Last year, Becker's spoke to the top 10 hospitals named to U.S. News and World Report's 2020-21 Best Hospitals Honor Roll to look at what they are doing to address health disparities. A year later, Becker's checked in with those systems to look at how their health equity initiatives have evolved, what has been the most successful and if there are any results to report from those initiatives.
Mayo Clinic
In 2020, Rochester, Minn.-based Mayo Clinic announced an investment of $100 million over 10 years to combat health disparities.
This was a "big, bold move" for health system leaders, who have spent time over the last year identifying strategic priorities related to the investment, said John Knudsen, MD, medical director for Mayo Clinic's Office of Health Equity and Inclusion.
Dr. Knudsen said Mayo has specifically considered how it will allocate this money across the organization from a multisite perspective, as well as how it will distribute the funds within research and education.
One part of the investment is developing an advanced diversity, equity and inclusion platform to identify and track progress in addressing disparities. It is intended to use both qualitative and quantitative metrics.
"This was one thing we thought was important, sort of a high-level dashboard, analytic platform to look at all aspects [of diversity, equity and inclusion]," said Dr. Knudsen. "And, obviously, it's not just something that's a single page. It's intended to say, 'What are we doing with workforce? What about research?' All of these things would have a place or a home in this platform."
Through pilot projects, he said Mayo has also identified and is now targeting health disparities in diabetes between white and Black patient populations and between the non-Hispanic or Latino and the Hispanic or Latino patient populations. Additionally, it is targeting similar health disparities in colon cancer screenings.
"A whole series of tactics will be deployed in the coming month to dig down and understand not only what's causing the disparities but what we can do to address them. We're looking at success as eliminating those," Dr. Knudsen said.
Mayo is not only focusing on patients, but also the workforce. For instance, part of the $100 million investment to combat health disparities has gone toward a pilot education and training program using virtual reality technology. Dr. Knudsen said the idea behind the program is to enhance the nursing team's empathic understanding of people's lived experiences and to create more realistic role-playing to better navigate difficult interactions with patients, patients' families or co-workers.
He said Mayo also used a technology platform last year to collect stories from employees who experienced or witnessed racism, bias or discrimination at work. Now, human resources and leadership are using the stories to inform policy and other workplace initiatives.
In August, Mayo launched the second phase of that platform allowing for sharing and learning for experiences of allyship among employees.
"There's a real yearning and interest in our workforce to do what they can to address some of these issues we know some of our workers are experiencing and facing," explained Dr. Knudsen. "So allyship has become something a lot of people have been looking for opportunities to get behind. This has been another way to get the workforce behind some of these efforts to not only recruit and retain a more diverse workforce but also to improve the work environment."
With research and community engagement, he said Mayo has worked hard to build strong relationships with community partners to get information out there from trusted sources but also create bidirectional communication frameworks, so the organization hears from communities about issues they're facing or information they're missing.
"In an organization with so many competing priorities and many activities going on, we're always looking at what's being supported by top leaders. That $100 million was an important message to all of us that this is something Mayo Clinic really cares about. It has reawakened and really activated a lot of people in the organization to begin to think of ways of how they or their practice or their domain could advance some of these goals around equity, inclusion and diversity," Dr. Knudsen said.
Massachusetts General Hospital
In November, Boston-based Mass General Brigham launched United Against Racism to address structural racism.
The comprehensive, systemwide plan "invests in leadership teams and leverages a multimillion-dollar commitment with goals, timelines, accountability and metrics of success," said Joseph Betancourt, MD, senior vice president of equity and community health at Massachusetts General Hospital, part of Mass General Brigham.
"The plan focuses on diversity of leadership and governance, training, and creating an anti-racist culture; equity in patient care via data collection, performance measurement, digital access, clinical interventions and the removal of race from clinical guidelines; and a broad new strategy on community health focused on addressing the social determinants of health, the deployment of community health workers, a mobile health initiative, advocacy and anchor investments," he said.
Massachusetts General Hospital has also launched its Structural Equity 10-Point Plan to support, complement and build on United Against Racism at the hospital.
Dr. Betancourt said the initiatives involve all four pillars of the hospital's mission — care, training, research and community health, and will significantly affect the organization's people, culture and care.
"While we are early in our implementation, we are making steady progress and are already seeing gains and achievements, with many more expected in the short and long-term," he said.
UCSF Health
At San Francisco-based UCSF Health, the health system has expanded its work on health equity since 2020, said Joshua Adler, MD, executive vice president and chief clinical officer. It deployed a comprehensive system for collecting race, ethnicity, sexual orientation and gender identity data from its patients. This has allowed the system to identify and address disparities in a number of important measures of health and health outcomes.
Over the past year, UCSF focused on hypertension control, in which its Black patients were not achieving the same level of blood pressure control as its patients overall. The health system engaged with its patients to determine who best to help them to achieve control, including directed outreach to patients to provide visits (video or in person) to evaluate blood pressure control; use of medications; any challenges they faced, provision of home blood pressure measuring devices; input from pharmacists on medication choices, side effects and mitigation efforts; and a focus on non-medication-based interventions that can lower blood pressure.
This also included straightforward approaches by nurse managers to standardize workflows during video visits, to make sure that clinicians captured blood pressure during those visits and outreach to patients to make sure they attended their scheduled physician visits. "By June 2021, the disparity had been completely eliminated in our primary care population," Dr. Adler said.
