PAST INITIATIVES & PROGRAMS
THE HEALTHCARE QUALITY & EQUITY ACTION FORUM
The DSC created and hosted the Healthcare Quality and Equity Action Forum, which took place in 2012, 2014, and 2016. The Forum provided essential strategies to improve quality, achieve equity, and deliver high-value healthcare to diverse populations. The program featured interactive sessions with leaders from multiple disciplines and health care organizations working in the areas of quality and safety; disparities, diversity and equity; health policy; and health care design and delivery.
Sessions addressed a range of topics, including:
Securing leadership buy-in on equity in the C-Suite
Leveraging big data to address disparities
Developing community-based approaches for addressing disparities
Preventing readmissions for diverse populations
Creating health plan strategies to improve equity
Advancing the Centers for Medicare & Medicaid Office of Minority Health’s Health Equity Strategy
Leveraging disruptive and innovative strategies to achieve equity
Addressing disparities in oral health care
Deploying population health management approaches
Delivering high-quality care to dual-eligible beneficiaries
The Forum provided a space for participants to network with colleagues and peers from hospitals, health plans, health centers, and other healthcare organizations focused on integrating disparities solutions into quality improvement and innovating at the front-line.
MGH REVERE DIABETES MANAGEMENT PROGRAM FOR CAMBODIAN PATIENTS
Cambodian patients at the MGH Revere HealthCare Center were identified as the population facing the greatest challenges to effective diabetes control. The DSC, in collaboration with the MGH Revere HealthCare Center, began a culturally competent diabetes management program for Cambodian patients in 2009, modeled after the Chelsea HealthCare Center’s successful diabetes management program. The program included two main components:
Individual bilingual (English and Khmer) coaching using a culturally competent model of care to address patients’ needs/concerns regarding diabetes self-management; and
Diabetes Self Management Education, including bilingual group education sessions with discussions facilitated by the diabetes coach.
In response to the needs of the Cambodian population, the diabetes coach also served as a patient navigator, helping patients interact with the health care system (e.g. calling pharmacy, sending appointment reminders, etc.). Over the course of the project, 55 patients participated in the program with a total of 334 sessions conducted. Program participants had a 0.88 drop in HbA1c. Project results demonstrate that culturally-tailored disease management programs are critical for improving patient care and self-management, especially for chronic diseases like diabetes. Coaching can be a successful model for motivating patients to improve self-care activities, and navigation services are particularly important for patients facing barriers associated with language ability.
Time Frame: 2008-2011
MGH CHELSEA DIABETES MANAGEMENT PROGRAM FOR LATINO PATIENTS
In 2005 an assessment at the MGH Chelsea HealthCare Center revealed that Spanish-speaking Latinos were more likely to be in poor diabetes control compared to English-speaking white patients. To address this disparity the MGH Chelsea HealthCare Center collaborated with the DSC, the Massachusetts General Physicians Organization, and the MGH Center for Community Health Improvement to develop a culturally competent and comprehensive
diabetes management program to improve diabetes control at the MGH Chelsea HealthCare Center. The Chelsea Diabetes Management Program (CDMP) was based on a culturally and linguistically competent disease management model involving both coaching sessions and diabetes education. Support group sessions co-facilitated by a mental health professional and the diabetes coach were also offered to reinforce program learning and promote a community-based peer support system.
As of September 2011, more than 700 patients had been reached by the program, including visits with a bilingual coach and bilingual nurse educator, as well as group classes, support groups, and clinical visits with a nurse practitioner. The disparity in poor diabetes control (HbA1c >9) was reduced substantially, while overall rates of good control (HbA1c<7) improved for both Latino and white patients.
Time Frame: 2005-2011
MGH CHELSEA COLORECTAL CANCER SCREENING PROGRAM
In 2006, the MGH Chelsea HealthCare Center identified disparities in colorectal cancer (CRC) screening between Latinos (41%) and Whites (58%). To address this disparity, the Chelsea Colorectal Cancer Screening Program was designed as a quality improvement and disparities reduction intervention. The program targets patients who are due for CRC screening and have not received it. As part of program development, forty interviews were conducted with patients to identify specific barriers to care for CRC screening and to
assess patients’ knowledge, beliefs, and experiences with colonoscopy screenings (or reasons for not having a screening). Based on the findings from patient interviews, a culturally and linguistically tailored colorectal cancer navigator program was implemented in January 2007.
The navigators, who are also outreach workers and interpreters at the health center, were trained to:
provide patients with education on CRC screening;
address patient-specific barriers and develop solutions to overcome barriers; and
schedule appointments, translate, and accompany patients (if needed) to CRC screening appointments.
Results of an RCT using an intention-to-treat strategy in 2007 showed that patients in the intervention group (receiving navigator services) were more likely to undergo CRC screening than patients receiving usual care services (27% vs. 12% for any CRC screening, p.<0.001; 21% vs. 10% for colonoscopy completion, p.<0.001). The higher screening rate resulted in the identification of 10.5 polyps per 100 patients in the intervention group vs. 6.8 for those receiving usual care (p=0.04).
Since completion of the RCT, the navigator program has continued to be available to all patients
at MGH Chelsea. During 2008 and 2009, 197 patients received a colonoscopy with the assistance of the navigators.
In 2010, the program expanded with additional funding from the Trefler Foundation, and an additional part-time
navigator was hired, which allowed for increased recruitment efforts and provision of program services.
Follow-up data show the CRC patient navigation has been very successful. Screening rates among all patients in 2006 were 13.3% lower in Chelsea compared to all other practices (49.2% vs. 62.5%, p<0.001). By the end of
2012 this difference had disappeared (74.9% vs. 75.4%, p=0.45).
Time Frame: Began in 2006
MENTAL HEALTH DISPARITIES PROGRAM
The Disparities Solutions Center worked with MGH Psychiatry to investigate where disparities in mental health service utilization existed throughout MGH, both through research and collaboration with participating clinics. The DSC proposed measures to increase mental health services to minority populations and to encourage clinicians and support staff to participate in improving care for minorities with depression.
Time Frame: 2007–2008