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33 QUALITY IMPROVEMENT & MEASUREMENT 'We alone can do our part': How US News' top 10 hospitals are addressing health disparities By Kelly Gooch T he COVID-19 pandemic and deaths of Black Americans such as George Floyd have spurred many health systems to take increased focus on addressing systemic racism and health disparities. As a result, organizations are implementing various initiatives, from outreach programs to education to recruiting a chief diversity officer. For a closer look into their efforts, Becker's Hospital Review asked the top 10 hospitals named to the U.S. News and World Reports' 2020-21 Best Hospitals Honor Roll how they are working to limit health dis- parities. Read their responses below, presented alphabetically. Editor's note: e following responses were lightly edited for length and clarity. Joshua Adler, MD, executive vice president and chief clinical offi- cer of UCSF Health (San Francisco): We have approached inequities from multiple angles, from addressing them in our own workforce recruitment and advancement, to systematically identifying health disparities among our patients. Any time you're trying to create a systemic change, you need to know where you currently stand, and for that, you need data. One of the most important, long-term efforts we have undertaken is to develop common definitions for demo- graphics (e.g., race/ethnicity, sexual orientation, gender identity) and collect that information systematically from patients, which we then incorporate into our performance dashboards for quality, patient experience and access. As a result, we've been able to identify dis- parities across all of our performance metrics, such as hypertension control among African Americans or differing patient experiences, and set up plans to continuously improve them. Cindy Barnard, PhD, vice president of quality at Northwestern Medicine (Chicago): Northwestern Medicine has placed optimal outcomes and mitigation of health disparities and inequities at the center of its quality priorities. ere are three principal areas of focus: robust partnership with our communities; a diverse and inclu- sive workforce; and patient-centered quality improvement in areas of clinical vulnerability and disparities, such as COVID-19, maternal health, flu vaccination and chronic medical conditions (diabetes, hypertension). e approach was exemplified in a rapid response to the racial dis- parities identified early in the COVID-19 pandemic. Chicago region data revealed significant disparities in the rate of COVID-19 infec- tion, hospitalization and death in Black and Latinx populations as compared to white residents. Our community partners endorsed the need for proactive engagement of patients to ensure they know what COVID-19 symptoms to monitor and how to get testing and help. Northwestern mobilized two outreach programs to support the community. e outpatient COVID19 monitoring program provides daily calls and monitoring for patients who report symptoms or are tested for COVID-19, enabling close follow-up and referral for esca- lated care when needed. is was particularly important for patients who did not have an established source of ongoing primary care. e outreach program has reached over 9,000 patients, helping patients live more comfortably at home, providing them with education, reassurance and comfort. e NM Health Outreach Promoting Equity initiative was imple- mented to reach out to patients in vulnerable groups, especially Black and Latinx patients, in identified hardship communities who are also identified by a custom-developed NM predictive model as potentially at risk for serious illness if they did contract COVID-19. ese are patients with comorbid medical conditions and other risk factors, including age. ese screening calls enable Northwestern to provide information and education to the patient about COVID-19 symp- toms and link patients back to their physicians for a test, televisit or in-person visit when needed. In the same call, we screen and make referrals for social determinants of health, such as housing or food insecurity, need for financial assistance for medications, social isola- tion and transportation. Over 5,000 patients have been individually called from the highest risk group, and the lower-risk patients receive text and paper mail outreach with the same resources. About 20 per- cent require medical support, such as a physician visit or medication refill, and 14 percent require support for social needs. Joseph Betancourt, MD, vice president, chief equity and inclu- sion officer at Massachusetts General Hospital (Boston): Since 2007, MGH has been monitoring the quality of care they deliver by race, ethnicity and language in their Annual Report on Equity in Healthcare Quality. is is fundamental and foundational to being able to identify and then address health disparities, given you cannot manage what you don't measure. Over the years, MGH has developed programs to eliminate disparities once identified, includ- ing a culturally competent diabetes coaching program, a colorectal cancer screening navigator program and programs to eliminate disparities in flu shot vaccination. Currently, MGH is working on addressing disparities in patient experience related to discharge and discharge instructions. Linda Burnes Bolton, DrPH, RN, senior vice president and chief health equity officer at Cedars-Sinai (Los Angeles): Cedars-Sinai is located in the heart of Los Angeles, one of the nation's most diverse cities. While racial and cultural diversity make for a vibrant city, some groups are underserved when it comes to healthcare education and outreach. at is why Cedars-Sinai's Research Center for Health Equity has provided cancer education workshops for Korean-Ameri- cans, Filipino-Americans and Black residents in churches and recre- ation centers. Outreach efforts in the Korean American community is particularly important because of the high rates of GI cancers among its residents. Workshops in that community have touched more than 1,700 people; 735 have attended in-depth sessions on cancer screening and prevention. Our health equity team follows up by arranging cancer screenings, oen at local free clinics. Chyke Doubeni, MBBS, family physician and inaugural director of the Mayo Clinic Center for Health Equity and Community Engagement Research (Rochester, Minn.): At Mayo Clinic, we feel called on to meet the moment, to confront racism and embrace transformation. We believe that what we do to support marginalized populations in our workforce and communities will benefit everyone. Mayo Clinic has made an investment of $100 million over 10 years to support areas in education, research and clinical care, [to reduce health disparities]. In the area of workforce diversity, we will invest in hiring new faculty to lead research in areas of health disparities and advance health equities across our three campuses. We are also working