Photo courtesy of Ipoba
Health inequalities are pervasive in the health care system, making it important for physicians to reevaluate what data is being collected and who is collecting the data.
One of the American Medical Association's (AMA) most pressing missions is to address systemic and community-wide inequities in the U.S. health care system and provide health equity to members of marginalized and minority communities. It is to do. Health inequalities, rooted in structural elements that have not evolved over many years, pervade the nation's health care system. Based on the data obtained from the AMA National Health Equity Grand Rounds event, physicians should reevaluate what data is collected and who collects the data.
Dr. Elena Mendez Escobar, co-executive director of the Boston Medical Center (BMC) Health System Health Equity Accelerator, spoke at the event. The Health Equity Accelerator's mission is to transform health care by eliminating disparities in life expectancy and quality of life among people of different ethnicities. Dr. Mendez-Escobar noted that historically some researchers and medical professionals have used data to hide from change rather than to prove its necessity. So while the Health Equity Accelerator's work is rooted in data, the group uses it in combination with qualitative and descriptive data.
For example, when looking at statistics on pregnancy complications at BMC, Dr. Mendez-Escobar and colleagues found the data to be inconclusive. But knowing that health inequities impact health outcomes by driving delays in care, the Health Equity Accelerator team went back and looked at the data more closely. Researchers found a significant correlation between severe pregnancy complications and preeclampsia, which contributes to poor outcomes in black patients. In response to the team's findings, BMC initiated interventions such as providing remote blood pressure monitoring devices to patients at their first prenatal visit. The organization also educated patients about the risks and symptoms associated with pre-eclampsia and encouraged them to make an appointment if they notice an increase in blood pressure. In addition, BMC will arrange childcare in case you need an emergency appointment.
The Health Equity Accelerator team also measured the time lag between the decision to have a Caesarean section (C-section) and the actual start of the procedure. White patients had an average delay of 78 minutes, while black patients had an average delay of 98 minutes. Dr. Mendez-Escobar emphasizes that the increase in time-lapse is associated with an increased risk of complications such as bleeding. As a result, the team created the goal of universally reducing caesarean section delay times to one hour. Subsequent interventions helped BMC achieve its goals and demonstrated the power of structural change in healthcare processes.
Another panel representative at the AMA event was Vikas Saini, MD, director of the Lown Institute, whose team uses tools such as the Hospital Index for Social Responsibility to promote equity, value, and accountability. We focus on responsibility. The index ranks the comprehensiveness of 3,200 hospitals through an examination of claims data in assessing the success of a hospital's Medicare patient population in reflecting its local community. For example, Dr. Saini and his team found that one hospital in Chicago, where the majority of patients were white, did not accurately reflect the local community, which had significantly more black and Hispanic residents. These few patients were seeking treatment elsewhere, or worse, not seeking treatment at all. According to Dr. Saini, this apparent contradiction points to a “dissociation between the housing market and the labor market.” Health systems across the country must leverage these barometers to identify inequities and use the results to implement initiatives and drive change.