Find out how to identify and eliminate health care inequities

Andis Robeznieks , Senior News Writer

Structural racism and other forms of discrimination contribute to poor quality care and suboptimal health outcomes for patients from historically marginalized racial and ethnic groups. But integrating equity into harm-event reporting is an effective way to identify when this happens so steps can be taken to prevent it.

Achieving optimal health for all

The AMA is confronting inequity at the system and community level to bring health equity to marginalized and minoritized communities in the U.S.

The “Advancing Equity through Quality and Safety Peer Network Series,” an AMA Ed Hub™ Health Equity Education Center resource, explores in detail how this can be done. The set of free, online CME activities—offered in collaboration with the Brigham and Women’s Hospital and The Joint Commission—builds on work started in 2019 by the Brigham and the Institute for Healthcare Improvement, which led to the design, testing and implementation of a framework for the work done by the AMA Peer Network for Advancing Equity through Quality and Safety.

This first-of-its-kind online curriculum provides comprehensive instruction for integrating equity into quality and safety practices. It includes an introductory set of modules that explain the basic principles and historical context behind the issues being examined, an introduction to the five focus areas involved in melding health-equity activities into the patient safety-quality improvement infrastructure, and then a set of modules that provide an in-depth look at each of the five focus areas.

The first focus area spotlights integrating equity into harm-event reporting and high-reliability technologies and processes. The Joint Commission defines high reliability as “consistent excellence in quality and safety across all services maintained over long periods of time.”

The modules in this set explain how health organizations can get started on this journey by systematically collecting and tracking harm events where discrimination or bias may have been a contributing factor and then applying an equity lens to reviewing all harm-event data in quality, safety, risk and patient experience reports.

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This series includes an explanation of how a University of Iowa Hospitals & Clinics team integrated equity prompts into their reporting solution. University of Iowa Hospitals & Clinics is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.

Other institutions whose stories are told in this set include Brigham and Women's Hospital, New York City Health and Hospitals and Yale New Haven Health System. Leaders from these organizations recall their journey of integrating prompts to identify bias and discrimination into their reporting solutions, plus challenges faced and lessons learned.

The module highlighting the first focus area defines key terms and explains underlying concepts, and it describes specific strategies to incorporate equitable practices into an organization’s existing harm-event reporting processes.

It starts with an example of how a patient’s experience in a harm event is typically described.

“Sixty-year-old woman has trouble getting her medication at the hospital pharmacy” is the description given, and it’s noted that the patient’s self-identified race, ethnicity, preferred language, disability status, socioeconomic status, or other potentially relevant factors have been left out.

The module suggests that including more details and demographic information about the patient would be useful: “60-year-old Spanish-speaking woman from the Dominican Republic with low vision has trouble getting her medication at the hospital pharmacy.” 

By including patients’ demographic information in a harm report, comparisons can be made to help recognize inequities in treatment among different groups, the module says. It notes that this is referred to as an “identity-explicit review,” and helps identify inequities that may have affected the outcome.

The module also describes how this patient’s experience may have been influenced by structural and social contributors, system contributors, performance contributors and behavioral contributors.

A system contributor may be a hospital’s inability to print medication information in the patient’s preferred language or in a larger font. While social drivers of health refer to individual-level "social needs" such as food insecurity, or to community-level conditions—also known as social determinants of health—such as food or pharmacy “deserts” that contribute to patient harm.

“Once an inequity is identified, possible solutions should be considered and provided that may provide relief for patient's immediate needs,” the module says.

“This could be a medication-delivery service in the case of pharmacy deserts or if there is a language barrier, the patient could be put in touch with a hospital representative who is fluent with their native language,” the module adds. “Longer-term and more sustainable solutions could include working with pharmacies to open locations closer to certain areas and also making pharmaceutical information available in multiple languages.”

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The modules include advice from experts such as Karthik Sivashanker, MD, MPH, the AMA’s vice president of equitable health systems and innovation.

“Start in one place, get it right in that one place first, and then expand,” Dr. Sivashanker says in the module.

“We can take this approach implemented really robustly in one space—like patient safety—and then we can spread it to experience, HR and other areas,” he says in the module. “I want to make that explicit—that this work can have ripple effects and that is the goal. But start small. Start focused.”

CME activities within the “Advancing Equity through Quality and Safety Peer Network Series” are enduring material and designated by the AMA for a maximum of either 0.25 or 0.5 AMA PRA Category 1 Credit™️.

The activities are part of the AMA Ed Hub™️ online learning platform that brings together high-quality CME, maintenance of certification, and educational content from trusted sources, all in one place—with activities relevant to you, automated credit tracking, and reporting for some states and specialty boards. 

Learn about AMA CME accreditation.