Programs & Initiatives
Developing a health equity database to support identification of disparities, target new initiatives, and measure impact
Race, Ethnicity & Language Documentation
It is critically important for us to understand and address the root causes of health inequities, including those that fall along racial and ethnic lines, as well as to measure our success in closing health equity gaps. Those efforts require widespread, reliable, and consistent data about our patients’ race and ethnicity. In the beginning of 2021—in collaboration with NYP’s Chief Information Officer, the VP of Revenue Cycle, the Division of Community & Population Health, and our academic partners—we launched an enterprise-wide, coordinated campaign to improve the collection of race and ethnicity data.
Key Accomplishments
- Co-led a steering committee, staffed by NYP senior leaders
- Identified electronic medical record improvements to streamline data collection
- Developed and deployed standardized staff education, providing specialized training on race, ethnicity, and language collection to over 2,600 staff members and sharing educational tools with our academic partners
- Created direct patient communication materials, including posters, FAQs, and a public-facing website
- Developed a series of real-time dashboards and data delivery mechanisms to support evaluation and ongoing monitoring
- Developed a toolkit for the ‘We Ask Because We Care’ campaign and shared these materials with health systems across the country in the New England Journal of Medicine Catalyst, as well as through the New York State Birth Equity Improvement Project and the Illinois Perinatal Quality Collaborative
Social Determinants of Health Screening
Health and wellness start in our homes, neighborhoods, and the communities in which we reside. Because 80% of health outcomes are driven by social, behavioral, and environmental factors, we need to address specific social aspects of health, as we work to address medical ones. We refer to these social needs—like food insecurity, inadequate or unstable housing, lack of access to transportation, and financial burdens—as the social determinants of health (SDoH). And the circumstances that create the SDoH are largely determined by the distribution of power, wealth, and resources.
Key Accomplishments
- Conducted a current state assessment, cataloguing all SDoH processes across the enterprise
- Interviewed other health systems to understand best practices and lessons learned
- Convened a series of workgroups with key stakeholders and established a panel of SDoH champions at each site
- Developed an SDoH playbook—a collection of best-practices and implementation materials to guide practices during the project
- Worked with the Epic Together Team to develop a timeline for developing an electronic interface with our social services navigation partner to facilitate referrals
Screening and Referral Process
We aim to have enterprise-wide SDoH screening available in 2022, with a robust program and resources for the four primary steps of SDoH screening. This comprehensive care approach will provide patients with the support they need, when they need it.
of health outcomes are driven by social, behavioral and environmental factors
Addressing Algorithmic Bias
NewYork-Presbyterian has joined the NYC Coalition to End Racism in Clinical Algorithms (CERCA), which aims to understand and address race correction in clinical algorithms. As summarized by Vyas, Eisenstein, and Jones in the New England Journal of Medicine, “When clinicians insert race into their tools, they risk interpreting racial disparities as immutable facts rather than as injustices that require intervention. Researchers and clinicians must distinguish between the use of race in descriptive statistics, where it plays a vital role in epidemiologic analyses, and in prescriptive clinical guidelines, where it can exacerbate inequities”.
As a member of the coalition, NYP commits to:
- Raise awareness on how race correction contributes to racial health inequities.
- Elevate and communicate its commitment to health equity.
- Eliminate race correction in at least one clinical algorithm within two years.
- Measure institutional and citywide impacts of eliminating race correction on racial health inequities.
- Avoid the potential impact race correction may have on the provision of timely care and referrals.
Algorithms of focus for year one
- Glomerular filtration rate (eGFR) equations, which measures kidney function
- Vaginal birth after cesarean section (VBAC)
- Pulmonary function testing (PFT)
Measuring Equity
A key pillar of our work to address health inequities includes equity measurement and monitoring. Our equity measurement strategy starts with identifying quality measures that reflect our organizational priorities and stratifying them by key demographic, descriptive variables (i.e. race, ethnicity, language, sexual orientation, gender identity, payor, and social determinant of health survey data). Our goal is to review and monitor these measures so that everyone gets the highest quality of care.
Key Accomplishments
In 2021, the Dalio Center and NYP's Division of Quality & Patient Safety launched a process to stratify and evaluate inpatient quality measures to identify potential equity gaps and prioritize future initiatives. As departments, divisions, and campuses across the NYP enterprise embark on health equity measurement, the Dalio Center and our partners across NYP, Columbia, and Weill Cornell have developed tools, references, and recommendations to support those efforts. These tools are available on our infonet site, including:
- A summary of resources available to improve demographic data capture
- A best practices guide for presenting and reporting race & ethnicity
- A primer on health equity measurement and stratification of measures
