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Advancing health equity

IU Health’s Office of Health Equity Research and Engagement

For health professionals, the tragic murder of George Floyd coupled with the disproportionate health and economic impact of COVID-19 on Black, Indigenous and Communities of Color (BIPOC) was a stark reminder that racism and related inequities such as poverty and unemployment remain a root cause of poor health outcomes. The aftereffects of the George Floyd killing spurred worldwide protests and prompted many Fortune 500 companies to issue statements condemning racism. Many of the nation’s leading health organizations such as the American Public Health Association and the American Medical Association, declared racism a threat to public health and in light of these events, there has been a push to advance health equity.

The Robert Wood Johnson Foundation defines health equity as “everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments and healthcare.”

Healthcare organizations across the country have adopted policies that recognize race as a social construct instead of a biological construct, meaning the consequences associated with race are the result of a history of laws, systems and practices that were created to disadvantage and exploit people of color, rather than inherent genetic or ancestral differences. This change is supported by research that shows that differences in the type and quality of healthcare received by minority and non-minority populations exist and occur in the context of broader historic, and present-day, social and economic inequities. The impact of these differences within the United States (US) healthcare delivery system has adversely affected communities of color and manifests itself as poor health outcomes, systematic segregation, discrimination and ultimately premature death.

The COVID-19 pandemic put a spotlight on the pervasive inequities within the healthcare system. It coupled and accentuated these divides in care. As a result of these gaps, Indiana University Health (IU Health) made a commitment to improving the health of all patients and communities across Indiana by hiring its first vice president and chief health equity officer, Dr. Brownsyne Tucker Edmonds, to focus on ensuring equitable levels of care and equal access to care for the diverse patients and communities that IU Health serves.7 Dr. Tucker Edmonds is a physician and health services researcher who is nationally and internationally recognized for her work in health equity, disparities, shared decision-making and reproductive healthcare.

In 2021, Dr. Tucker Edmonds and her team established the IU Health Office of Health Equity Research and Engagement (HERE) to examine IU Health’s internal operations and clinical care through the lens of its diverse patients and communities, focusing on equitable patient access, experiences, and quality outcomes. Aligned with IU Health’s community health strategy, HERE has identified three clinical areas of focus: cardiovascular health, maternal and infant health, and behavioral health.

Dr. Tucker Edmonds’ vision is to develop IU Health’s health equity infrastructure, which includes data analytics, community engagement and health equity embedded decision-making processes to improve patient access, experiences and outcomes of care. In one short year, Dr. Tucker Edmonds and her team have made some great strides. Here are some of the highlights:

Access

HERE has established the Indianapolis Health Equity Access outReach and Treatment Collaborative (iHEART) program to improve access to care for underserved communities and reduce health inequities related to cardiovascular health. iHEART is a $3.1 million award funded through an industry-sponsored collaborative agreement to deploy community health workers to three high need Indianapolis neighborhoods to screen and refer community members for medical care and social services. The program brings together academic partners from the Indiana Clinical and Translational Sciences Institute, the Diabetes Impact Project-Indianapolis, and the Polis Center with health system programs from the Cardiovascular Institute, the Congregational Care Network, and Community Health department. To date, IU Health’s HERE and Community Health teams have worked together to hire a workforce of community health workers and have conducted heart health screening outreach events in partnership with several churches and community organizations, resulting in hundreds of blood pressure screenings and health services delivered and 3500 residents contacted in communities of need.

Data suggests that only 20% of adverse health outcomes are driven by challenges related to access to health care or quality of healthcare; the other 80% is driven by social and structural drivers of poor health related socioeconomic factor (education, employment; community safety, etc), physical environment (air quality, safe drinking water, etc); and health behaviors (smoking, diet, exercise, etc.).8 With that in mind, in addition to the ongoing community outreach efforts described above, HERE is actively working to enhance cross-sector collaboration to address social and structural determinants of health that impact the health of our patients in the settings where they live, work and play. Earlier this year, HERE partnered with Eli Lilly and Company to host a health equity symposium that was attended by more than 120 participants representing more than 80 industry, government, and community partners committed to multisector collaboration to advance health equity throughout the state.

