Equitable Care Health Outcomes: Building a Strong Foundation towards Health Equity
Through our Equitable Care Health Outcomes (ECHO) initiative, we’ve been using video ethnography and extensive interviewing to investigate the key drivers of disparities and to identify care interventions at the levels of patients, clinicians, and the health care system itself. At our West Los Angeles Center of Excellence in Culturally Competent Care for African-Americans – one of Kaiser Permanente’s nine Centers of Excellence – this work has for use on hypertension and diabetes.
ALL/PHASE Heart Project
The sharing of Kaiser Permanente’s ALL/PHASE: cardio-protection project with safety net providers has produced striking results among low-income and vulnerable populations of diabetic patients since the safety net dissemination program began in 2006. A simple, inexpensive, evidence-based regimen of medications (Aspirin, Lisinopril, and a Lipid-lowering medication [statin]) that dramatically reduces the risk of heart attac and stroke among diabetics, the ALL/PHASE program, winner of the 2010 James A. Vohs Award for Quality, is one of the innovative ways Kaiser Permanente shares information and tools to measure disparities and promote equitable care.
Closing the Gap: Hypertension Control and Colorectal Cancer Screening
Healthy communities leave no one behind. Kaiser Permanente continues our work to open the doors to high-quality health care for vulnerable individuals and families. We focus on those who lack access to vital services due to barriers to private health care coverage, the limited capacity of safety net programs, or the persistence of racial, ethnic, and other disparities in health and health care.
Among the many ways we advance the health equity agenda is our commitment to achieving two ambitious goals for populations that suffer numerous health care disparities. These goals are to significantly narrow the gap in control of hypertension between our African-American members and white members within two years, and to narrow and then close the gap in the rate of colorectal cancer screening between Hispanic members and white members within five years.
In October 2011, senior Kaiser Permanente national and regional leaders in quality and diversity gathered for the organization’s first Equity Summit, charged with setting specific targets to reduce health care disparities across all Kaiser Permanente regions. They came away with an ambitious plan calling for each region to focus on one or both of the following goals:
- To reduce the gap between African-American members and white members in the control of hypertension by 25 percent in 2012 and 2013, and
- To reduce the gap between Hispanic members and white members in the rate of colorectal cancer screening by 25 percent in 2012 and 2013 – and to close that gap within five years, while becoming the best in the nation for colorectal cancer screening for all populations.
Closing the gap in hypertension control for African-Americans will entail a variety of initiatives, including data gathering, population segmentation, and dissemination of successful practices.
Take on the HIV Challenge
HIV is still an epidemic in the United States, with 56,000 people becoming infected each year and more than 1.1 million Americans living with HIV. Since the HIV epidemic emerged 30 years ago, we’ve treated more than 60,000 HIV patients and reduced disparities among our current HIV population of more than 20,000 people. Our work has met or exceeded the objecives of the National HIV/aids Strategy developed by the White House Office of National aids Policy – and our achievements have been notable.
Our HIV mortality rates are half the national average.
There are no disparities among our black and Latino HIV-positive patients for mortality and medicatioin rates, compared to a 15 percent higher rate for mortality and a lower rate for access to medication nationally.
89 percent of our HIV-positive patients are in HIV-specific care within 90 days of their HIV test results, compared to just 50 percent within one year nationally.
69 percent of our HIV-positive patient have maximal viral control, compared to just 19 to 35 percent nationally.
During 2011, we assembled a toolkit of the clinical best practices, educational materials, and health information technology resources that went into achieving these numbers. Our plan was to offer the toolkit to other health care providers as part of a challenge announced at the Care Innovations Summit hosted by the Center for Medicare & Medicaid Innovation in early 2012.
Our message: Improve health equity for people living with HIV by increasing their access to effective treatment.