Building Toward Health Equity: A Report on Maryland Hospitals' Progress

Building Toward Health Equity:

A Repo R t on M ARyl A nd HospitA ls’ pRog R ess

executive summary

The Maryland Hospital Association is proud to release, “Building Toward Health Equity: A Report on Maryland Hospitals’ Progress,” an important overview of health equity initiatives undertaken by hospitals across the state.

Health equity, defined as the highest level of health for all, irrespective of demographic factors, remains an unmet goal in society. This report sheds light on Maryland hospitals’ actions and commitment to address health disparities and outlines innovative efforts in this vital area, including:

• Increasing workforce diversity and promoting professional development for underrepresented groups in health care

• Providing culturally responsive care that respects patients’ diverse backgrounds and experiences

• Addressing social drivers of health, such as poverty, lack of access to healthy food, and inadequate housing

Hospitals play a pivotal and uniquely important role in advancing health equity. Recognizing this, the MHA sought and compiled examples of unique health equity work from the state’s hospitals and health systems. This report showcases 37

programs and projects, which are representative of the myriad activities hospitals invest in to tackle social drivers of health under these five key domains:

• Economic Stability

• Education Access and Quality

• Health Care Access and Quality

• Neighborhood and Built Environment

• Social and Community Context

In addition to sharing ongoing efforts, recommendations for future work and reporting are included to ensure ongoing progress. It guides future initiatives and fosters collaboration among hospitals, health systems, and stakeholders.

As we collectively work toward the highest level of health for all, this report stands as a testament to the dedication and innovation within the hospital field to address and rectify disparities.

We look forward to making progress toward our shared goal of health equality for all Marylanders.

Formation of Foundational structures

- Diversity, Equity and Inclusion Advisory Group & Health Equity Task Force formed

- Identification of opportunities for fieldwide collaboration to address inequities across Maryland

integration of equity principles

- Equity becomes core value of MHA and member hospitals

- Introduction of the Commitment to Racial Equity

- Partnership with Maryland Health Education Institute for racial equity training and peer learning

data and educational Content development

Development of an Equity Dashboard for shared learning, insights and accountability.

evolution of Assessment and operational Approach

- Creation of equity toolkits

- Implementation of equity policy assessment process including internal MHA equity policy audit

- Creation of Vice President for Quality and Equity role at MHA

- Formation of the Health Equity Advisory Committee

- HBCU Nurse Staffing Consortium is established

education and Workforce Focus

- Embedding equity education in monthly MHA Associates meetings

- Hospital field supports JoinMdHealth to focus on diversifying hospital workforce

Continuous improvement

- Regularly assess and refine equity policies and practices

- Monitor and report on progress of equity initiatives

- Encourage ongoing collaboration and learning across the hospital field

MHA Commitment to Racial Equity

Adopted by MHA’s Executive Committee of the Board and all member hospitals and health systems in June 2020

The evidence is indisputable: racism—overt, implicit, and structural—has had catastrophic consequences impacting health and life expectancy for generations. The COVID-19 pandemic shines a powerful light on racial inequities we’ve already known to exist in access to care and disparities in health outcomes.

Racism amounts to a public health crisis. Those who experience racism suffer undue, often constant stress, which has ill health effects. Racism also underlies social determinants of health such as housing, education, nutrition, employment, and public safety. Inequities in access to health care, as well as in the quality and outcomes of care, are detrimental to the health of our whole community. Moreover, racism strains the resilience of our own health care workforce. Such inequities are wholly avoidable and unjust.

To dismantle racism and its very real, incapacitating effects, MHA leans on its mission, “To advance health care across our state and the health of all Marylanders.” We have already begun the journey toward health equity; we will now redouble our efforts.

Maryland Hospital association will:

• Partner with other aligned groups within and beyond the health care sector to secure adoption of public policies that promote racial equity in social, economic, environmental, and other domains

• Conduct and disseminate research on ways to eliminate bias and remove disparities in health care and to achieve equitable health outcomes

• Support expanded access to health care for marginalized groups, such as prioritizing health care resource allocation for underserved populations and eliminating gaps in health insurance

• Engage in community conversations about race, social determinants of health, institutional bias, and ways to elevate community members’ trust in the health care system

The governing body of MHa asks Maryland’s hospitals and health systems to:

• Ensure that equity and inclusion are embedded in organizational values; operationalize these values through policy and practice; apply a racial equity lens in evaluating performance

• Teach leaders and associates how to understand and to speak about race; to become equipped to undo implicit bias and structural causes of poor health; and to practice culturally competent care

• Change the make-up of governing boards and leadership staffs to reflect the diversity of the community; identify and remove systemic barriers to advancement

• Measure racial disparities in specific areas of organizational performance and undertake formal efforts to reduce those disparities, with accountability for those responsible

• Collaborate with educational institutions to grow the number of health care professionals of color in Maryland

• Adopt racially equitable and inclusive approaches to purchasing and investment decisions

Meaningful change will take time. MHA and Maryland’s hospitals and health systems will hold themselves accountable to fulfill these commitments. We will set metrics and periodically publish reports on progress.

Hospitals Prioritize Health Equity

Health equity Advisory Committee Advances Foundational Work

Hospitals, through MHA, formed two committees in 2019: the Diversity, Equity & Inclusion Advisory Group and the Health Equity Task Force. In December 2022, the two groups merged to form the Health Equity Advisory Committee to better align initiatives, resources, and learnings.

the Committee includes hospital leaders focused on:

diversity, equity, inclusion

population Health

Health equity

Community outreach

the Committee aims to:

• Improve workplace diversity, equity, and inclusion

• Increase health equity for all Marylanders

• Identify opportunities for collective action

• Provide guidance and recommendations to address and reduce health disparities across the state

• Develop and implement policies and practices that promote health equity

• Counsel MHA leadership, MHA’s governance councils, and other work groups

• Improve health outcomes of vulnerable and marginalized communities and promote more equitable access to health care

• Leverage data-driven insights to formally assess equity implications of policy decisions

Breaking Down Silos: Health Equity Advisory Committee

CUltURe

Engage executive leadership in prioritizing DEI and to encourage transformational change at the hospital/and or system level

diversity, equity, inclusion Advisory group

WoRKFoRCe

Increase development, promotion and retention of diverse talent

shared Activities

CliniCAl

Develop and engage in strategies to reduce racial and other disparities

Eliminate racial disparities

Health

equity task Force

CoMMUnity

Prioritize addressing findings from Community Health Needs Assessment

Develop actionable plans to address SDOH needs of patients and families

Health Equity Education

MHA launches Health equity online Resource

In January 2023, MHA launched an online health equity resource hub to reinforce MHA’s commitment to health equity and tools to help the field achieve shared goals. A central location for MHA’s equity-focused activities helps to amplify vital messages and maintain accountability and transparency around these efforts.

MHA’s Health Equity Page offers:

• Resources, such as the Maryland hospital fieldwide Commitment to Racial Equity, social risk communication guidance for members, and a toolkit on managing patient bias and requests for provider concordance

• Webinars and events, including those offered in partnership with the Maryland Healthcare Education Institute

• Information on MHA’s member-led groups focused on addressing health equity, including the Health Equity Advisory Committee and the Birth Outcomes Accountability Work Group

toolkit: Managing patient Bias and Requests for provider Concordance and Reassignment

Managing Patient Bias and Requests for Provider Concordance and Reassignment

Concordance is similarity, or shared identity, between a physician or other healthcare provider and patient based on a demographic attribute, such as race, sex, or age. When a patient change healthcare demands a different healthcare provider, this is referred to as reassignment.

Toolkit designed to assist members at various stages of internal policy development that includes how to engage and strengthen leadership buy-in, formalize policies, accountable practices, and reporting mechanisms, and providing education.

Toolkit includes templates and samples to assist members with policy development, reporting mechanisms, and accountable practices.

Partnered with Your GPS Doc, LLC and Moxie Consulting Group

ocial Risk Management: Assessment and Response tools

Social Risk Management Assessment and Response Tools

Leaders find themselves managing social risks at an increasing rate as organizations are expected to communicate on social justice issues and commit to real action. Responding to social risks is based in understanding the sphere of influence hospitals and health systems have regarding human rights.

Includes scoring criteria to help members determine an appropriate response to social issues and related current events

Partnered with IMPACT ROI, a corporate responsibility and sustainability firm

Addressing structural Racism: tools and techniques to Build Better Culture

• Partnered with the Maryland Healthcare Education Institute

• Webinars focused on developing an anti-racist hospital workforce

• Guidance on how to recognize and stop microaggressions in the workplace and tools and techniques to combat common biases and put an end to institutional biases

• These changes must happen to truly impact and improve health disparities and inequities

“ this seminar provided the most concrete, specific info on how to respond to microaggressions that i have had in a training!”

