The numbers don’t lie. That’s the old saying. But in the world of health inequities created by deep-seated structural factors, it is critical to reevaluate what data is being collected, by whom, and to address whose priorities.
That is one key takeaway from an AMA National Health Equity Grand Rounds event on using data to advance health equity.
Elena Mendez-Escobar, PhD, was one of the speakers who took part in the wide-ranging event. She is co-executive director of the Boston Medical Center (BMC) Health System Health Equity Accelerator, which is “working to transform health care to eliminate gaps in life expectancy and quality of life among different races and ethnicities.”
She noted that despite her institution’s early adoption of a health equity focus “when we looked at our data by race and ethnicity, we found the same gaps that everybody else finds.” This finding prompted the creation of the health equity accelerator.
“Whereas we wanted to base our work on data, we were very aware of the pitfalls that can come from it and how one can use data to hide from change,” she said. “We didn’t want to stop at describing the problem.”
The National Health Equity Grand Rounds event also featured speakers Linda Villarosa, a journalist and educator, and Ryan J. Petteway, DrPH, MPH. He is an associate professor in the Oregon Health & Science University-Portland State University School of Public Health.
Watch the entire event now, or skip ahead to a segment with a particular speaker’s remarks.
Dig deep for data on inequities
Mendez-Escobar noted that, when she and her colleagues at the Health Equity Accelerator looked into their health system’s statistics on pregnancy complications, the data was inconclusive at first glance. But, from the medical literature, they knew one way racism affects health outcomes is by delaying treatment, so that’s what they went back and measured.
“As we dug deeper in that data, we found a very strong correlation with severe pregnancy complications and preeclampsia that was driving worse outcomes for our Black patients,” said Mendez-Escobar, who also oversees the Boston Medical Center Health System Grayken Center for Addiction.
Interventions were put in place that included giving patients a remote BP-measurement device during their first pregnancy-related visit.
Patients were educated about preeclampsia risks and symptoms and told to schedule a visit if their blood pressure went up and that BMC would arrange for child care if needed.
Mendez-Escobar's colleagues also measured the time between when a decision is made to deliver a baby by caesarean section and when surgery starts. For white patients, the time was 78 minutes. For Black patients, it was 98 minutes.
“The longer time passes, the higher the risk for complications such as hemorrhages, so we really wanted to reduce that gap,” she said, adding that a goal was to cut the time from decision to C-section down to 60 minutes—for all patients.
The interventions they put in place lowered the time from decision-to-C-section to under an hour for both Black and white patients.
“This is an example of a powerful intervention where we did structurally change the process so that our bias would have less of an opportunity of affecting the outcome,” Mendez-Escobar said.
Learn about AMA advocacy to improve maternal health.
Data shows racism’s legacy
Vikas Saini, MD, president of the Lown Institute, also took part in the panel. The nonpartisan think tank focuses on equity, accountability and value, has created the Hospital Index for Social Responsibility. The index uses claims data to rank 3,200 hospitals on inclusivity after assessing how well the demographics of a hospital’s Medicare patient population match its surrounding community.
Dr. Saini showed maps illustrating how the patient population of a Chicago hospital didn’t match its community as the area’s Black and Hispanic patients were either going elsewhere for care or maybe not going anywhere at all.
“There is a clearly a discrepancy, but the discrepancy is not about the hospital,” he explained. “This is about legacy. This is about redlining. This is about residential and labor-market segregation. It’s many things, but it’s reflected in hospital claims data.”
A recording of the event, “Creating Accountability Through Data: From Racism and Neglect to Transparency and Repair,” is available with free CME as enduring material and designated by the AMA for a maximum of 1.5 AMA PRA Category 1 Credit™️.
The module is part of the AMA Ed Hub™️, an online learning platform that brings together high-quality CME, maintenance of certification, and educational content from trusted sources, with automated credit tracking and reporting for some states and specialty boards.
Learn about AMA CME accreditation.
