Equity in Care: Picking Up the Pace

Eliminating disparities in healthcare is a goal of every American hospital. Despite our best efforts, we know that race, ethnicity, and language preference continue to affect the chance that patients will receive the care they need and the outcomes they deserve. For example, Hispanic adults with diabetes are far less likely to receive recommended preventive services and African American women are more likely to die after they are diagnosed with breast cancer than are their white counterparts. Because each hospital comprises and serves a unique community, increasing both the collection and the use of race, ethnicity, and language preference (REAL) data is an essential part of achieving equity in care for all Americans. With good data, hospitals can test the validity of their assumptions about the quality of care they provide. That care may be ideal, but without measurement, it is impossible to know. With careful measurement, every provider can document whether differences in outcomes and opportunities exist so it can improve the quality of care delivered by implementing customized approaches using evidence-based care. Supporting hospital efforts to eliminate disparities is one reason the American Hospital Association is a founding partner in the National Call to Action to Eliminate Health Care Disparities. With our partners, the American College of Healthcare Executives, Association of American Medical Colleges, Catholic Health Association of the United States, and National Association of Public Hospitals and Health Systems, we set out to achieve three interrelated goals: increase collection of REAL data, increase cultural competency training, and increase diversity in leadership. We have set up the Equity of Care website (http://www.equityofcare.org) to help hospitals, health systems, clinicians, and others improve the quality of care for each and every patient by sharing resources and best practices. We believe that most healthcare providers are moving in the right direction and that many are taking important steps to make care more equitable. But given the speed of change in our communities, we feel that this process must be accelerated, and information sharing is an important way to facilitate that. Healthcare providers must begin with a basic understanding of the population trends in the community they serve. American communities are undergoing huge demographic changes that may not immediately appear in the patient population of a given provider--but most surely will in the future. For the first time last year, most babies born in the United States were nonwhite. As health insurance coverage increases, each provider will be challenged to provide the best possible care to a unique patchwork of patient populations with different beliefs, lifestyles, family structures and support, and healthcare experiences. Planning for equitable care involves developing ongoing relationships with community organizations that can support providers' efforts to build cultural competency in delivering that care. Providers must anticipate community needs to, for example, ensure access to those with no or limited English proficiency or to develop patient education materials that consider differences in both language and culture. With careful measurement of REAL data, quality indicators, and patient outcomes--and using that information to constantly improve the quality of the care for each patient and for the community at large--providers will position themselves for future success. Measures of clinical quality and patient experience have increased significantly in recent years, and they are driving improvements across the board. But overall national quality measures cannot be readily broken down by race, ethnicity, and language preference. Recently, the Institute for Diversity in Health Management surveyed hospitals and found that 81 percent of hospitals collect REAL data, but only 18 percent used these data for quality interventions. …