We Were All Created Equal – Man Made Us Different.

by Christopher Cornue

Our last post in the series focuses on collaborative efforts around disparities in cardiovascular disease for African-Americans and Hispanics.

A second approach has focused on cardiovascular disease and has its roots in the Institute of Medicine’s 2001 Crossing the Quality Chasm: A New Health System for the 21st Century, and the aforementioned 2003 report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Using these reports as a basis for proof that racial and ethnic disparities exist in Healthcare, the Robert Wood Johnson Foundation launched the Expecting Success: Excellence in Cardiac Care collaborative project, led by The George Washington University, School of Public Health and Health Services’ Department of Health Policy. Through a rigorous selection process, 10 hospitals nationwide were selected to participate in this 29-month collaborative project, with the aim to improve the quality of health care provided to minority populations. The ten hospitals include: Del Sol Medical Center (El Paso, Texas); Delta Regional Medical Center (Greenville, Mississippi); Duke University Hospital (Durham, North Carolina); Memorial Regional Hospital (Broward County, Florida); Montefiore Medical Center (New York, New York); Mount Sinai Hospital Medical Center (Chicago, Illinois); Sinai-Grace Hospital (Detroit, Michigan); University Hospital (San Antonia, Texas); University of Mississippi Medical Center (Jackson, Mississippi); and Washington Hospital Center (Washington, DC). Based in the roots of the project is the assertion that hospital cannot improve the quality of care without gaining a better understanding of the community in which they operate and their patients live. Launched in September 2005, each of the hospitals use the established core measures for AMI and Heart Failure, in addition to Measures of Ideal Care, Readmission Rates, and other metric, to measure ongoing clinical improvement and success. Woven into each of these metrics, is an application of collected race and ethnicity data. By measuring these metrics, in conjunction with the race and ethnicity for the patients, each hospital can assess how well they are doing in narrowing any observed disparity gap. Indeed, the collection of these data was the first step that many of the hospitals took to ensure they are appropriately measuring the effect of their efforts. With improvement plans for both the inpatient and community settings, each hospital has identified numerous opportunities to address the fundamental cornerstones in efforts to address disparities … namely:

o educating patients, families, healthcare providers (including community physicians) as to the essentials of superior heart care;
o increased presence in the communities in which our patients live;
o development of partnerships with key community & professional organizations;
o collection of race, ethnicity and language data for each patient;
o consistent and appropriate collecting, reporting and sharing of data and metrics to wide audiences

More information about Expecting Success can be found at www.expectingsuccess.org including a First Year Summary report. Further detail, with a report about successes achieved through this project, will possibly be the subject of a future posting.

As this series concludes, I think it is safe to state that we know that disparities exist … the evidence in numerous research, literature, studies and publications is incontrovertible. As Unequal Treatment suggested … research and the identification of the problem is a first step, but now we need to move toward action. This is the challenge for, and charge to, all of us in healthcare.

This post is part of a 5-part series on healthcare disparities:
- Part 1: Introduction to Healthcare Disparities
- Part 2: A few healthcare organization role models to follow
- Part 3: Measuring disparities meaningfully
- Part 4: Two big disparities projects in the works
- Part 5: Cardio in African-Americans and Hispanics