July 29, 2021

Coming soon to US News hospital rankings: Health equity?

Daily Briefing

    Alongside its release on Monday of its annual "Best Hospitals" rankings, U.S. News also unveiled new "health equity measures" for more than 1,400 hospitals nationwide.

    How to advance equity for your workforce, patients, and community

    About the new 'health equity measures'—and what they could mean for the future

    To determine its health equity measures, U.S. News identified the demographics of Medicare-insured patients who underwent elective procedures at each studied hospital, then compared those to the demographics of the hospital's community.

    The aim was to identify any racial gaps between the hospital's patients and the population of the surrounding area.

    According to U.S. News, its analysis focused on scheduled procedures to "tease out hospitals visits that were solely based on proximity," since scheduled procedures "are much more responsive to hospital marketing and medical discretion."

    The results are listed on each hospital's U.S. News profile, but they did not affect the 2021 "Best Hospital" rankings. However, U.S. News is considering expanding upon its equity measures in the future.

    According to Ben Harder, managing editor and chief of health analysis for U.S. News, the publication "is evaluating ways to combine the [current] health equity measures into a future composite index that is applied at the hospital level."

    Harder told the Daily Briefing that possible future uses of that "health equity index include developing a standalone evaluation of health equity, which could serve as a useful information tool for patients, and potential inclusion into existing U.S. News Hospitals methodologies."

    U.S. News is also considering investigating outcomes of care and social determinants of health, Harder added.

    Key findings from this year's analysis

    U.S. News found that patients who had common elective procedures—such as joint replacement or cancer surgery—were disproportionately white across the United States.

    In fact, according to the analysis, just 29% of hospitals treated a proportion of Black patients comparable to or higher than the proportion of Black residents within the hospitals' local communities, U.S. News found. Similarly, just 18% of hospitals treated a representative share of Hispanic patients, and only 5% of hospitals did so for Asian/Pacific Islander patients. 

    The analysis also found that, in many areas, compared with similarly insured residents of other races, Black Medicare beneficiaries experienced more potentially avoidable hospitalizations. Specifically, U.S. News found an elevated rate of potentially avoidable hospitalizations among Black residents in Atlanta, Chicago, Dallas, and Philadelphia.

    Some hospitals treat a higher proportion of minority patients

    Even though most hospitals served a share of minorities disproportionate to their surrounding communities, some hospitals did the opposite, U.S. News found.

    For example, at Boston Medical Center, the share of patients who were Black or Hispanic was around double that of the surrounding community. Similarly, in Dallas, where 17% of residents with Medicare are Black and 4% are Hispanic, 40% of patients at Parkland Health and Hospital System were Black and 16% were Hispanic. And Chestnut Hill Hospital, Einstein Medical Center Philadelphia, and Temple University Hospital—all located in Philadelphia—all treated a greater proportion of Black patients than were local residents.

    Kate Walsh, CEO of Boston Medical Center, said her organization's patient mix is a result of the hospital's efforts to provide support services to disadvantaged patients, such as a translator, help finding work, or a three-day supply of food.

    "You can walk from here to four top-ranked U.S. News hospitals," she said. "I don't think patients we care for come here because we're the closest stop." (Harder et. al., U.S. News & World Report, 7/27; U.S. News & World Report 2021-2022 Best Hospitals Health Equity Measures methodology, accessed 7/27)

     

    If you weren't already prioritizing health equity, now is the time to act. Here's how.

    By Darby Sullivan, consultant

    U.S. News has taken a commendable first step toward bringing much-needed transparency to an historically shrouded part of our industry. Many provider organization leaders remain hesitant to track (much less publicize) their performance on health equity measures for a range of reasons—an unwillingness to accept that their organizations may be part of the problem, the threat of damage to their brands, and the fear of potential legal action. But it's impossible to design effective solutions without understanding the extent of the problem.

    Action by third parties like U.S. News can help to move the dial by incentivizing progress. Especially if they expand the number of measures tracked and incorporate them into the next iteration of its "Best Hospital" rankings. And they should—quality care is inextricably linked with equitable care.

    However—and as U.S. News acknowledges—these two measures alone are insufficient. While they may help surface some aspects of racial inequities in care access and segregation in care delivery, they don't tell a comprehensive picture of health inequities within an organization and across communities. And racial disparities are only one facet (though a major one) of health inequities. Leaders who aim to meet today's mandate to advance equity need a more in-depth approach to tracking and analyzing data. They should:

    1. Select holistic metrics to quantify disparities

      Include a combination of leading and lagging indicators to measure both short-term and long-term performance across two categories:

      • Institution-oriented metrics assess disparate outcomes across the organization's patient population, including clinical and behavioral outcomes, acute utilization, access to care, and more. Leaders have more direct control over the policies and procedures that can lead to these disparate outcomes, and transparency in performance can help make a stronger case for long-term investment.
      • Community-oriented metrics track inequitable community conditions like economic stability and food insecurity impact health outcomes. A better understanding of the social determinants of health (which can impact up to 50% of an individual's health outcomes) can help leaders prioritize community partnership and target geographic hotspots.

    2. Compare outcomes across multi-layered demographic groups

      Cut the data by multiple socio-demographic domains, especially (but not limited to) race, ethnicity, gender identity, sexual orientation, age, and language. Pay special attention to groups who may experience multiple layers of marginalization by analyzing the data by more than one domain at the same time (e.g., gender and race). These groups are the most at risk of experiencing disparities in care delivery, social needs, and clinical outcomes.


    3. Analyze data to audit existing efforts and identify new focus areas
    4. Use the growing database to identify how existing strategic efforts (such as workforce development and quality improvement) either reduce or contribute to disparities and design future initiatives that address the needs of marginalized groups. And as always, this valuable quantitative data must be paired with community input to build effective, sustainable coalitions.

    For more guidance on measuring health equity progress, use our Health Disparity Metric Picklists and review Take a Data-Driven Approach to Identifying and Reducing Disparities.

    Leena Aurora and Andrew Mohama contributed to this piece.

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