The workgroup’s next priority was workflow design. They determined which staff would have responsibility for implementing screenings and how the data would be collected and documented. Information would be collected from patients at multiple points before, during and after their appointment, including via the online patient portal and the check-in kiosk. If a patient screened positive on any of the domains, specific resources would appear on the patient’s after-visit summary. If a patient indicated their situation was urgent, social work and case management teams would be contacted to follow up.
Dr. Flores emphasized that this is a multidisciplinary team effort and requires support and input from many hospital departments. For example, IT collaboration is critical to ensuring the electronic questionnaire is accessible, easy to use, and links patients with the appropriate resources. The professional education department developed an educational program for nursing staff, including an online module and in-person training. The work group implemented an organization-wide communication plan, so that messaging regarding the screening could be standardized and relayed by hospital leadership. Once the screening was live, the workgroup had a week of daily huddles to immediately address concerns as they arose.
Dr. Flores emphasized that leadership must monitor the data and intervene when disparities are observed. Additionally, health organizations must ensure that resources are actionable for their marginalized patients. For example, a food pantry on site at the hospital can directly meet the needs of patients with food insecurity.
Conclusion
To improve healthcare access, treatments and outcomes for marginalized patients, health systems will have to undergo structural and organizational changes beyond screenings. However, ensuring that patient data is being collected and utilized properly, meeting mandatory health equity standards, and organizing towards health equity within one’s own organization are all steps toward a more equitable future.
Glen K. Rodman is the assistant editor of The Rheumatologist.
References
- Hood CM, Gennuso KP, Swain GR, et al. County health rankings: Relationships between determinant factors and health outcomes. Am J Prev Med. 2016 Feb;50(2):129–135.
- NQF issues quality roadmap for reducing healthcare disparities. National Quality Forum. 2017 Sep.