-Hospital Employee

Legislative Priorities & Advocacy

MHA increases engagement on equity-Related legislation

As part of the field’s commitment to advance health equity, MHA expanded the field’s legislative priorities. Since 2020, MHA almost doubled its support and engagement in legislation related to health equity and/or social drivers of health. This includes:

Bills supported strengthening Health equity 1

This includes legislation to:

Require implicit bias training as part of licensure requirements for health care practitioners subject to the Maryland Health Occupations Boards

Improve nonemergency medical transport processes for individuals on Medicaid with mobility concerns and transportation difficulties

Increase funding for the Physicians and Physician Assistant Loan Assistance Repayment Program to expand access to providers in underserved communities expand availability of affordable health insurance coverage via the Maryland Health Benefit Exchange to undocumented individuals living in Maryland

Advocate for capital funding to support hospitaldriven patientfocused projects that align with the goals of the Maryland Model

Reduce barriers to health insurance by creating Medicaid “express lane enrollment” for individuals receiving certain public benefits, and linking tax returns and unemployment insurance applications to the Maryland Health Benefit Exchange for “easy enrollment” in health insurance

Broaden Medicaid coverage to provide comprehensive medical care to undocumented pregnant women and their children up to the age of 1 year (Maryland Healthy Babies Equity Act)

Create a Nurse Loan Assistance Repayment Program to incentivize nurses to work in underserved areas of the state

Maintain widespread access to telehealth services including audioonly services, which are critical for underserved communities without access to affordable broadband internet—beyond the waivers granted during the COVID-19 health emergency

Establish the Young Adult Health Insurance Subsidies Program to encourage greater health care coverage and access to preventive services for a commonly uninsured age demographic

legislative priorities: social drivers of Health Focus

Economic Stability: Workforce

Bolstered Maryland’s health care workforce to ensure greater access to services and supported bills to lower barriers for more diverse candidates, including international providers

Neighborhood & Built Environment: Housing

Supported measures to subsidize repairs and housing opportunities for disadvantaged populations

Social & Community Context: Violence Prevention

Supported legislation on gun violence prevention, including safe spaces, storage requirements, and voluntary do-not-sell registries

top five

Maryland is ranked among the top five states implementing health equity legislation in a recent Chartis report. The report highlights several health equity-focused statutes, including:

Nonprofit hospitals are required to report their efforts to track and reduce health disparities.

The state’s Office of Minority Health must publish a health care disparities policy report card, which includes racial and ethnic composition data of individuals who hold a license or certificate issued by a health occupations board.

Physicians must complete an approved implicit bias training program in order to renew their medical license or certification.

1 This number includes bill cross files.

Health Equity Innovations

MHA asked member hospitals and health systems to share significant programs and changes to hospital operations that have helped to improve or address health equity and social drivers of health and/or strengthen diversity, equity, and inclusion efforts within their organizations.

A sample of those submissions is included in this report. These incredible examples of innovation show the commitment of Maryland hospitals to achieving health equity.

Each example addresses a social driver of health, and each submission is labeled to identify the area of focus and the community or communities they serve.

Use this table to learn more about how each hospital program is improving care for all Marylanders.

economic stability – 6 submissions

Refers to individuals steady and undisrupted ability to access resources that are essential to one’s life and well-being.

education access & Quality – 4 submissions

Opportunity to participate in quality education programs from elementary, secondary, and higher education to training programs and other continuing education opportunities

Health Care access & Quality – 26 submissions

The extent to which people have equitable, affordable, and available access to needed quality health care services— including physical accessibility and availability via financial means, transportation options, and other factors

neighborhood & built environment – 3 submissions

The physical surroundings and community infrastructure that shape people’s living conditions and access to resources

social & Community Context – 20 submissions

Interpersonal relationships, cultural influences, and community dynamics that shape experiences, opportunities, and overall well-being within a given social environment

Adventist HealthCare

MonTgoMeRy and PRinCe geoRge’s CounTies

pRojeCt:: Community Partnership Fund (CPF) economic stability

Health Care access & Quality

neighborhood & built environment

social & Community Context

pA st F U nd Re C ipients

For more than 10 years, Adventist HealthCare’s Community Partnership Fund (CPF) has awarded grants and event sponsorships to organizations whose work promotes health equity and wellness in the communities it serves. In 2022, CPF supported 36 communitybased organizations through 25 grants and sponsorships. The funding supported efforts related to access to care, mental health, food access, rehabilitation and disability services, racial equity and justice, workforce development, and educational equity for youth.

To be eligible, requests must:

• Originate from a not-for-profit organization

• MobileMed

• Casa de Maryland

• Manna Food Center

• University of Maryland School of Public Health – Center for Health equity (Mission of Mercy)

• Education, Income, & Workforce: Educational equity; workforce development; housing stability

CPF can pivot when significant health crises arise like in 2020 at the start of the COVID-19 pandemic. Aligning giving with community identified needs helped Adventist HealthCare increase the dollar amounts awarded that count as community benefit from 88% to close to 100%.

there has been a 20% increase in objectives being met successfully by grantees.

• Focus on populations in Adventist HealthCare’s services areas of Montgomery and Prince George’s counties

• Address documented health disparities or inequities

• Have a measurable impact on the community being served

• Align with one or more of the Community Partnership Fund Priority Areas

Funding priority areas are updated every three years to align with the Community Health Needs Assessment. When addressing the holistic health of a community, collaboration is paramount. Through CPF, Adventist HealthCare develops partnerships with and provides support to organizations addressing social drivers of health. Current funding priorities include:

• Access to Care: Access to comprehensive mental and physical healthcare

• Healthy Behaviors: Prevention & screenings; food security & physical activity; chronic disease prevention & management

During a typical year, grant applications are reviewed biannually in the spring and fall while event sponsorships are accepted on a rolling basis. Each application is reviewed by a diverse board including stakeholders from across the Adventist HealthCare system. Applications are evaluated by set criteria including but not limited to:

• A thorough understanding of the needs of the population being served (disparities and inequities; barriers they may encounter such as language or transportation, etc.)

• A program reflective of, and responsive to, the needs of the population being served

• SMART (specific, measurable, achievable, relevant, and time-bound) process and outcome measures

To ensure funding has a meaningful impact in the community, the review and application processes is continuously reviewed. Applicants are now required to provide both process and outcome measures (at least three in total) with discreet targets in their applications. If awarded funding, organizations must submit outcome reports to share progress toward their targets. Grantees complete a mid-year and final report while sponsorship awardees complete a post-event final report. Successful implementation of a program, including achieving measure targets, is considered when reviewing subsequent funding requests from organizations.

Adventist HealthCare

MonTgoMeRy and PRinCe geoRge’s CounTies

pRojeCt:: Equity, Diversity, and Inclusion Education and Training

social & Community Context

At Adventist HealthCare (AHC), advancing equity, diversity, and inclusion (EDI) is an integral part of meeting strategic objectives and achieving the hospital system’s mission. A key part of making AHC the “Best Place to Work and Grow” is making sure that team members feel safe and respected. In 2021, with input from their workforce, it implemented a strategy to develop inclusive leaders and team members by providing education and training on understanding and addressing unconscious bias.

AHC’s EDI team introduced a self-paced, e-learning module called Invisible Influencers on April 1, 2021, to educate all employees on the effects of unconscious bias. The objective of this comprehensive module was threefold:

1. To discover patterns related to evaluating other people based on one’s own cultural background

2. To understand how unconscious bias affects decisions and outcomes

3. To apply mitigation strategies to unconscious bias in hiring and the workplace

Between december 2021 and december 2022, e-learning completion among leaders increased from 84% to 93% (see Figure 1), and it increased significantly for individual contributor employees (from 26% to 73%).

Between july and december 2022, 4,348 non-leaders and 636 leaders completed the training. the invisible influencers module is expected to exceed the previous year’s completion rate of 93% for leaders.

Since its inception, this module has been offered annually to all team members and is required for leaders (supervisor and above).

Organization-wide communication from senior leaders and quarterly reminders were essential for communicating EDI learning opportunities to help foster an inclusive, safe, and equitable workplace.

Building awareness among employees not only increased module completion but may have led to improved employee engagement scores for EDI items. In the 2022 Employee Engagement survey, launched in November 2022, the item “This organization values employees from different backgrounds” had a score higher than the state average (4.32 vs. 4.28 out of 5). The top-rated EDI item for Adventist HealthCare was “This organization demonstrates a commitment to workforce diversity”. The question received an 88% favorable response and scored higher than the national health care average. Qualitative responses included statements like “I appreciate the company’s effort on the diversity and inclusion front.”

Adventist HealthCare

MonTgoMeRy and PRinCe geoRge’s CounTies

pRojeCt:: Adventist HealthCare Lucy Byard Scholarship

economic stability

education access & Quality

Health Care access & Quality

Adventist HealthCare (AHC) has long been committed to attracting, engaging and developing the best people to cultivate its mission-centric culture with the goal of having a welcoming, equitable, and safe place to work and grow for all employees.

AHC holds firmly to this commitment even as it addresses the profound nursing shortage experienced by hospitals around the country. To best serve a culturally and linguistically diverse population, AHC makes every effort to ensure that its population of caregivers is similarly diverse. In fall 2021, AHC introduced another initiative to further strengthen its EDI profile: the Adventist HealthCare Lucy Byard Scholarship.

According to American nURse magazine, published by the American nursing Association, Black Americans make up 13% of the U.s. population, but only 11% of bachelorlevel nursing students, 10% of Rns, and 9% of academic nurse educators are Black.