Patient Experience

HERE has partnered with IU School of Medicine to introduce Trauma Informed Care (TIC) into the monthly New Faculty and Provider Orientation curriculum. Trauma Informed Care is a model of care that teaches medical providers how psychological trauma and adversity may impact the health and well-being of individuals and how to use trauma informed approaches in their interactions with patients to mitigate harm. In light of the recent trauma experienced during the pandemic by all, and the historical and present-day trauma exacted by systemic racism, it is imperative that healthcare providers become more knowledgeable about trauma’s impact on health and wellness and more skilled at approaching patients with a set of practices that convey physical and psychological safety to patients. A cohort of faculty and HERE team members were trained in TIC in June 2022 and 284 providers were trained in the first five months of the new program. Further, pilot efforts are underway to train labor and delivery nurses in TIC to improve patient birthing experiences and satisfaction. These trainings, taken in combination with newly required unconscious bias training for all IU Health team members, are intended to ensure that all team members are better equipped to provide equitable patient care experiences, free of bias and harm.

Patient Outcomes

HERE has identified targets for quality and safety improvements needed to reduce health disparities in our inpatient and outpatient settings in the areas of controlled hypertension, childhood immunizations and severe obstetrical complications. HERE was also awarded a large grant to fund the Health Equity Advancing through Learning Health System Research (HEAL-R) Collaborative, a partnership between IU School of Medicine’s Clinical and Translational Sciences Institute, the Regenstrief Institute, and the Irsay Family Research Center at Indiana University Bloomington that is funding 12 health equity pilot projects to advance equitable patient access, experiences and outcomes of care.

These research and analytic teams have been put in place to compare hospital data on clinical outcomes and patient experience across racial, ethnic and linguistic groups to determine whether quality and safety outcomes and experiences of care are equitable, in order to identify targets for performance improvement to close outcome disparity gaps.

In order to ensure that these analyses would lead us to draw correct conclusions, we first needed to ensure that the data we collected from patients on Race, Ethnicity and preferred language were consistently and correctly collected. With that in mind, HERE launched the We Ask Because We Care campaign in October 2022. This campaign was a system wide initiative to enhance the quality and accuracy of Race, Ethnicity and Language (REaL) patient data collection. It also included a community-facing marketing campaign in partnership with 2 other Health Systems serving Marion County.

The REaL data quality improvement project included the electronic medical record, point of care marketing and required modules for team member education. To date, more than 40,000 IU Health team members and contractors have been trained on ‘What is REaL’, and all registrars were retrained on the new workflow and scripting. This system-wide effort will help capture REaL data to better measure and address health disparities.

High quality REAL data is a critical tool in identifying disparate quality and safety outcomes, targeting performance improvement, and creating place-based outreach interventions.

In closing, IU Health believes all of society benefits when everyone has access to quality health care. HERE seeks to accomplish that through investments in high quality data; research and evidence-based interventions that have been proven to be effective in communities of color; and a community engagement strategy that creates a two-way line of communication with patients, communities, and stakeholders. IU Health’s Office of Health Equity Research and Engagement is ‘HERE’ to ensure that every patient, particularly the historically excluded and underserved, experience IU Health as a physically and psychologically safe and welcoming place to receive high quality care.

Dr. Stacy Grundy is the Executive Director of the Office of Health Equity Research and Engagement at IU Health. Dr. Grundy is the former Interim Director for the Office of Community Engagement for Southern Illinois University System.

Dr. Brownsyne Tucker Edmonds is the inaugural Vice President and Chief Health Equity Officer for Indiana University Health and the Associate Dean for Health Equity Research for Indiana University School of Medicine (IUSM), where she holds an endowed chair for Health Equity Research.

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