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Missouri Health Equity Collaborative (MOHEC)
Bootheel Regional Meeting
October 20, 2010
Introductions
Collaborative & Interactive format
Logistics – bathrooms, cell phones, ground rules
Agenda
Agenda
MOHEC – Background and Purpose Regional data on health disparities Best Practice – NAACP Health Committee In-depth Interviews – AA/HL patients Making the case for Inclusive Healthcare Next Steps
The History of MOHEC Early 2007
The Centers for Health Policy at the Univ. of Missouri & Washington University teamed up to establish the Collaborative through a grant from MFH
Spring of 2007 Regional health equity meeting with Office of Minority
Health and St. Louis ConnectCare titled “Community Voices”
2nd regional health equity meeting in southwestern Missouri focusing on LEP (Limited English Proficiency) populations
Achieving Health Equity Conference in Kansas City
Fall of 2007 On the success of the conference, the Kansas City
region was added to the Collaborative through a grant from Health Care Foundation of Greater Kansas City
Spring of 2008 Social Determinants of Health Town Hall meeting in
Columbia Social Determinants of Health Forum in St. Louis
Fall of 2008 & Spring of 2009 4 health equity forums in the Kansas City region This led to a health equity workgroup meeting to
determine next steps for the Collaborative
The History of MOHEC (con’t) Summer 2009
Key stakeholders meeting in Jefferson City decided to enhance the education component of the
MOHEC work. Plans were made for a series of regional health equity meetings throughout the state in 2010.
Fall 2010 Five regional health equity meetings
Northeast (St. Louis) – September 15 Mid-Missouri (Columbia) – September 29 Southwest (Springfield) – October 13 Southeast (Portageville) – October 20 Northwest (Kansas City) – November 10
MOHEC Activities Increasing the awareness of health disparities and
strengthening the collaborative effort to achieve health equity
Hosting statewide conferences and regional meetings
Providing local and state policy recommendations for reducing health disparities
Establishing MOHEC.org as an online resource connecting people (researchers, policy makers and community leaders) to emerging health disparities issues, research, and resources
MOHEC Activities (cont.)
Coordinating and promoting education programs for health professional in training (students) and those in practice (providers)
Promoting health equity issues, research, and events through the MOHEC list serve
Establishing and coordinating collaborative working groups focused on specific disparities issues
MOHEC Collaborators-Airick Leonard West-Alzheimer's Association-Black Health Care Coalition, Inc.-BlueCross BlueShield of Kansas City-BJC Healthcare-Catholic Diocese of Jefferson City-Catholic Diocese of Kansas City – St. Joseph-Centers for Medicare & Medicaid Services-Center for Practical Bioethics-Children's Mercy Hospital-City of Columbia, MO-City of Kansas City, Missouri-Community Resource Network-Coterie Theatre-Cox Health-El Centro, Inc.-Family Counseling Center, Inc.-Food Sleuth-GlaxoSmithKline-Green Ridge R-VIII School District-HCA Midwest Health System-Health Care Foundation of Greater Kansas City-Iowa Department of Public Health-Jackson County Community Mental -Health Fund -Johnson County, Kansas Government-Kansas City Free Health Clinic-Kansas City University of Medicine & -Biosciences-Kansas Department of Health & Environment-KCUR 89.3-Local Investment Commission
-Lupus Foundation of America, KC Chapter-Maternal, Child & Family Health Coalition-Merck-Mid-America Regional Council-Missouri Association for Social Welfare-Missouri Department of Health & Senior Services-Missouri Department of Social Services-Missouri Foundation for Health-Missouri Institute of Mental Health-Missouri Primary Care Association-Mother & Child Health Coalition-Northwest Health Services-Operation Breakthrough-Passport Health-PRIMARIS-REACH Healthcare Foundation-Research College of Nursing-Resource Development Institute-Samuel U. Rodgers Health Center-Saint Luke's Health System-Samuel U. Rodgers Health Center-Southeast Missouri State University-St. Louis University-Truman Medical Centers-U.S. Department of Health & Human Services-United Methodist Mexican-American Ministries-University of Kansas-University of Missouri-University of Missouri - Kansas City-University of Missouri - St. Louis
The Purpose of MOHEC
“To empower Missourians to eliminate racial and ethnic health disparities through communication and collaboration by connecting educators, researchers, students, health professionals, and a wide variety of community organizations in a mutual partnership.”
MOHEC.org
Connect to a diverse network of health equity resources, knowledge, and expertise
Bridge research and community needs
Inform Missourians about effective and evidenced-based practices and programs
Provide a centralized source of current events, reports and programs focused on cultural competency, diversity, and eliminating health disparities
“Diversity is not an end in itself, or a pleasant but dispensable accessory. It is the substance from which much human learning, understanding, and wisdom derive. It offers one of the most powerful ways of creating the intellectual energy and robustness that lead to greater knowledge, as well as the tolerance and mutual respect that are so essential to the maintenance of our civil society.”
