged in readmissions-related quality improvement activities. The Guide was prepared for the CMS Office of Minority Health by the Disparities Solutions Center at Massachusetts General Hospital in partnership with NORC at the University of Chicago. Racial and ethnic minority populations are more likely than their white counterparts to be readmitted within 30 days of discharge for certain chronic conditions. Social, cultural, and linguistic barriers contribute to higher rates of readmissions in these populations. This guide offers new, action-oriented guidance for addressing avoidable readmissions in this population by providing:
- An overview of key issues related to disparities in readmissions
- A set of activities that can help hospital leaders address readmissions in this population
- Strategies aimed at reducing readmissions in diverse populations
Improving Patient Safety Systems for Patients With Limited English Proficiency: A Guide for Hospitals and TeamSTEPPS® Enhancing Safety for Patients With Limited English Proficiency Module
The Disparities Solutions Center at MGH and Abt Associates, Inc. in Cambridge, MA, were awarded a four year contract by the Agency for Healthcare Research and Quality (AHRQ) to develop tools to reduce medical errors and improve care for LEP patients in hospitals. The project used a robust mixed methods approach to 1) identify the role of language and cultural barriers on patient safety events; 2) document how hospitals are addressing the safety of LEP and culturally diverse patients; and 3) provide guidance and tools for how hospitals can address these issues. The final products include a Hospital Guide and a TeamSTEPPS Training Module focused on improving team communication to reduce medical errors for LEP patients.
The Hospital Guide provides quality and safety leaders within hospitals with a variety of key guidelines and strategies for identifying, reporting, and addressing medical errors that occur as a result of language barriers in LEP and culturally diverse patients. The Guide also provides hospital leaders with systems-level information on how to develop reporting systems that can successfully capture medical errors that predominantly affect LEP patients, as well as modalities that can be implemented to prevent errors for LEP and culturally diverse patients. The TeamSTEPPS training module is designed for the full interprofessional care team, including interpreters, and includes a case-based video vignette of an LEP patient in the emergency room. The goal of the Module is to help the interprofessional care team acquire the knowledge, attitudes and behaviors needed to reduce the number and severity of patient safety events that affect LEP and culturally diverse patients.
The report on Healthcare Disparities Measurement provides practical recommendations for healthcare organizations to increase their portfolio of race, ethnicity, and language data collection strategies – and consequently, utilize that data to develop disparities-sensitive measures. This report is intended to guide organizations in disparities and quality measurement through the following strategies:
- Data Collection: Building the Foundation
- Disparities Measures and Indicators: What to measure
- Methodological Approaches to Disparities Measurement: How to Measure and Monitor
- Priorities and Options for Quality Improvement and Public Reporting of Healthcare Disparities
Small medical practices play an important role in the care of patients with diverse needs. These practices often have limited infrastructure and face significant barriers to providing the highest quality health care. If small practices are to provide accessible, effective and efficient care for vulnerable patients, they will need additional attention, resources and support. Given the proportion of care these practices provide, especially in underserved urban and rural areas, failure to provide adequate help in adapting to the new demands for health information technology, quality and accountability could greatly impair the chances for successful health care reform.
To understand the needs of small practices in providing the best quality care, the National Committee for Quality Assurance (NCQA) launched a quality improvement demonstration program for small physician practices serving minority populations. With funding from The California Endowment, NCQA provided grants and technical assistance to small practices (5 physicians or fewer). The goal of the project was to learn what types of resources and tools these practices need in order to conduct and sustain quality improvement activities, especially for serving disadvantaged populations.
*Created in partnership with the National Committee for Quality Assurance (NCQA)
The Institute of Medicine (IOM) Report Crossing the Quality Chasm, released in 2001, highlights that there is a significant gap between the quality of health care people should receive, and the quality of health care people do receive. Just a year later, the IOM released another influential report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, highlighting an even larger quality chasm for racial/ethnic minorities in the United States.
Over the last few years, there has been an increased focus by hospital leadership on improving quality by responding to the six key elements proposed in Crossing the Quality Chasm. In regards to equity, research has shown that racial and ethnic disparities in health care have an impact on quality, safety, cost, and risk management. Addressing disparities has now been acknowledged by the National Quality Forum and the Joint Commission as essential component of quality. Despite this, few hospital leaders have the issue of equity, and identifying and addressing disparities, prominently on their radar screen.
The goals of this Guide are to:
- Highlight the evidence for racial and ethnic disparities in health care and provide the rationale for addressing them—with a focus on quality, cost, risk management and accreditation.
- Highlight model practices—hospitals and leaders who are actively engaged in addressing disparities and achieving equity.
- Recommend a set of activities and resources that can help hospital leaders initiate an agenda for action in this area.
Just as a quality report allows hospital executives, physicians, and staff to examine quality of care across multiple dimensions, an equity report highlights potential inequalities in utilization, care processes, outcomes, and patient experiences with care. By building on existing quality reporting efforts, an equity report helps examine the extent to which a hospital provides equally high quality care to all patients, regardless of their race, ethnicity, language, socioeconomic status, and other characteristics.
Creating Equity Reports: A Guide for Hospitals is a resource that can help your staff develop an equity report. The Guide provides practical information on how to collect data on race, ethnicity, language, and socioeconomic status – and how to use those data to develop an equity report that will allow your hospital to take action.
*Funded by the generous support of the Robert Wood Johnson Foundation, with additional support from the Office of the Attorney General of Massachusetts
The Healthcare Equity Blueprint offers strategies and practices that can be tailored to individual hospitals to address equity in providing quality care. The Blueprint is a starting point for designing and implementing interventions to address racial and ethnic disparities in health care. Aspects of this Blueprint apply to numerous health care settings, but the primary focus is on hospitals. In addition, the Blueprint should be considered “a work in progress, “to be improved and modified by hospitals that use it.”
The proposed improvement strategies are grouped into the following five categories:
Create Partnerships with the Community, Patients, and Families
Exercise Governance and Executive Leadership for Providing Quality and Equitable Care
Provide Evidence-Based Care to All Patients in a Culturally and Linguistically Appropriate Manner
Establish Measures for Equitable Care
Communicate in the Patient’s Language — Understand and be Responsive to Cultural Needs and Expectations
The Blueprint also provides recommended tools, resources, and guidelines on the collection and measurement of data related to addressing health care disparities.
Executives and governing bodies may use this Blueprint to organize and prioritize the goals, strategies, expected outcomes, and performance benchmarks for addressing health care equity within their established strategic planning process. Working groups within the hospital may identify specific changes in care and support operations that can be tested initially on a small scale within an organizational unit.