Collecting data on diverse communities: Challenges and successes from health plans, hospitals, and health departments

In the wake of the Institute of Medicine’s publication, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care," HealthPartners Medical Group and Regions Hospital swiftly embraced the imperative that healthcare providers assume responsibility for eliminating treatment inequalities. The American Medical Association is also recommending medical practices collect race and ethnicity data on their patients in order to provide new ways of delivering care to their patients.

Regions Hospital is a premier, full-service, private hospital providing outstanding medical and surgical care with special programs in heart, women's care, cancer, seniors' services, burn, emergency and Level I trauma. Established in 1872, the hospital has served the Twin Cities and surrounding region for more than 125 years. Patients receive state-of-the-art care in an environment that promotes comfort and healing. The health professionals at Regions Hospital are involved in teaching and research focused on improving health and medical care. Regions Hospital is part of the HealthPartners family of health care organizations. Please visit the Regions Hospital web site at www.regionshospital.com .  Regions serves a culturally diverse patient population from St. Paul and surrounding communities, including Western Wisconsin.  Regions is a nonprofit, teaching hospital that provides a high amount of uncompensated care ($44 million in Fiscal Year 2007).  Regions has 435 in-patient beds and in 2007 had 26,242 admissions with 64,941 Emergency Department visits.

The HealthPartners Medical Group is one of Minnesota's largest medical groups with nearly 580 physicians practicing in more than 35 medical and surgical specialties. This multi-specialty group focuses its efforts on compassionate, patient-centered care, from helping to prevent illness to caring for patients with acute and chronic conditions. Physicians of the HealthPartners Medical Group provide health care services in more than 50 HealthPartners, Regions, RiverWay and North Suburban clinics located in the Twin Cities, as well as in hospitals in the Twin Cities and western Wisconsin. The HealthPartners Medical Group is part of the HealthPartners family of health care organizations focused on improving the health of its members and community. Please visit the HealthPartners web site at www.HealthPartners.com.

Racial and ethnic groups in Minnesota account for nearly one in eight Minnesotans identify themselves as racial or ethnic minority.  91% of Minnesota’s African American population lives in the Twin Cities metro area and 84% of Minnesota’s Asian population lives in the Twin Cities.  Minnesota’s Hmong population has increased almost 150% since 1990 to about 42,000 people according to the 2000 U.S. Census.  Hmong families typically have 4 to 8 children; the growth in Minnesota’s Hmong community is likely to continue.  Minnesota’s Hispanic/Latino population more than doubled during the 1990’s to 143,000.  The State of Minnesota estimates there are 14,000 to 15,000 Somalis statewide.  Minnesota is believed to have the country’s largest population of Somali refugees.  Minnesota’s African American population is projected to more than double to more than 275,000 by 2025 and Minnesota’s population of Asian and Pacific Islanders and Hispanics is projected to nearly triple by 2025 and grow to 275,000.

By systematically collecting race and ethnicity data at the point of care, HealthPartners and Regions Hospital have developed the capacity to measure differences in acute and ambulatory care clinical outcomes and patient satisfaction between racial and ethnic groups.  HealthPartners and Regions believe that collecting data is the first step in understanding the disparities.

Baseline data gives the momentum to formulate culturally diverse improvements.  Teams have been charged with testing targeted interventions that add customization to standardized care processes, and spreading successes across the organization. Several key factors in HealthPartners’ timely response and execution enabled the successful integration of the Institute of Medicine’s recommendations into long-term organizational priorities. This presentation will describe HealthPartners’ journey on the path to achieving equity in care delivery.

Specifically, HealthPartners experienced success in the race and language spoken data collection by approaching collection in a learning environment. The data collection has been more successful at the point-of-service areas at HealthPartners Clinics and Regions hospital, than at HealthPartners health plan unit. Throughout the discussion we will outline the initial processes designed at data collection, learnings and strategies towards data capture and data integrity. We plan to share our learning that we recognized opportunities to impact actions occurring in other sectors of society aimed at eliminating disparities. HealthPartners partnered with external entities to advance our equitable care and services goals. Further, the presentation will address the challenges with data collection, interpretation and future direction in the overall disparity reduction work plan at HealthPartners.

In the presentation, HealthPartners will share the healthcare integrated data driven approach to achieving equity and describe the types of interventions implemented in direct care settings to improve outcomes for our diverse populations. We welcome the opportunity to share one integrated health care organization's approach to disparity reduction through demonstrated successful race, ethnicity and payer data collection using standardized care model approaches.

HealthPartners clinics, HealthPartners Health Plan and Regions Hospital are committed to providing competent cross cultural care to patients and families.  The data collection has been key to ensuring proper provision of this care.  Cross cultural care and service is defined as a set of values, behaviors and practices that enables health care providers to work effectively with patients from varying racial ethnic backgrounds.             What is HealthPartners doing to provide equitable care?

Gathering data (self-reported by patients) at the clinic and hospital level on race, country of origin and language preference has been a priority effort.  Through a grant from the Medtronic Foundation, disseminating best practices in culturally competent care from Regions Center for International Health, to hospitalized in-patients through the use of Medtronic Fellows, a program designed at Regions.  The equitable care fellows concept will be spread to HPMG clinics in 2008.  Through a Robert Wood Johnson grant, best practices have been developed and spread in the use of interpreters for limited English speaking patients at Regions Hospital.  Regions has __ full time and  __ on-call interpreters for 12 key languages spoken by the HealthPartners/Region’s patients.  In addition, providers have access to interpreter services for more than 150 other languages through the Language Line, telephone service.  HPMG maintains a Cross Cultural Care web site that provides resources for staff including continuing medical education course and monthly lunch and learns to provide ongoing cross cultural education to employees.

Lessons Learned/Challenges Overcome:

• Recognize how a care delivery organization’s culture and executive leadership support can provide the foundation for initiating an equitable care and service agenda
• Describe the types of interventions implemented in direct care settings to improve outcomes for diverse populations.  How focused efforts in data collection and real-time feedback can assist in overcoming barriers to collection.
• Design a structure for oversight of improvement strategies that is based within the clinic and hospital settings by designing a data driven approach to achieving equity. Clearly communication the strategies and reasons behind the data collection to head off skepticism and resistance initially.