Economic barriers are among the top reasons people of color drop out of nursing school. The Adventist HealthCare Lucy Byard Scholarship was established to mitigate that barrier for qualified nursing students.

In May 2022, Adventist HealthCare named the first three recipients of the Adventist HealthCare Lucy Byard Scholarship. The scholarship provides $20,000 to highly qualified students in their last two years of nursing school. While the scholarship is open to any student

entering their last two years of nursing studies and clinicals, preference is given to candidates who are experiencing financial challenges.

In 2023, two of the initial scholarship recipients qualified for additional funds, and two new scholarships were awarded. Scholarship recipients also are invited to apply to participate in the Nurse Residency Program. After satisfactorily meeting graduation requirements and passing the state nursing exam, awardees are invited to work at an AHC facility. Currently, three of four scholarship recipients are employed by AHC. Additionally, one will graduate in December and has accepted a position in AHC.

AHC provided the seed money to launch the program. AHC’s philanthropy team now is actively raising funds for an endowment that will enable scholarships to be granted in perpetuity.

To cast a wide net for the strongest candidates, in the scholarship’s inaugural year AHC worked with the deans of nursing at two Historically Black Colleges and Universities: Howard University and Oakwood University, and a local college, Washington Adventist University. Within AHC, a work group comprised of stakeholders representing a cross-section of departments including compliance, nursing, human resources/recruitment, mission integration and spiritual care, and philanthropy reviewed the applications and interviewed the candidates. A consensus was reached, and scholarships were awarded.

Ascension saint Agnes Hospital

balTiMoRe CiTy, balTiMoRe CounTy, HoWaRd CounTy

pRojeCt:: Reducing Racial Disparity in AMG Primary Care Offices

education access & Quality

Health Care access & Quality

Ascension Medical Group (AMG) employs 46 primary care physicians at eight offices across Baltimore City, Baltimore County, and Howard County, serving more than 60,000 patients. Twenty-six percent of AMG patients have poorly controlled diabetes (HbA1c > 9). The rate of poorly controlled diabetes among the Black of African American patients is 1.25 times higher than white patients.

Through the Leaders in Equity and Diversity (LEAD)

Collaborative, AMG sought to reduce the disparity in poorly controlled diabetes for Black or African American patients by 20% relative to current baseline.

Key interventions and tests of change implemented to progress towards the goal included:

• Engaged key stakeholders and leaders across departments to identify drivers and change concepts

• Monitor HbA1c disparity trends

• “Touch of Sugar” diabetes education class embedded at Catonsville Primary Care Office

signs of early success include:

• 16% of disparity gap closed

• “Touch of Sugar” diabetes education class no-show rate decreased from 60% to 11%

• Percentage of patients who strongly agree or agree they have a better understanding of diabetes and how to manage it increased from 75% to 100%

• Of those who have their HbA1c checked post-intervention, 100% lowered their HbA1c (n=5)

To reach the goal of reducing racial disparities in poorly controlled diabetes, continuing to embed diabetes education in primary care practices is essential to improve provider engagement, referrals, and access for AMG patients. Additionally, strategic alignment and streamlining of priorities across departments will continue to support better outcomes.

next steps:

• Offer culturally competent diabetes education in all AMG primary care practices

• Advocate for and collaborate with insurance companies on health plan design that provides coverage for diabetes education

Atlantic general Hospital

WoRCesTeR CounTy

pRojeCt:: Mobile Integrated Community Health Program

Funded by the Rural Maryland Prosperity Investment Fund, the Worcester County Mobile Integrated Community Health (MICH) program launched in FY 2022. This program is a collaboration between Worcester County Health Department, Atlantic General Hospital, and twelve Worcester County Fire/EMS departments. The program is designed to provide care coordination services to Worcester County residents identified as having increased social needs or high utilizers of health services, specifically high EMS and ED utilization. In addition to grant funding, both Worcester County Health Department and Atlantic General Hospital provide in-kind resources.

The MICH provider teams consist of a designated paramedic and nurse to be physically present at the patient’s home. Services provided by the MICH team include Health Needs Assessments; Social Determinant of Health Needs Assessment; Health Education; Home Safety Assessment; Vital Signs; Medication Reconciliation; and a patient-center Plan of Care to provide linkage and referrals to community resources. The MICH team will at times provide transportation to medical appointments for MICH patients if alternate transportation is unavailable. In addition, follow-up phone calls and home visits occur as needed. Patients enrolled in the MICH program are followed for up to one year. The main goals are to:

• Establish a multi-disciplinary Mobile Integrated Community Health (MICH) team, a consortium for program support, and a referral process for high utilizers of ED and EMS services to the MICH program

• Provide care coordination activities to reduce social determinant of health barriers and increase access to appropriate preventative health services and community resources

• Improve health outcomes by increasing MICH patients’ ability to self-manage their chronic diseases

• Reduce over-utilization of EMS and ED services for MICH patients

Data from FY 2022 shows data collection and analysis became standardized in Q4. Referrals were tracked by source, jurisdiction, age, race, referral result (accepted/ refused by patient), and primary diagnosis.

FY 2023 enrollment by jurisdiction is shown below. In FY 2023, Worcester County Health Department worked with CRISP to utilize pre/post reports, as well as CRISP Breakdown of Charges reports. These reports, not shown, demonstrate the savings yielded by this program related to ED and EMS costs for the enrolled patients. As an example, analysis of the most recent three-month period for Atlantic General Hospital, the pre/ post enrollment breakdown of charges report showed a decrease in ED costs from $211,275 to $90,507 for MICH patients. While cost is decreasing, access to care and outcomes are improving. These patients are connected to primary care and community resources.

The goal in FY 2024 is to expand the MICH program by broadening referral criteria and integrate a provider who can actively manage the patients’ medical conditions utilizing telemedicine capabilities and provide ongoing follow ups. The program sustainability depends on external funding resources, primarily grant funds.

CalvertHealth

CalVeRT CounTy

pRojeCt:: HR Collection Tool and Community Resources Webpage

Health Care access & Quality

social & Community Context

CalvertHealth is proud to provide the highest level of safe, quality health care regardless of race, culture, language, religion, disability, sexual orientation, gender identity or expression, and age. As a part of new patient safety goals that took effect in July 2023, CalvertHealth’s top priorities were to deploy the Community Resources page through its website—www.calverthealthmedicine.org/communityresources—and activate the social determinants of health screening tool for all inpatients. The screening tools and the resources webpages were published on May 30, 2023.

The organization is improving access to important information and resources that address basic needs such as food and shelter; health screenings and needed care; education to improve health; and a variety of other resources. Once admitted to the hospital, case managers utilize the social determinants of health tool in the EHR to screen each patient. If a patient indicates there is a barrier to care or access to basic needs, a process is triggered in which the patient is provided the necessary resources from the webpage. The case manager works with the patient through the entirety of their stay to ensure there is a safe discharge plan with appropriate connections to resources, and upon discharge follow up phone calls and other assistance is provided as needed. Post-discharge coordination efforts include medication and transportation assistance programs.

Feedback has been extremely positive with CalvertHealth’s Healthcare Roundtable members taking advantage of the website resources in a one-stop resource center.

Hospital Consumer Assessment of Healthcare providers and systems (HCAHps) score for discharge information has improved since the launch with an increase in patients better understanding of information and more concise information being given to them.

Anecdotal feedback has been extremely positive with CalvertHealth’s Healthcare Roundtable members taking advantage of the website resources in a one-stop resource center.

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Score for Discharge Information has improved since the launch with an increase in patients better understanding of information and more concise information being given to them.

This initiative has combined the resources across many community partners such as Partners in Accountable Care Collaboration and Transitions (PACCT), Highway to Health in collaboration with the Calvert County Health Department, Skilled Nursing Facility Workgroup to assist with improving handoffs, Community Tenure Workgroup to focus on discharge instructions and data sharing and screening tools for social determinants of health, as well as Wheels to Wellness for assistance with transportation. Resources for caregivers such as dental needs, screenings, substance use disorder treatment services, support groups, transportation and utilities, housing, and food insecurity were placed on CalvertHealth’s publicfacing website.

The materials were available for patients and community partners in one convenient location, but this also provided an avenue for medical staff members to respond to health disparities among their own patient populations.

Carroll Hospital, part of lifeBridge Health

CaRRoll CounTy

pRojeCt:: Access Carroll

Carroll Hospital opened Access Carroll in January 2005 to serve medically uninsured patients. Supported through The Partnership for a Healthier Carroll County, a partnership between Carroll Hospital and the Carroll County Health Department, Access Carroll addresses health disparities in Carroll County providing:

• Primary Health Care – Acute and Chronic

• Behavioral Health Assessment and Treatment

• Withdrawal Management – Detoxification

• Medication Assisted Treatment – Vivitrol and Suboxone

• Overdose Response Education - Naloxone

• Family Dental Care

• Medication Assistance – Medical Supplies

• Laboratory Testing

• Radiology Services

• Referrals to Specialists

• Medical Case Management – Care Navigation

• Peer Recovery Assisted Support

• MobileMed

• Casa de Maryland

• Manna Food Center

• University of Maryland School of Public Health – Center for Health equity (Misson of Mercy) Medical Visits

5,260 6,071 2,944

Behavioral Health Visits dental Visits

• More than 2,000 Individuals engaged in Care Management

• More than 1,100 individuals working with peer support

• 1,011 people in active SUD treatment

• Public Assistance Application Support

• Patient Education

• Community Resource Information

• Health Insurance Exchange and Medicaid Enrollment onsite

The goal is to reach high-risk community residents in Carroll County before they come to the hospital/ED or after discharge, providing integrated medical, dental, behavioral health, and substance use disorder care/ services at one location.

