The IOM Report “Unequal Treatment” Translating Research & Recommendations into Policy and Practice A Hospital Case

1. The IOM Report “Unequal Treatment”Translating Research & Recommendations into Policy and PracticeA Hospital Case Study Joseph R. Betancourt, M.D., M.P.H. Senior Scientist, Institute for Health Policy Director for Multicultural Education, Massachusetts General Hospital Assistant Professor of Medicine, Harvard Medical School

2. Outline • Background: National and Local Context • Process: Developing an Approach • Key Lessons Learned

3. Background: Efforts Underway Prior to 2002 • MAO: Minority Recruitment, Retention, Prof Dev • Interpreter Services: Increasing Volume • Cultural Competence Education: Mandatory in Med • Race/Ethnicity Data Collection: Active deliberations at systems level; QI in place at hospital level

4. Background: Timeline of Key Events • March 2002: IOM Report “Unequal Treatment” • July 2002: Dr. Satcher presents in Boston • December 2002: Boston Mayor Menino convenes hospital CEO’s re role in eliminating disparities • December 2002: Dr. Satcher presents at MGH • April 2003: Mayor’s Hospital Working Group formed: 12 month plan to address disparities • April 2003: MGH appoints Disparities Committee

5. MGH Disparities Committee Underlying Principle • While data specific to disparities at MGH important, not necessary to begin to take action given IOM Report documented issue nationally Charge • Identify and address disparities in health and health care wherever they may exist at MGH • Coordinate with the Mayor’s Efforts • Present Plan to Board in Jan ‘04; Results Sept ’04 • Also to GEC and President’s Advisory Council

6. Translating Research into Policy and Practice Committee will base work on IOM Report “Unequal Treatment”

7. IOM’s Unequal Treatmentwww.nap.edu Recommendations • Increase awareness of existence of disparities among key health care stakeholders • Address systems of care • Support race/ethnicity data collection* and QI • Encourage use of evidence-based guidelines • Improve workforce diversity* • Facilitate interpretation services* *Efforts underway at MGH

8. IOM’s Unequal Treatmentwww.nap.edu Recommendations • Provider education (mechanisms of decisionmaking, cultural competence)* • Patient education (health care system navigation, activation in the medical encounter) • Research (identifying sources, promising strategies, barriers to eliminating disparities) *Efforts underway at MGH

9. MGH Disparities Subcommittees Form Based on 4 months of deliberations: • Education and Awareness • Quality • Patient Access and Experience *Budget provided for each group’s efforts

10. Education and Awareness Subcommittee Charge: Raise awareness at MGH of disparities and contributing factors 2004 Goals: • At least two major presentations at grand rounds/leadership meetings • To Date: Byrd and Hill present in May 2004 • Comprehensive communication strategy developed and underway • To Date: MGH Hotline, Fruit St MD, FYI Posters • Message on disparities incorporated into orientations • Under development

11. Quality Subcommittee Charge: Stratify outcomes of QI initiatives by race and ethnicity, and design improvement activities based on findings 2004 Goals: • Data on outcomes of asthma and diabetes QI initiatives stratified by race and ethnicity; plan and develop interventions based on findings • Patient Satisfaction Data – inpatient and outpatient data stratified by race and ethnicity • Embed Disp’s Questions into Quality Rounds • Demographic Profile of the Hospital – who are our patients and what services do they use

12. Patient Experience of Care and Access to Care Subcommittee Charge – Assess the experience of care for MGH patients and develop and implement action plan based on findings 2004 Goals: • Conduct inpatient and outpatient survey • Create Multi-Cultural Advisory Committee and plan initial meeting • Develop inventory of existing disparities research

13. Crossing the Quality ChasmInstitute of Medicine, 2001 Quality can be achieved if health care systems are: • Safe • Effective • Patient Centered • Timely • Efficient • Equitable *Consider Disparities for all strategic planning

14. Key Lessons Learned Challenges • Race/Ethnicity Data Collection: Categories, Standardization, Ease, IT • Quality: …versus research; Challenges of current data systems • Satisfaction: Do we have correct tools? • Expanding buy-in Key Ingredients: • Leadership; Commitment; Mainstreaming; Plunge In