Using Data to Transform Health Equality into Health Equity

By Dr. Adriane Burgess, Director for Quality Improvement, WellSpan Health

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This editorial is part of Transforming Health’s Expert Voices, where health care professionals discuss issues facing our community. All information is based on the expert’s experience and is not meant to replace professional medical advice or treatment plans. We encourage you to contact a qualified health care professional to discuss your individual health concerns.

Many believe that the terms equality and equity can be used interchangeably. However, these terms have distinctly different meanings. Equality means that everyone is given the same opportunity and resources while health equity focuses on providing opportunities and resources so that every person can attain his or her full health potential regardless of social position or other socially determined circumstances.

For decades, healthcare organizations had goals to provide equality in access to care and resources, but more recently have realized that this was leading to disparities in health outcomes, especially among vulnerable populations. Subsequently, healthcare organizations were falling short of achieving health equity.

Dr. Adriane Burgess, Director for Quality Improvement, WellSpan Health

Dr. Adriane Burgess, Director for Quality Improvement, WellSpan Health

Healthcare organizations are required to collect patient self-reported data on race, ethnicity, and language. With the adoption of the electronic health record, we’re now given a great opportunity to leverage this data to assess for disparities in access and outcomes and use data to shine light on gaps in care. With that information, we can make sure we utilize culturally appropriate health interventions and care.

To identify inequities in care, healthcare organizations must have standards in place when looking at metrics to determine disparities in access and outcomes.  To meaningfully analyze and interpret data to identify disparities it takes the support and collaboration of teams from a variety of departments in the health system including clinical care, quality, patient access, informatics, analytics, diversity and inclusion, community outreach and interpreter services. Therefore, if we want to provide health equity, every part of the organization must be on board.

One example of this work: each year in the U.S. about 700 women die as a result of pregnancy or delivery complications and another 50,000 will experience severe pregnancy complications. There are significant disparities in severe maternal morbidity, and maternal mortality is three times greater for Black women than for White women in the U.S.

Due to increasing trends in racial disparities noted in preeclampsia/eclampsia, healthcare organizations have been called upon to address ways to improve treatment of severe hypertension and reduce racial/ethnic disparities in preeclampsia and severe maternal morbidity. To begin this work, organizations must examine their data on severe maternal morbidity and preeclampsia by race and ethnicity to assess for disparities in process and outcomes measures. Outside of data analysis, health systems should perform individual case reviews to determine if inequitable care or institutional policies are facilitating racial disparities.

Organizing data by race, ethnicity and language provides an opportunity for healthcare organizations to not only identify disparities, but also to engage communities, and then develop outreach and innovation in this space.  For example, in the case of severe maternal morbidity and preeclampsia, innovations to address disparities can include free access to blood pressure cuffs, the creation of alerts in the electronic health record to ensure timely treatment of severe hypertension or the creation of prenatal screening tools to ensure that patients at high risk for preeclampsia are prescribed low dose aspirin therapy in accordance with professional guidelines.

Health systems should use data on race and ethnicity to identify gaps, action improvement, and create institutional policy to improve care. However, it is integral that data be used in concert with conversations with the communities they serve, as well as education to staff about the impact of implicit bias and systemic racism on disparities in outcomes.