Children’s national Hospital

WasHingTon, d.C.

pRojeCt:: Anti-Racist Residency Program

education access & Quality

Health Care access & Quality

social & Community Context

The Children’s National Hospital Pediatric Residency Program focuses on training our future pediatrician workforce in an environment that is intentional about equity. The 120 trainee physicians learn and serve on the front lines of 14 Children’s National Hospital clinical divisions, and incorporating equity in their training is essential for current and future health outcomes of children.

The pediatric residency program has had a focus on diversity, equity, inclusion and justice for many years. This focus was amplified by the creation of the Advancing Diversity in Academic Pediatrics (ADAP) program in 2014 that hosts and mentors senior medical students from around the country who identify with races and/or ethnicities underrepresented in medicine.

The program also created an affinity group to enhance belonging and a residency faculty leadership role for DEI to further enhance these efforts. As these initiatives were implemented, Children’s National experienced a gradual and sustained increase in residents from groups considered underrepresented in medicine—from 11% (2014) to 35% (2023). During this same period, the national average for these same pediatric residents has remained unchanged at 16%.

The program was awarded the 2022 Accreditation Council on Graduate Medical Education Dr. Barbara Ross-Lee DEI Award, and the successful initiatives were published in the journal Academic Medicine.

As these initiatives were implemented, Children’s national experienced a gradual and sustained increase in residents from groups considered underrepresented in medicine—from 11% (2014) to 35% (2023). during this same period, the national average for these same pediatric residents has remained unchanged at 16%.

In 2020, as the world recognized the continued effects of racism, the program’s residents and leadership team asked themselves how they could intentionally be an anti-racist residency program. This led to the formation of six resident-led and faculty-supported working groups, called the Building Equity Initiative, where trainees took the lead in addressing issues ranging from representation to equity in research. Through the generous support of Horacio and Cinthia Rozanski, the Building Equity in Graduate Medical Education (BEING) Initiative was created to centralize and focus the effort.

Ten BEING Team faculty and multiple collaborators now focus on local and national scholarly work and demonstration projects dedicated to equity in academic medicine. Key projects include:

• An expanded community-based service-learning curriculum was created that established a national model for service-learning in graduate medical education. Children’s National partnered with a local, nonclinical, community-based organization journal Academic (CBO) that serves under-resourced children and families living with mental health issues to provide all second-year residents the experience of participating in activities including serving as medical experts for family support groups, advocating for support services during hearings for justice-involved youth and participating in school advocacy work, all to improve access to health care, experience learning from our community and build trust with community members.

• A novel opt-out mental health wellness program was implemented to promote equity in mental health access among trainees, as the disparity in mental health care was observed to extend to this already vulnerable group. Also, the stressors that are believed to exacerbate biases in health care providers are amplified for medical trainees. Through this program, a psychologist has developed a special understanding of the unique needs of residents and provides mental health counseling and connects them to community resources to help maintain their well-being as they serve our communities.

• Creation of an antiracism in residency report card was led by our Children’s National team in collaboration with national experts. Delphi methodology was used to convene a national expert panel who refined antiracism metrics for residency training programs in all disciplines. These metrics have already demonstrated an impact through pilot testing nationwide. The goal is for these metrics to influence future regulatory requirements of training programs.

• Health equity learning objectives were created using a scholarly approach with a national expert panel. The goal was to further describe the knowledge, skills and attitudes that pediatric residents should achieve by the end of training in order to advance equitable outcomes for children. These learning objectives provide a scaffold for residency programs across the country to build health equity curricula.

• An alumni advocacy analysis has helped validate and apply a tool that gauges the impact of our training program on child advocacy nationwide.

The efforts of BEING has produced 16 abstracts presented at local, national and international conferences, a manuscript in an academic journal, and most importantly, tangible innovations in how pediatricians are trained to better serve an increasingly diverse group of children and families.

• A national faculty health equity needs assessment surveyed nearly 1,000 pediatric faculty nationwide to identify faculty development needs related to teaching and modeling health equity principles. Based on the findings, department-wide trainings are underway for Children’s National faculty who are critical to teaching and modeling health equity for the trainees who serve our community.

Frederick Health

fRedeRiCK CounTy

pRojeCt:: Reducing Readmissions for Patients with a High Patient Advisory Index (PAI)

Health Care access & Quality

Frederick Health identified a health disparity in readmission rates for patients with a high PAI vs. those with a low PAI. It began to address this disparity in 2021, and efforts intensified after joining the LEAD Collaborative in August 2022.

Risk-Adjusted Readmission Rates Base: Cy 2018

september 2021 - August 2022

Key interventions:

• Developed detailed, actionable reports to identify and understand opportunities and prioritize efforts.

- Medicaid status was the primary risk variable. When linked to performance with timely follow-up for Medicaid beneficiaries (CRISP), Frederick Health initiated a workflow redesign engaging community health workers to ensure follow-up appointments were made and barriers addressed to increase the likelihood of a successful appointment.

• Established a PAI Task Force responsible for reviewing data and initiating PDCA efforts.

• Updated Care Alert process

• Partnered with MCOs to actively co-manage multi-visit patients

• Engaged and educated key stakeholders

• Conducted readmission interviews with high PAI patients to better understand the readmission drivers from the patient’s perspective versus our assumptions

• Implementation of Social Determinants of Health screening, with plans to risk stratified by Race, Ethnicity and Language (ReaL) data, ZIP code, and payer

Case-Mix Adjusted Readmission Rates

june 2022 - May 2023 CRisp Results

lessons learned:

• There was a smaller subset of patients within the larger Medicaid population with very high needs; many had a mental health or substance related diagnosis. Many patients were well known to the system; however, interventions were not effective Underscored the importance of patient centered interventions based on readmission interviews and/or Social Determinants of Health screening

• Needed to engage and build trust early to increase engagement after discharge

• Community health workers, peer recovery specialist, and community connections are critical to success

garrett Regional Medical Center

gaRReTT CounTy

pRojeCt:: Well Patient Program

Health Care access & Quality

Garrett Regional Medical Center (GRMC) began its Well Patient Program in 2019. The program addresses the issue of chronic disease patients returning frequently to the emergency department (ED) for care. Staff noted that these returning patients often lacked a primary care provider, were low income, struggled with numerous social determinants of health, and seemed to have little control over their health condition(s). The Well Patient program supports these patients as they work toward improved health outcomes.

In the Well Patient Program, staff:

1. Assists in finding patients a primary care provider

2. Assists in determining challenges in patients’ lives that prevent them from realizing a better quality of life

3. Helps patients assess choices they are making that could hinder their improved health

4. Helps patients create a plan to address issues that are preventing them from an improved health outcome

Patients work with staff to create a patient care plan that helps them realize they can make decisions that

2019

CHW: 163 patients served

empower them in their daily lives. The plan addresses physical health, but also addresses issues/stressors that could exacerbate the patient’s health, such as lack of childcare or elder care, transportation challenges, food insecurity, housing, etc.

As patients work through their care plan, they have the support of hospital personnel. Each patient works directly with a community health worker (CHW), who helps them find support through community agencies and organizations that help people overcome daily challenges they face. Patients work with a nurse navigator from the emergency department, who supports health care decisions as patients are discharged from the ED. The ED personnel use the CRISP program to breakdown patient-specific information that can help determine the level of assistance patients may need once discharged.

Patient returns to the ED are tracked. Well Patient Program staff work with these patients to determine the cause of the ED visit.

Patient tracking continues when patients are transferred for care to other facilities; as these patients are discharged from those facilities, GRMC staff contact them to ensure they have a post-discharge care plan. If they do not, GRMC staff work to help the patient create one. Well Patient Program staff continue to treat these patients as GRMC patients, helping them work through care plans and toward the goals the patients themselves outlined.

2023

CHW: 1,278 patients served

ED Nurse Navigators: 79 patients served ED Nurse Navigators: 756 patients

342 total patients assisted

3 Months prior

46 patients = 150 ED visits

2,034 total patients assisted

3 Months in program

Same 46 patients = 24 ED visits

The program has been extended to GRMC’s cardio-pulmonary and cardio-vascular departments.

greater Baltimore Medical Center

balTiMoRe CounTy

pRojeCt:: GBMC Pathways: Advanced Primary Care

Patient-Centered Medical Home Model

Health Care access & Quality

social & Community Context

In November 2019, Greater Baltimore Medical Center (GBMC) began using its proven advanced primary care patient-centered medical home model in the Jonestown neighborhood of Baltimore City with the goal of providing a comprehensive team approach to disease management for residents struggling with diabetes, hypertension, and obesity.

