Gabriel Perna | July 7, 2021
When Sutter Health formally established the Institute for Advancing Health Equity, it engaged in three core principles.
“First, start with understanding the current situation. Measure where you are with regards to disparities with your own system. Second, organizations have to commit to action. It’s one thing to understand where you are and it’s another thing to do something about it. Commit to action and measure progress to inform your strategy. Third, you need to have a long-term commitment. This is highly complex. It’s not going to be solved overnight,” says Leon Clark, Sutter Health’s Chief Research and Health Equity Officer.
Sutter Health, a large health system based in Northern California, took a leap toward these principles this past December when the system launched its Institute for Advancing Health Equity. The Institute will aim to accelerate the health system’s existing efforts to reduce disparities, including its Health Equity Index, which uses analytics and dynamic population data to measure disparities. It also will combine existing research efforts around COVID-19, maternal care, and health equity across the spectrum of clinical care into one dedicated organization within Sutter.
Health Evolution interviewed Clark and Kristen Azar, RN, the Scientific Medical Director of the Institute for Advancing Health Equity, about the organization, how the Health Equity Index has been a catalyst to the larger work being done at Sutter, improving COVID-19 vaccine equity and more.
What made Sutter Health decide to launch the Institute for Advancing Health Equity?
Leon Clark: It’s important to note Sutter has been engaged in this work for more than a decade. It’s reflective of the size of our organization and our patient mix. We’re a majority minority from a patient base perspective. It’s part of fulfilling our mission to provide high quality care across our integrated network. It’s not something new to us. I think what’s happened and it’s happened across the country, as we experienced social unrest and as COVID was playing out, we saw tremendous disparities and outcomes. We just felt, along with many others across the country, that now was the time to act urgently to address all these problems. The establishment of the Institute was a formal way to amplify work that we’ve been doing for more than a decade.
Kristen Azar: The Institute is the evolution of that process and really taking it to the next level of creating a system-level coordinated approach. We are leveraging the power of our large integrated health system to really make a maximum impact.
What are the main goals of this institute?
Azar: Our real goal here is to advance the science of health equity in order to achieve optimal health outcomes, not only for our Sutter patients but also to generate knowledge that can improve the health of our communities both in California and across the country. That’s our ultimate goal here. We have three areas and domains of expertise that we’re developing. We really focus on our data and insights as our first area. We really want to look at our Sutter data and our EHR data and be able to learn from it.
That really will inform our next area, which is solutions advocacy, where we take that data and we make it actionable. We want to build solutions that really can be impactful and feasible in real-world settings to address the different opportunities we’ve identified. And by doing so, we will share that knowledge and become advocates in a greater sense beyond and within Sutter.
The third area of expertise that we’re developing is education and training. It’s very important to us to focus on preparing the next generation of health equity researchers and clinicians, but also to look at our own care team and make sure that they feel confident, comfortable, and capable of caring for our diverse patients. We’re looking to offer them things like unconscious bias training, cultural competency training, and other trainings like that.
We’re focused on five specific practice areas: mental health equity, maternal health equity, oncology/cancer care, diabetes and cardiovascular disease and, finally, access and care transitions. Thinking about that interface between our communities and our clinical settings, we hope to conceptualize work in those main domains.
How are you leveraging the Health Equity Index as part of this Institute?
Azar: The health equity index initial version really focuses on ambulatory sensitive conditions. What I mean by that is conditions that end up being treated in our emergency department that would be more optimally managed in primary care. We can prevent complications to diabetes or those types of hypertensive emergencies if we have better care upstream. We have been using that internally within Sutter on some of our dashboards and are currently in the process of evaluating how that’s really been helpful to our leaders in trying to understand the next iteration of that internally.
Leon Clark, Sutter Health
Externally, we’ve actually created a very user-friendly packaging of this and have been solicited by multiple different institutions to share that knowledge and the actual model on how to calculate the health equity index and how to use it. So, there are several different partners across the country exploring that work and seeing also how they may adapt it. We’ve used that index in creating a larger body of work that we’re developing around measuring health equity in general. We’ve done a lot of work around vaccine equity in our system and have developed a vaccine equity index with some of the same underlying concepts as an evolution of that process.
All of this is a body of work that adds to a national conversation around how do we measure health equity? How do we hold ourselves accountable to being sure that we are equitable or that we’re achieving health equity? We view ourselves on the cutting edge in starting that conversation and the health equity index is a catalyst for our large work in the space.
What are some other initiatives that are part of this Institute?
Azar: I think a major initiative that’s been a great example of the Institute in action has been our work around vaccine equity within the Sutter system. We’ve really been on the front lines of working with our greater vaccine task force to create a subcommittee that’s specifically focused on vaccine equity. We are trying to create targets that incorporate equity…and the disproportionate burden of COVID within hospitalization and how we might then think about our targets to address that for some of our patient groups.
Another major area that we’re focusing on is social determinants of health data. That is something that’s being talked about and recommended across the country. Health systems are really thinking about the best way to capture this information. Not only because it really helps in the individual patient interaction between the physician and a patient, but also at the programmatic level in understanding how our populations may differ in terms of their social determinants of health. Understanding those determinants within our system is important for us to think about how we address the root causes of these issues.
Another project that we’re excited about is our work in understanding our housing insecure population. There was some recent legislation in California that came into effect in 2019 where we can capture that information for all of our patients who come to the emergency department. We’re now able to look at that information and start to understand some of the nuances in our housing insecure population. That goes into that area of access and care transitions and thinking about what we as a health system may do in response.
Clark: One other thing that we’re doing that’s critically important to health systems is understanding how we engage the community. We’re in the process of putting together a community action network. Health systems across the country need to sort of rethink how they engage with patients, especially those that are most vulnerable. Right now, the system requires them to understand our system and how to access care appropriately. What we’re finding is that there is variation…and we have to really turn it on its head and think about how to bring information and guidance to people where they are. How do we leverage the most trusted voices in the community? These are typically community-based organizations. We want to work with them to develop solutions on behalf of a target population.
What challenges do you foresee in advancing this work?
Clark: There is a difference between equity and equality. We have to recognize that for vulnerable groups, we may have to take additional steps to achieve equitable outcomes. That is a new message within health systems. We all think about providing equal care but that doesn’t necessarily consider the probability of an adverse outcome. We know that certain populations have a greater risk of a bad outcome. The indexing that we do adjusts for that. The action is we have to do more outreach. You may have to provide disproportionate resources.
Secondly, equity is not secondary to our primary mission to support the needs of every patient who comes through our door without regard to sex, race, ethnicity, and sexual orientation. Integrating this fully within our core business operations and core practice settings has been a real challenge, but one that I think many organizations have to commit to in order to make progress.