Harvard University President Neil Rudenstine 1993-95 Report, Diversity and
Learning
Bootheel Best Practices
“Booting Obesity in the Bootheel County of New Madrid”
New Madrid County Health Department
Patricia and Theodis Maltbia
Making the Case for Inclusive Healthcare
Unequal Treatment 2002
Racial/Ethnic disparities found across a range of care settings, diseases, and services even when controlling for confounding variables (insurance status, income status).
No one source/cause No one solution
Patient factors – LEP, low health literacy, lack of trust, different beliefs/preferences
Healthcare system factors – limited race/ethnicity data, QI not focused on this issue, lack of CLAS
Provider factors – lack of cultural competency and health literacy training, stereotyping, subjectivity and little decision support
IOM Recommendations Increase awareness of existence of disparities Address systems of care
Support race/ethnicity data collection, QI, evidence-based guidelines, community outreach
Improve workforce diversity Facilitate interpretation services
Provider education - Health disparities, cultural competency
Patient education – Navigation, empowerment Research – Barriers, promising strategies
We need both individual and organizational approaches
An Inclusive Institution
“An inclusive institution is one that embraces all individuals and which actively engages in a continuous process of mutual adaptation to connect the institution with the individuals, the individuals with the institution and the individuals with each other.”©
- Azizan-Gardner, 2008
Organizational Level
Leadership Develop a leadership program to produce
culturally-competent and integrative leaders Policies and processes
Hiring, performance appraisal, promotion Organization culture and climate that’s
inclusive
If we don’t measure our progress, we won’t know when we are improving.
Making the case……..
Professional obligation
Business case
Regulatory/Legal case
Demographic projections
The U.S. continues to become more and more racially and ethnically diverse. By 2042, minorities will become the majority
54% by 2050 The Hispanic/Latino population will nearly triple by
2050 and make up one in three U.S. residents The African American population will increase to
15%
U.S. Census
Making the case - the moral imperativeEdmund D. Pellegrino, MD
The nature of illness itself makes medicine a special kind of human activity. The sick person is uniquely dependent, vulnerable, and exploitable.
It is this fundamental vulnerability of the patient and the need for trust in the healing relationship that constitutes the moral imperative for the physician to serve the patient with the patient's best interest in mind.
Second, the physician's knowledge is not proprietary. It is acquired through the privilege of a medical education. Society sanctions certain invasions of privacy………
The physician's knowledge therefore is not private property. Nor is it intended primarily for personal gain, prestige, or power. Rather, the profession holds medical knowledge in trust for the good of the sick.
By accepting the privilege of medical education, physicians enter into a covenant to use their medical knowledge for the benefit of society.
Moreover, this covenant is acknowledged publicly when the physician takes an oath. The oath . . . is a public promise--a "profession"--that the new physician understands the gravity of his or her calling, promises to be competent, and promises to use that competence in the interests of the sick.
It is these 3 aspects--the nature of illness, the nonproprietary character of medical education, and the oath of fidelity to the patients' interests--that define medicine as a moral community and determine the ethical obligations of the individual physician and the profession as a whole.
Edmund Pellegrino
It is our professional obligation to obtain an authentic understanding of the patients that we serve
Professional obligation and the business case can overlap
Making the case……
More effective communication between patient and provider.1
Better diagnosis.1
Greater understanding of patient needs.1
Benefits to Cultural Competency & Diversity
For Providers
Benefits to Cultural Competency & Diversity
For Providers
Fewer return visits.2
Provide more tailored services.3
Better identify needs of diverse populations served.3
Benefits to Cultural Competency & Diversity
For Employees
Enhanced staff sensitivity to cultural norms.1
Increased ease of handling diversity.1
Brings a higher level of creative problem solving.4
More diverse decision making.4
Benefits to Cultural Competency & DiversityFor the Health Care Facility
Higher staff retention.5
Improved public image & market share.5
Attraction and retain more clients.3
Better patient safety….decreased liability.6
Benefits to Cultural Competency & DiversityFor the Patient
Greater patient empowerment.6
Increased patient satisfaction.7
Enhanced patient safety.6
Better health outcomes!!
Cultural Competency – one definition
“Cultural competence in health care describes the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patients’ social, cultural, and linguistic needs.
Experts interviewed … describe cultural competence both as a vehicle to increase access to quality care for all patient populations and as a business strategy to attract new patients and market share.”
-- Joseph R. Bettencourt, MD, MPH, Massachusetts General Hospital – Harvard Medical School; Alexander R. Green, MD and J. Emilio Carrillo, MD, MPH, New York Presbyterian Hospital – Weill Medical College of Cornell University; October 22 Field Report presented to The Commonwealth Fund
Legal and Regulatory Landscape
Regulations -Title VII of the Civil Rights Act of 1964-
Prohibits discrimination by employer because of: Gender Race/Ethnicity National Origin Religion
Failure to provide language access services for Limited English Proficiency persons may be a form of discrimination based on national origin.