In 2022, hospital admissions in the Jonestown neighborhood were more than double state averages— 52.4% of residents lived below the poverty line and 44.3% lived in a food desert. With a history of distrust in the health care system, GBMC needed to focus first on being visible in the community through events such as Walk with a Doc as well as create strong partnerships with local community organizations to gain residents’ trust as a health care resource. To-date, GBMC serves 917 patients in its Jonestown practice, 59% of which are Black.

In April 2022, GBMC sought outside funding for the program and elevated its approach. It continues to pursue funding for this initiative, and a portion of funds raised are shared among 10 community partners.

The Jonestown practice focuses on the unique needs of every individual, and a team proactively follows up with patients to practice preventive medicine and chronic disease management. The practice is convenient, accessible, and offers a network of specialists, including behavioral health services, if needed.

Providers and administrative leadership regularly review an ondemand dashboard that tracks patient metrics such as BMI, depression screenings, and Hemoglobin A1C levels. The entire team can adjust the approach based on the data.

the patient-centered medical home has been proven with data to be effective in managing chronic disease and improving outcomes. it helped 82.4% of patients control their blood pressure, up from 75% in August 2022. Currently, 91% of qualified patients receive a BMi screening and followup appointment, up 10 percentage points from last fall. Also, the number of patients with uncontrolled diabetes (defined by poor A1C levels) has been reduced from 45% to 23%.

Environmental, racial and lifestyle factors also play a significant role in overall health, so GBMC screens patients to ensure they have the wraparound services they need. Partnerships with local community nonprofits have been instrumental in providing patients with resources to address social drivers of health (SDOH).

As an example, GBMC aims to completely resolve transportation as a barrier to quality health care by bringing care directly into the homes of elders through Gilchrist as well as partnering with Lyft to bring patients to appointments.

In February 2024, GBMC will launch an integration of EMR where GBMC providers can close the loop on SDOH by connecting and tracking referrals to community partners. This multi-directional communication protects patient data but allows GBMC providers to see if individuals accessed resources available, track their progress, and recommend further care.

Holy Cross Health

MonTgoMeRy CounTy

pRojeCt:: Recruitment Strategy to Promote Equity economic stability

Holy Cross Health has a recruitment strategic plan that promotes diversity, equity, and inclusion. The goal is to attract and retain a workforce that reflects and leverages the diversity of the community. Holy Cross recruitment initiatives are designed to source applicants at all levels. This submission, however, is to highlight a diversity initiative, the PIE Program, that supports recruitment of applicants for entry-and support-level positions.

Holy Cross Health created the PIE program (Pathways to Independent Employment) in 2015 to remove employment barriers for individuals from hard-to-hire populations.

Annually, Holy Cross Health identifies the number of positions to fill through the PIE Program and established strategic partnerships with community agencies who serve as a pipeline for candidate referrals. They also work closely with hiring managers where job opportunities exist. Their awareness and support of the program are key components to the program’s success. Program applicants undergo a two-level vetting process. They are initially screened by the referring agency,

followed by an interview with a Holy Cross Health recruiter. Candidates whose applications are often overlooked due to a variety of factors from their past, are now provided with an opportunity to interview with hiring managers. Once hired, they receive ongoing support through an employment coach, a PIE Program Coordinator, and an employee assistance program.

The positions identified for the PIE Program cover an array of duties and responsibilities that affect patient care. Since the program’s inception, Holy Cross hired 46 candidates. The hiring target for fiscal year 2023 was eight, and nine new colleagues accepted positions within support services, clinical support ,and administrative job teams. Holy Cross is planning for 10 PIE program hires in FY2024.

Holy Cross’ mission emphasizes commitment to ensure accessibility of services to those most vulnerable and undeserved. Whether going from homelessness to getting an apartment or obtaining health insurance for the first time, this program is changing lives in a positive way.

tAR get pop U l Ations include veterans, the homeless, seniors, at-risk youth and others in hard-to-hire categories

provide meaningful employment opportunities that offer competitive pay, health care benefits, and career growth

Holy Cross Health

MonTgoMeRy CounTy

pRojeC

t:: Holy Cross Health Centers

Health Care access & Quality

Since 2004, Holy Cross Health has operated safety-net health centers serving low-income residents who are uninsured. It started the health centers in recognition of the challenges uninsured patients face accessing health care services. Beginning with one site, the network has now expanded to three sites, serving both adult and pediatric patients. Locations were selected based on a high community needs, index score, and good access to public transportation. Most staff are bilingual in English and Spanish, and many staff members are immigrants themselves.

Each year, Holy Cross Health Centers provide approximately 35,000 visits to 10,000 unique patients. The typical patient is a 45-year-old Latina immigrant from Central America. Many of patients have complex medical histories. Chronic diseases such as hypertension and diabetes are common as is a history of trauma.

These services are rooted in primary care but have expanded to provide a more comprehensive portfolio including medications, medical and surgical specialty care provided by volunteer physicians, integrated behavioral health, and a social work program offering case management and assistance from community health workers. In addition to clinical care, Holy Cross offers health education programs to help patients manage chronic conditions. When patients are hospitalized, the hospital ensures a timely follow-up visit is scheduled prior to discharge. For patients newly diagnosed with diabetes, they learn how to test their blood sugar in the hospital using the same products they will be given in the health center.

improve access to care for low-income, uninsured residents to improve health status and reduce avoidable hospital utilization

Holy Cross established a fund in the Holy Cross Health Foundation that pays for things that are creating significant barriers to good health. This has included prosthetics, hearing aids, rent, legal assistance for an asylum application, food, and transportation. In addition to providing individual assistance, a portion of this fund supports the community surrounding our Health Centers. Initiatives have included support for a community garden, assistance with Supplemental Nutritional Assistance Program (SNAP) enrollment, and employment readiness support for individuals who have had difficulty securing a job.

The cost for operating these programs is partially offset by Montgomery County’s safety net programs— Montgomery Cares and Care for Kids. However, most of the expense is covered by Holy Cross Health operating revenue. This program is valuable because it improves the health and well-being for the most vulnerable residents in the community, and it helps to better manage total cost of care by reducing the need for avoidable hospitalizations to address unmanaged health conditions.

the johns Hopkins Hospital and johns Hopkins Bayview Medical Center

balTiMoRe

pRojeCt:: The Johns Hopkins Access Partnership (TAP)

Health Care access & Quality

social & Community Context

In 2009, The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center established The Access Partnership (TAP), a financial assistance program for uninsured residents of Baltimore City to obtain specialty care.

Since the implementation of the Affordable Care Act (ACA), TAP has primarily served low-income immigrants who are ineligible for Medicaid coverage or subsidies under the ACA (primarily undocumented immigrants).

Between Jan. 1, 2020 and Dec. 31, 2022, 4,406 unique patients were enrolled in TAP, of whom 60% were female, the median age was 40, and the vast majority (91%) identified as Hispanic or Latino with limited English proficiency.

50,452

outpatient appointments were scheduled through tAp

A total of 50,452 outpatient appointments were scheduled through TAP, with the highest volume in radiology (17%), followed by internal medicine (14%), physical therapy (10%), ophthalmology (10%), and pediatric psychiatry (6%).

Since 2020, TAP has experienced consistent growth in outpatient utilization (11,870 visits in 2020, 16,845 in 2021, and 21,737 in 2023), but slightly decreased emergency department utilization (705 visits in 2020, 671 in 2021, and 646 in 2022). Approximately onefourth (26%) of emergency department visits resulted in inpatient hospitalizations. TAP plays an essential role in the care of uninsured low-income residents in Baltimore, especially undocumented Latino immigrants.

johns Hopkins Medicine

balTiMoRe

pRojeCt:: Expanding the Collection, Reporting and Analysis of Standardized

Data

Health Care access & Quality

social & Community Context

From April 2022 through April 2023, the Johns Hopkins Medicine (JHM) Office of Diversity, Inclusion and Health Equity, Armstrong Institute for Patient Safety and Quality, and Office of Population Health conducted a health equity workgroup. The purpose of the workgroup was to ensure that regulatory metric requirements aligned with JHM’s health equity strategic priorities and to create a systemwide health equity metrics implementation/action plan. Regulatory requirements from The Joint Commission, the Centers for Medicare and Medicaid Services, and the National Committee for Quality Assurance HEDIS measures were reviewed to stratify quality and safety data, identify disparities and develop a written action plan for at least one disparity.

data in a health equity view tab on their existing dashboards:

• Current record vs. historical demographics

• Race and Ethnicity

• Historical Race and Ethnicity Values

• Preferred Language for Healthcare Discussions

• Age

• Payor

• Sexual Orientation and Gender Identity (SOGI)

• Health Equity View Template

The race and ethnicity categories were updated as of September 13, 2022, and March 16, 2023, per the U.S. Department of Health and Human Services Office of Minority Health (2011 Standards), which were required to be included in the CMS IRFPAI 4.0 (Inpatient Rehabilitation Facility Patient Assessment Instrument).

the purpose of the workgroup was to ensure that regulatory metric requirements aligned with jHM’s health equity strategic priorities and to create a systemwide health equity metrics implementation/action plan.