In another intervention, the system found that its Latino patients have a lower rate of completed advance care directives. With interventions that included improved language concordant documents, use of interpreters and timing the discussions so that family members could participate, UCSF was able to eliminate this disparity as well.
Since UCSF's data infrastructure was in place, it was able to recognize an emerging disparity in real time. Patients with limited English proficiency were using video visits at a lower rate than patients overall. This was particularly relevant during the early months of the pandemic when video visits were the preferred method of care. The health system implemented an on-demand interpreter program for video visits recently and hope that this intervention will help patients utilize this technology when desired.
NYU Langone Health
New York City-based NYU Langone Health launched the Institute of Excellence in Health Equity in 2020. The goal of the institute is to make sure patient outcomes are comparable, regardless of whether a patient is in Brooklyn or Manhattan, said Fritz Francois, MD, chief medical officer and patient safety officer at NYU Langone Health.
The fuel behind NYU Langone's strategy is its key pillars such as research, clinical care and education. Community engagement, by far, has been the most successful initiative. By going into communities, the health system can get a pulse on what is going on with social determinants of health. For example, to address food insecurities, the health system uses food pantries to support the community's needs. Community engagement is the most successful initiative because it also allows the health system to engage with communities about COVID-19 vaccine hesitancy.
The health system is going to start focusing on how it develops the next generation of physicians to address health equity. It is looking at opportunities to embed this type of training in medical school, residency and beyond.
NYU Langone measures the results of its initiatives by comparing mortality rates between Manhattan and Brooklyn residents. What they have seen is that patients from both locations have been having similar outcomes. The system also compares rates of hospital-acquired conditions, where there are also no differences between populations.
The institute was successful in securing funding from the National Institutes of Health to look at efforts related to hypertension. It's an example of where the center will position itself in the future. It's not just clinical work or just education, Dr. Francois said. It is also asking questions that can be answered with research and applying collective funding to it, he said.
Johns Hopkins Medicine
Baltimore-based Johns Hopkins Medicine's health equity initiatives have continued to evolve during the COVID-19 pandemic. Last year, the health system discussed using a mobile COVID-19 testing site in the parking lot of one of the hardest-hit Baltimore ZIP codes with a large number of Latino residents, said Sherita Golden, MD, vice president and chief diversity officer at Johns Hopkins Medicine and professor of medicine at the Johns Hopkins University School of Medicine. Since Feb. 26, more than 4,180 individuals have been vaccinated in 40 clinics held at this location.
Johns Hopkins partnered with public health agencies in Washington, D.C., and Maryland to deliver vaccines to community members unable to access mass vaccination and clinical sites because of transportation barriers, disabilities impairing mobility, limited computer usage, lack of healthcare access and lack of broadband. Approximately 90 percent of residents vaccinated through these efforts have been Black.
During February and March, more than 2,000 people were vaccinated in senior housing communities in Washington, D.C. — a collaboration between Johns Hopkins Medicine, the D.C. Department of Health and the D.C. Housing Authority. The initiative was expanded to Baltimore in collaboration with the Baltimore City Health Department. Since this initiative launched in late February, more than 4,000 people have been vaccinated in senior housing, places of worship and other community-based sites. Johns Hopkins also operates a mobile van to facilitate pop-up vaccine sites throughout Baltimore to reach those having difficulty accessing vaccines.
Johns Hopkins' Office of Diversity, Inclusion and Health Equity partnered with local and community organizations to host virtual Facebook Live town halls. Each of these events reached thousands of community members across Maryland and Washington, D.C. It is key to address community concerns and restore trust, particularly in the Black and Latino communities, Dr. Golden said.
Johns Hopkins continues to monitor the demographics of those vaccinated through its mobile community efforts. It is also monitoring the reach of its education collaborations with diverse media outlets and collecting viewership statistics after each event. Johns Hopkins Medicine's patient demographic data is missing less than 10 percent of entries. This will enable the system to look at vaccination rates among patients by race and ethnicity to guide its future efforts, Dr. Golden said.
NewYork-Presbyterian
In October 2020, New York City-based NewYork-Presbyterian launched the Dalio Center for Health Justice, dedicated to understanding and improving health equity, addressing health justice, and driving action that results in measurable improvements in health outcomes for its patients, employees and communities it serves. Because 80 percent of health outcomes are driven by social, behavioral and environmental factors, the Dalio Center focuses on supporting community initiatives, understanding and championing economic empowerment, social engagement, workforce development, neighborhood revitalization, and education, said Julia Iyasere, MD, executive director of the center.
In collaboration with New York City-based Weill Cornell Medicine and New York City-based Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian recently announced a health equity research grant program to support innovative research that will directly advance efforts to reduce health inequities and disparities. A grants committee with tripartite membership will evaluate and oversee the awards, with preference to funding research that provides solutions and takes action.
The system is also developing educational and outreach programs about health disparities for its staff and communities. In collaboration with the Division of Community and Population Health and the Office of Government and Community Affairs, the trio hosted a series of interactive vaccine education presentations to staff, patients and the community, engaging with about 15,000 people to date. It will start hosting an annual health equity symposium to bring together leading healthcare professionals, researchers and advocates in the field.
The system is working with its medical school partners and hospital operations team to develop and expand several institutional projects to bolster its clinical programs that focus on improving access to and quality of healthcare, such as the Black Transplant Health Initiative. The goal is to address both new and historic barriers to care through enhanced engagement with the Black community — listening, building awareness, providing education, increasing access and advancing transformational transplant care.