Regulatory landscape
The US Dept of Health and Human Services, Office for Civil Rights issued “Policy Guidance on the Prohibition Against
National Origin Discrimination As It Affects Persons With Limited English Proficiency” in February, 2002
Department of Health and Human Services regulations require all recipients of federal financial assistance from HHS to provide meaningful access to LEP persons
HHS utilizes a four factor analysis for recipients (of federal funds)
1. The number or proportion of LEP persons eligible to be served by the program or grantee;
2. The frequency with which LEP individuals come into contact with the program;
3. The nature and importance of the service provided by the recipient to its beneficiaries; and
4. The resources available to the grantee/recipient and the costs of interpretation/translation services.
Key point:What is considered “reasonable” for one recipient may not be reasonable for another.
What about Missouri state law?
The Missouri Human Rights Act prohibits discrimination based on national origin in public accommodation in Missouri.
Missouri case law has held that the principles of federal law regarding discrimination are used to analyze claims under the Missouri Human Rights Act.
Non-compliance
The Office for Civil Rights will investigate complaints that are made, notifying the recipient of noncompliance and outlining corrective action when necessary.
Remedies include – revocation of federal funding or further enforcement action through the U.S. Department of Justice.
2009 was an active year
NCQA – measures released in 2009 National Quality Forum
Developed cultural competence quality measures in 2009
National Business Group on Health Major effort to educate employers about
disparities, brief released 2009
DHHS – CLAS standards
14 standards directed at health care organizations
Should be integrated throughout an organization
Undertaken in partnership with communities being served
CLAS Standards
Three types – mandates, guidelines, and recommendations
Three themes Culturally Competent Care (1-3) Language Access services (4-7) Organizational supports for cultural competence
(8-14)
The Joint Commission
January 2011
Issues to Address
Effective Communication Identification of patient communication needs Provision of language services
Data collections and use Collection of patient-level demographic data Use of population-level demographic data for
service planning & performance improvement Addressing specific patient needs
Cultural, religious, spiritual needs & beliefs Patient and family involved in care
RegulationsJoint Commission on Accreditation of Healthcare Organizations
(Joint Commission)
Standards Hospitals should training on cultural sensitivity.
Hospitals should provide education and training
on how to use available communication tools, language access services, auxiliary aids and plain language.
RegulationsJoint Commission on Accreditation of Healthcare Organizations
(Joint Commission)
Proposed Standards8
The hospital should provide patient education and training based on each patient’s needs and abilities.
Should address health literacy needs and barriers to communication.
Successful Implementation
Requires support from all levels1
Senior management Doctors Nurses Patient staff Administrative staff
Next Steps
Keep talking with the Choir!
Engage the Congregation!
References
1. Wu, E., & Martin, M. (2006). Taking cultural competency from theory to action. The Commonwealth Fund. Retrieved February 10, 2010, from http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2006/Oct/Taking-Cultural-Competency-from-Theory-to-Action.aspx
2. Goode, T., Dunne, M. C., & Bronheim, S. (2006). The evidence base for cultural and linguistic competency in health care. The Commonwealth Fund Retrieved February 10, 2010, from http://www.commonwealthfund.org/usr_doc/Goode_evidencebasecultlinguisticcomp_962.pdf
3. Krause, E. (2004). Making the case for workforce diversity in public health: Transformations in public health. Retrieved February 9, 2010, from http://www.cdphe.state.co.us/ohd/reportsandarticles/makingcasearticle.pdf
4. NASA.gov. (2008). The business case for diversity: Starting the dialogue. Retrieved February 10, 2010, from http://diversity.gsfc.nasa.gov/Documents/BusCaseDialogue.pdf
5. Chartered Management Institute. (2007). Embracing diversity, guidance for managers. Retrieved February 9, 2010, from http://www.managers.org.uk/client_files/Diversity%20Final1.pdf
6. US DHHS. (2006). The rationale for diversity in the health professions: A review of the evidence. Retrieved February 11, 2010, from ftp://ftp.hrsa.gov/bhpr/workforce/diversity.pdf
7. US DHHS, & Agency for Healthcare Research and Quality. (2004). Setting the agenda for research on cultural competence in health care: Introduction and key findings. Retrieved February 4, 2010, from http://www.ahrq.gov/research/cultural.htm
8. The Joint Commission (2009). Proposed requirements to advance effective communication, cultural competence, and patient-centered care for the Hospital Accreditation Program. Retrieved February 10, 2009, from http://www.jointcommission.org/NR/rdonlyres/D44C4DE4-F5CD-4116-84AF-D5B3E8D4E94F/0/PDF1HAPProposedRequirements.pdf