JHM’s approach was to identify central and entityspecific resources, which included an inventory of quality improvement and clinical outcome dashboards. JHM’s Office of Diversity, Inclusion and Health Equity provided stakeholders an overview of how health disparities affect patient outcomes, gave guidance to all analytic teams on race, ethnicity, and language (REaL) data stratification, and developed a process for tracking disparities to measure progress toward achieving health equity. In March 2023, the workgroup released guidance on how to accurately present the following patient demographic

The job aid was debuted during JHM’s Data Analytic Forum on March 8, 2023, where over 70 analytics developers across the organization received an overview of the health equity view and instruction on how to pull historical data from JHM data warehouses to stratify race and ethnicity trends in a consistent fashion. All Tableau quality improvement and patient safety dashboards were updated as of April 10, 2023. New dashboards extending existing ones focusing on behavioral health outcomes are developed as of February 2024.

Overall, the collaborative process made it possible for JHM to effectively use the collective knowledge and expertise of various subject-matter experts and mobilize existing analytical infrastructure and tools to examine potential disparities on key metrics and identify the most immediate actions for reducing health disparities.

johns Hopkins Medicine

balTiMoRe

pRojeCt:: Baltimore Metropolitan Diabetes Regional Partnership

Health Care access & Quality

social & Community Context

In 2019, the Johns Hopkins Medicine (JHM) and the University of Maryland Medical Center (UMMC) were awarded funding from the Maryland Health Services Cost Review Commission (HSCRC) to transform care for patients with prediabetes and diabetes in Baltimore City and Baltimore, Howard, and Montgomery counties, and throughout Maryland.

At its core, JHM and UMMC are spearheading the implementation and expansion of two evidence-based standard-of-care programs: the Diabetes Prevention Program (DPP) and the Diabetes Self-Management Training (DSMT). While the goals for both programs by the HSCRC are volume-based referrals, initiation and retention, the partnership is also prioritizing clinical outcomes aligning with the state’s Statewide Integrated Health Improvement Strategy priorities and population health metrics to include weight loss and BMI improvement, A1c improvement, decrease in health care utilization, and improvement of total cost of care.

Processes/interventions

DPP: The DPP is a yearlong evidence-based program designed for individuals at risk for diabetes or prediabetes. This group-based initiative, usually comprising around 15 participants, is led by a CDCtrained Lifestyle Coach. It guides participants toward a healthier lifestyle by focusing on diet, increased physical activity, stress’s impact on eating behaviors and problemsolving for sustained changes. Program goals include at least 5% weight loss, at least 150 minutes each week of physical activity and HbA1c reduction of 0.2% or greater.

FIGURE 1. DPP Referrals and DSMT Initiations Cumulative Growth Since Funding Inception (Performance Year Started in CY2022)

Cumulative CY22-CYTD23 July dPP Referrals

DSMT: DSMT offers personalized care for individuals with diabetes, delivered by a Certified Diabetes Care and Education Specialist (CDCES). This standard-ofcare clinical service tailors topics including nutrition guidance, medication management, glucose monitoring, diabetes technologies, coping skills, and complications prevention/management to individual needs, enhancing health outcomes.

The Partnership further enhanced awareness for DPP and DSMT via targeted marketing campaigns (print, radio, social media, TV ads). In addition, establishing a Patient and Family Advisory Council (PFAC) played a pivotal role in refining approaches to engage with underserved populations and dismantling impediments to health equity. While transforming and expanding the programs’ infrastructure, the Partnership integrated care teams with nurses, social workers and community health workers (CHWs) to screen for and address barriers to care. The care team works to provide-wrap around services to members to achieve successful health goals and health outcomes. Most recently, the Partnership launched an extensive publicly facing campaign called Healthier2gether and has been working with Baltimore City Local Health Improvement Coalition, places of worship, community housing, and senior centers to engage in DPP and DSMT.

Consistent with the national trend, the health systems significantly underutilized the DPP and DSMT before this initiative. Despite over 50% of the adult population served are eligible, referrals remained below 5% before 2021. To date, access to DPP and DSMT has been expanded for prediabetes and diabetes patients across the City and State by over 10-fold (Figure 1). Notably, UMMC’s DPP achieved Full Recognition status from the CDC, and JHHS’ DPP earned Full Plus Recognition. These statuses reflect successful clinical and retention outcomes within this year-long program.

Cumulative CY22-CYTD23 July dsMT initiations

Kennedy Krieger institute

balTiMoRe

pRojeCt:: Center for Diversity in Public Health Leadership (Center for Diversity) economic stability

i M pACt

Officially established in 2015, the Center for Diversity in Public Health Leadership (Center for Diversity) at Kennedy Krieger Institute’s mission is to develop diverse scholars and leaders who use culturally relevant, evidencebased, and health equity approaches to inform research, practice, advocacy, and policies that promote optimal child brain development. With federal funding from Centers for Disease Control and Prevention, Health Resources and Services Administration, and the Office of Minority Health, the Center for Diversity has supported over 800 undergraduate and graduate scholars and, developed a consortium of university sites including Historically Black Colleges and Universities: Morgan State University, Howard University, and Morehouse School of Medicine, and City University of New York School of Public Health, Rollins School of Public Health at Emory University, University of South Dakota, partnering with Tribal Serving Institutions, the Aaniiih Nakoda Tribal College on the Ft. Belknap Reservation, and the University of California Davis.

With the leadership hub at the Center for Diversity at Kennedy Krieger, this innovative, collaborative program provides undergraduate and graduate scholars from across the country with mentored real-world experiences in evidence-informed and equity-based approaches to promote health and well-being. In the summer of 2023, 85 scholars were welcomed to Baltimore City for a comprehensive orientation that focused on learning and applying health equity approaches to address health disparities and structural and institutional policies that marginalize individuals from historically oppressed racial and ethnic groups, individuals with disabilities, and individuals who are LGBTQ+.

developed diverse scholars and leaders and supported over 800 undergraduate and graduate scholars.

Scholars return to partnership sites to participate in culturally responsive research, clinical, and community advocacy activities. The Center for Diversity includes strong mentoring and coaching components. The Center for Diversity uses a web-based professional development system, the Public Health and Social Sciences-Individual Development Plan (PHaSS-IDP), developed at Kennedy Krieger, for academic and professional development. The PHaSS-IDP guides and helps the scholar to plan successful academic and career trajectories.

A recent 10-year (2012-2022) review of one of the graduate components of the program, the Dr. James A. Ferguson Emerging Infectious Diseases RISE Fellowship, found that the majority (66.0%) of the former fellows were employed in clinical, academic, government, or health department agencies. Almost one-fifth (19.4%) of the responding fellows were actively enrolled in graduate or medical school. Collectively, the Ferguson RISE fellows published over 215 peerreviewed publications, many focused on areas of health disparities solutions. The Ferguson RISE Fellowship was selected as one of the 2024 top 10 summer fellowship programs.

Another equity-based activity previously coordinated by the Center for Diversity is the annual September Room to Grow: Journey to Cultural and Linguistic Competency Conference. Now in its 13th year, the conference is free to students and community members and continues under the Office for Health, Equity, Inclusion, and Diversity at Kennedy Krieger.

Kennedy Krieger institute

balTiMoRe

pRojeCt:: Shared Leadership in Kennedy Krieger’s Equity, Diversity, and Inclusion Mission: Building Leaders Inside and Out (BLIO) economic stability

i MpAC t

In 2020, Kennedy Krieger launched the Office for Health, Equity, Diversity, and Inclusion (O-HEID) to promote the health and well-being of those who work and receive training and services at Kennedy Krieger Institute through evidence-based, culturally relevant, and equitybased approaches that ensure diversity and inclusion. The vision of O-HEID is promoted by activities within the Institute, Maryland state, and the nation. The first step was the establishment of affinity and employee resource groups. Affinity groups benefit the members and the Institute by fostering a welcoming environment, and employee resource groups are employees who collectively gather to address a central unifying purpose. The first affinity group was the Black Affinity Group (B. A.G.) to promote the health and well-being of Black staff at Kennedy Krieger – and provide a safe, brave, and inclusive space to process their lived experiences, receive communal support, and foster an inclusive environment by exploring and implementing anti-racism strategies to apply within the Institute and community. Meeting virtually every other Friday, B.A.G. is open to all Kennedy Krieger employees.

B.A.G.’s collaborative and exemplary leadership work was demonstrated through the development of Building Leaders Inside and Out (BLIO). BLIO developers

Created a collaborative to provide resources, promote trainings and mentorship among staff and community members including Baltimore City high school students.

included partnerships across the Institute - leadership from the B.A.G., O-HEID, human resources, administration, behavior psychology, neurodiversity at work, physical therapy, and representatives from other departments to create this dual-branch institute-wide program. BLIO includes mentorship for employees of the Institute, the Building Within branch, and Building the Bridge, a program that mentors Baltimore City high school students virtually through Canvas Learning Management and clinical shadowing.

After a year of collaborative planning, the Building Leaders Inside component was launched in 2023. Following the recruitment of employee-mentees interested in professional advancement and experienced employee-mentors at Kennedy Krieger, seven menteementor pairs were identified based on professional interests, goals, and experience. Mentors participated in a workshop on Enhancing Mentoring: Using Culturally Relevant Approaches for Mentoring. The mentee-mentor program included sessions on What to Expect from Building Within, Storytelling, Exposure to Disciplines, How You Show Up Matters, and Unlocking Your Potential. The program also included weekly one-on-one mentor-mentee sessions and in-person group mentee sessions for reflection, growth, and application.

lifeBridge Health

balTiMoRe

pRojeCt:: Conversations About Racism & Discrimination (CARD)

social & Community Context

Conversations About Racism & Discrimination (CARD) launched in March 2023 during Women’s History Month as a monthly hour of discussion on a DEI topic. The objective is to create a safe space for team members and employees to talk about racism and discrimination in a meaningful way. The overriding goal is to increase our team members’ comfort with allyship and speaking up in their work environments. This is important because DEI knowledge must translate into DEI literacy and allyship that enhances inclusive workspaces and decreases health inequity. Topics are selected based on current events and employee resource group (ERG) identified needs. Panelists are topic experts, and the sessions are moderated by our Justice, Equity, Diversity & Inclusion leadership. CARD is held virtually every month to allow team members from all LifeBridge campuses to join. Holding it during the traditional lunch hour makes it easier for hourly team members to participate. Sessions are recorded and made available on the JEDI Office website.

outcomes/impact:

increased team members’ comfort with talking about racism and discrimination and enhancing inclusive workspace and allyship.

lessons learned: Prior to the inception of CARD, there was no program at LifeBridge that encouraged team member dialogue on DEI topics. The original goal was to host this session at a set time every month. However various leaders often have standing meetings, and it was impossible to find a set time that worked for everyone. Since participation of senior leadership is key to establishing the importance of the program, it was prioritized to hold CARD meetings when all senior leaders can participate. Soliciting physician participation would be enhanced by providing CME credit.

Although participants are encouraged to complete an evaluation at the end of each session, the response rate has been low. In lieu of evaluations, the chat box data has been a useful source of feedback about each session. Currently, other innovative ways of generating conversation and getting team members’ reactions to the topics discussed are being explored. With these various moving parts, having administrative support is key to the sustenance of this program.

lifeBridge Health

balTiMoRe

pRojeCt:: Employee Resource Groups

social & Community Context

Employee Resource Groups (ERGs) serve the needs of a diverse employee base by promoting inclusion. All ERGs are open to members of the community and allies. They provide a safe space for interaction, advocacy, education and service. ERGs began at LifeBridge in 2018 with the LGBTQIA+ ERG and the Veterans ERG. Since then, it has been expanded to six groups with the addition of the Hispanic Latino ERG (Spring 2020), Black Culture ERG (Winter 2020). Pan Asian ERG (Fall 2022), and the Interfaith ERG (Fall 2022).

ACtions ContRiBUtion to inClUsiVe enViRonMent At liFeBRidge

Interfaith

Black Culture

Hispanic Latino

Veterans Network

The Interfaith ERG provides a platform for employees of diverse religious backgrounds to network and to gain understanding of the various faiths and traditions of fellow colleagues thus reducing tensions that may arise due to religious differences.

The Black Culture ERG works to create an inclusive environment for all African American and Black employees by providing mentorship, networking opportunities, educational courses, and cultural events. Key initiatives: Black History Month events, Juneteenth celebration, mentorship program, and Community Market.

The Hispanic Latino ERG promotes an inclusive environment at LifeBridge Health by creating a space where Hispanic and Latino employees and allies can engage in conversation, collaboration, and community in order to provide opportunities for networking, professional development, and community involvement.

The Veteran Employee Resource Group is a place for members to go for support, to voice needs and concerns unique to those who have served in the Armed Forces, and to learn about benefits and upcoming events. It is also a place where non-Veterans can learn about Veterans, their issues, concerns, and culture.

LGBTQIA+

Pan-Asian

The goal of the LGBTQIA+ Employee Resource Group is to make all LGBTQIA+ team members and patients feel safe and included. It advances inclusion through education, advocacy, serving as a haven for members of the LGBTQIA+ community at LifeBridge Health, and providing an outlet for solidarity, expressing concerns and advocating for change. Key initiatives: Human Rights Campaign’s Healthcare Equality Index, Baltimore Pride and Westminster Pride.

The Pan-Asian ERG creates an inclusive environment for people of Asian descent at LifeBridge. The ERG has been instrumental in the helping of international nurses hired by LifeBridge Health across the different entities in assimilating into the American culture. Activities include assisting them with understanding their paychecks, connecting them with employees of the same culture and other ethnic social organizations for transition support, navigating banking challenges, providing recommendations for housing, explaining school zones and information on driver licensing.

outcomes/impact:

lessons learned: Each group is led by a chairperson and co-chairperson. Their role as volunteer leaders is recognized with a stipend and Bravo points, an internal rewards system. There must be strong collaboration between the ERGs to address the multifaceted dimensions of team member identity. The ERGs also serve as resources for various departments and units in their efforts to promote cultural and interpersonal humility. While the ERGs in and of themselves are not innovative, few local organizations have an interfaith ERG. This group is small but growing and has already demonstrated that religious differences can be something to rally around, not something to divide. ERGs are led by volunteers but require a strong employed administrative assistant to coordinate the events and activities they produce. Having an ERG manager and administrative assistant have been key to sustaining these groups so the volunteer leaders are not overburdened.

lifeBridge Health

balTiMoRe

pRojeCt:: Affirm Care Clinic

social & Community Context

LGBTQIA+ individuals have disparate experiences in health care and have varied unmet medical needs. Affirm Care Clinic opened its doors on March 20, 2023 to provide compassionate primary care to the LGBTQIA+ community in Baltimore. The clinic is located in Towson, Baltimore County. It is open three days a week.

There is an overall increase in the number of patients we are seeing each month.

March 2023 April 2023 May 2023 june 2023 july 2023 August 2023

lessons learned: This program is one of few clinics in the region dedicated to the care of the LGBTQIA+ community. Launching it required a collaboration between clinical and non-clinical staff including IT, marketing, the JEDI office, and the LGBTQIA+ Employee Resource Group. The program is growing through marketing and involvement in community events like Baltimore Pride, Westminster Pride, and other events by the human rights campaign.

The program continues to attract unique patients who were previously never seen at LifeBridge Health. Our goal is to expand services to the LGBTQIA+ community in greater Baltimore and build a center of excellence in LGBTQIA+ primary care services. Some new initiatives include looking to partner with local colleges and offering HIV pre-exposure prophylaxis care. The practice is envisioned to be a five-day-a-week operation with its own dedicated full-time provider group.

luminis Health

anne aRundel and PRinCe geoRge’s CounTies

pRojeCt:: NTSV C-Section Disparity Rate

Health Care access & Quality

NTSV C-Section Disparity Rate

Charlene Harrison, MHA, Monica Jones, MD & Judy Thomas, MBA

Luminis Health

To reach this goal, the health system:

• Published NTSV C-section rates by race, by individual provider

• Held MD MOM implicit bias training for nurses and providers

• Conducted analyses that showed Black patients were 35% more likely to have a vaginal birth with a doula compared to without

LEAD

Collaborative

NTSV C-Section Disparity Rate

Data

• Launched Centering Pregnancy (group prenatal care), which received overwhelmingly positive patient feedback

Lessons Learned and Summary

Charlene Harrison, MHA, Monica Jones, MD & Judy Thomas, MBA

Luminis Health

Luminis Health, the regional health system that includes Anne Arundel Medical Center and Doctors Community Medical Center, set a goal of reducing the disparity in NTSV C-section rates between nonHispanic white and Black patients from 7%—the current baseline—to 5% by November 2023. This measure identifies the proportion of live babies born at or beyond 37 weeks’ gestation to people in their first pregnancy, that are singleton (no twins or beyond) and in the vertex presentation (no breech or transverse positions), via Cesarean.

• Began educating and introducing patients to doula services at the first trimester obstetrics visit

• Publication of NTSV C-Section rates facilitated conversation among care team providers & aided in advancing the focus on this topic

• Standard work implemented to ensure all patients receive education on doula supported births

Charlene Harrison, MHA, Monica Jones, MD & Judy Thomas, MBA

By November 1, 2023, reduce the disparity in NTSV CSection rates between non-Hispanic White and Black/ African American patients from 7% (current baseline) to

Aim Statement

Luminis Health is a nonprofit regional health system formed in July 2019 to build a brighter, healthier future for our region by expanding Anne Arundel Health System with the addition of

We have 100+ affiliated care sites, providing care for 1.8 million people in Anne Arundel and Prince George’s Counties,

By November 1, 2023, reduce the disparity in NTSV CSection rates between non-Hispanic White and Black/ African American patients from 7% (current baseline) to Publication of NTSV C-Section rates by race by individual MD MOM Implicit Bias training – nursing and provider Analysis of our Doula grant demonstrated that African American patients were 35% more likely to have a vaginal

“Luminis” represents our commitment to being a beacon of

PDSA: At the first trimester OB visit, the clinical team will educate and introduce patients to Doula services to include

Luminis Health also contributes close to $100 million annually

Key Interventions and Tests of Change

Based on the success of these efforts, Luminis Health is seeking additional funding for doula services and to expand Centering Pregnancy locations, as well as to continue to educate patients about the benefits of doula supported births.

• Engagement with doula providers was critical in this process and they were invited to attend patient education classes offered at the hospital

Data Lessons Learned and Summary

Health

NTSV C-Section Disparity Rate FY23

• By November 1, 2023, reduce the disparity in NTSV CSection rates between non-Hispanic White and Black/ African American patients from 7% (current baseline) to 5%.

NTSV C-Section Rates by Race and Fiscal Year

Key Interventions and Tests of Change

Publication of NTSV C-Section rates by race by individual

• Publication of NTSV C-Section rates by race by individual provider

MD MOM Implicit Bias training – nursing and provider

• MD MOM Implicit Bias training – nursing and provider education

Analysis of our Doula grant demonstrated that African American patients were 35% more likely to have a vaginal

• Analysis of our Doula grant demonstrated that African American patients were 35% more likely to have a vaginal birth with a doula compared to without

PDSA: At the first trimester OB visit, the clinical team will

educate and introduce patients to Doula services to include utilization of Epic smart phrase and patient handout

• PDSA: At the first trimester OB visit, the clinical team will educate and introduce patients to Doula services to include utilization of Epic smart phrase and patient handout

• Patient education material was developed to provide tips on how to find the right doula for you

Data

• Centering Pregnancy was launched to overwhelmingly positive patient feedback

• Publication of NTSV C-Section rates facilitated conversation among care team providers & aided in advancing the focus on this topic

• Standard work implemented to ensure all patients receive education on doula supported births

• Engagement with doula providers was critical in this process and they were invited to attend patient education classes offered at the hospital

• Patient education material was developed to provide tips on how to find the right doula for you

Next Steps

• Centering Pregnancy was launched to overwhelmingly positive patient feedback

NTSV C-Section Rates by Race and Fiscal Year

• Continue to provide education to patients on the benefits of Doula supports births

• Champion for funding for doulas services so that patients whose insurance does not cover the service have access to this benefit

• Centering Pregnancy: continue to expand our locations where this service is offered. Review outcomes data as cohorts conclude.

NTSV C-section Rates by Race and Fiscal Year

• Continue to provide education to patients on the benefits of Doula supports births

• Champion for funding for doulas services so that

luminis Health

anne aRundel and PRinCe geoRge’s CounTies

pRojeCt:: Reducing Racial Disparities in Total Joint Replacement Outcomes

Health Care access & Quality

Luminis Health, the regional health system that includes Anne Arundel Medical Center and Doctors Community Medical Center, established a goal to track and reduce the disparity in total joint patient (TJR) outcomes between non-Hispanic white and Black patients by 50% by measuring hospital length of stay.

Key interventions included:

• Standardized preoperative risk assessment for all TJR patients—comorbidities, psychosocial, socioeconomic risk factors

• Minority patients and those with multiple risk factors receive one-to-one counseling with a nurse navigator; all patients receive group preoperative education and written materials

• 1:1 counseling includes: comorbidity management, connection to community resources, coordination of medical clearance/PAT, three-to-five-day postop check-in

Additional LOS Interventions:

• Expansion of TJR rapid recovery protocol to Doctors Community Medical Center

• 50% increase in ambulatory survery center-based TJR to facilitate same day discharge outside of the hospital

• Prioritization of patients on discharge day through standardized rounding

• Utilization of bedside dispensing to provide patients w/ medications prior to discharge

Providing high risk and minority patients with additional education and access to institutional resources such as nurse navigators is effective at reducing disparities in length of stay, nonhome discharge rates, 30-day ED returns and readmissions in comparison to institutional historical benchmarks.

While standardized process improvements (e.g. discharge rounding and bedside dispense) have improved length of stay overall, they do not appear to mitigate disparities given their universal application.

Additional interventions targeting Black and African American patients specifically are warranted to reduce remaining length of stay disparities.

Luminis Health plans to conduct additional studies and seek grant funding to support these efforts.

Average LOS Hours Difference: Black/African American vs. Non-Hispanic White: CY2022-2023

Average LOS Hours by Race: CY2022-2023 Black or African American Non-Hispanic White

Difference (Black/AA - NH White) Goal

Medstar Health

balTiMoRe CiTy and MonTgoMeRy, PRinCe geoRge’s, and sT. MaRy’s CounTies

pRojeCt:: Health Equity Organizational Infrastructure, Investments, and Accountability

Health Care access & Quality

social & Community Context

MedStar Health established an operational infrastructure for health equity to ensure it is integrated into existing clinical governance structures and validated as a strategic body of work that impacts the delivery of high-quality and safe care for everyone. The organization established workgroups for the following three areas of focus in its structure: health equity performance improvement, health equity data optimization, and equitable care delivery. The health equity performance improvement workgroup identifies key performance indicators (KPIs) for health

As a result of the organization’s institutional bias reduction efforts, a rigorous retrospective review of historically racecorrected egFR measurements of kidney function was completed to modify wait times for kidney transplants, which resulted in:

• 586 Black individuals with chronic kidney disease having an improvement in their transplant wait time, with a 2-year average wait time improvement

• 33 kidney transplants completed among Black individuals who may have otherwise still been on the wait list with the race-corrected formula.

also develops cultural humility training for registration associates by way of asynchronous training modules and small group facilitated sessions to foster an inclusive patient experience at the time of registration. The equitable care delivery workgroup embeds an including the event reporting and event review process.

gaps in the completeness and accuracy of demographic, language, and social needs data to support health equity initiatives and monitors data integrity. The workgroup

biological constructs, to ensure its systematic removal.

universal GFR formula, the organization led a rigorous retrospective review of prior lab results, using data from the electronic health record, health information

Health e Workshops

Multidisciplinary subject matter experts and key stakeholders synthesize recommendations for health equity initiatives that are data-driven and community-engaged and support entity action plans.

teering Committee

Executive leaders are informed of workgroup recommendations and provide feedback from an EI&D lens.

Councils

EI&D entity councils are informed of health equity initiatives and may provide voluntary support, as needed and based on capabilities.

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Figure-1. Health equity operational structure , and the system’s community members who serve as key

exchange, and scanned reports from outside laboratories, to ensure as many individuals as possible receive the benefits of the more inclusive formula. Within two years, this resulted in 586 Black individuals experiencing an improvement in their transplant wait time, with an average improvement of 2 years, and 33 kidney transplants completed among individuals who may have otherwise still been on the wait list with the race-corrected formula.

, and the system’s community members who serve as key

To support this operational structure, dedicated resources were allocated for health equity and a Health Equity Leaders Coordinating Council (HELCC) was established. The HELCC is comprised of senior executive leaders for each MedStar Health entity who are accountable for overseeing the execution of health equity initiatives. The Assistant Vice President of Health Equity collaborates across the system to lead the direction of health equity programs and has a dual reporting role to the Vice President of Equity, Inclusion, & Diversity (EI&D) and Chief Quality & Safety Officer. A council of community , and the system’s community members who serve as key

members with diverse representation of historically marginalized communities was established to partner in the development of each health equity initiative. Finally, a board EI&D committee was established for the governance of the organization’s health equity operations. MedStar Health has invested dedicated effort across twenty-one associates in the Data and Analytics team, Q&S department, and EI&D department. Among these associates are two system executive leaders sponsoring the work – the Chief Quality & Safety Officer and the Vice President of EI&D. MedStar Health also hired in 2023 an Assistant Vice President of Health Equity, who is growing the system’s portfolio of health equity initiatives and supporting clinical and non-clinical leaders to advance

Additionally, the HELCC has included membership of thirteen executive leaders representing each of the system’s clinical entities, who have collectively identified twenty-one clinical entity representatives to serve on the health equity workgroups.

Health equity performance improvement

Informs strategy to define and improve key performance indicators (KPIs) for health equity.

Health equity data optimization

Informs strategy to address gaps in demographic and language data.

equitable Care delivery

Informs strategy to address sources of systemic bias with implications on equitable care.

embedding equity in safety

*Develops recommendations for healthcare disparity reduction action plans, monitors performance, and collaborates with HELOC in iterative refinements.

Develops recommendations for optimizing demographic and language data fields and data integration. Establishes process to monitor data integrity & communicate findings.

Cultural Humility in data Collection

Establishes training program(s), in collaboration with SiTEL and key stakeholders, that equip associates to collect demographic, language, and social needs information in a culturally sensitive and inclusive manner.

Develops a strategy to embed equity into safety operations, including event reporting, event review, and application of high reliability principles. Establishes process to monitor effectiveness of equity initiatives in safety workflows.

institutional Bias Reduction

Examines clinical algorithms that introduce discriminatory bias based on its use of race and/or ethnicity as biological constructs. Engages key stakeholders to address the algorithms.

Action teams

Figure-2. Health equity Workgroups

Medstar Health

balTiMoRe CiTy and MonTgoMeRy, PRinCe

geoRge’s, and sT. MaRy’s CounTies

pRojeCt:: Community-Based Programs

Addressing Social Drivers of Health

economic stability

neighborhood & built environment

uberHealth

In partnership with Uber, MedStar Health has created a convenient ride option program to provide a reliable means for transportation at no cost to patients who need access to medical care or social services.

MedStar Health patients are eligible if they need medical treatment, lack appropriate or reliable transportation, have a financial need for participation, need local transportation (<25 miles) to and/or from an appointment, and agree to receive texts with ride information. Case managers and social workers can refer patients to the program. Trained and certified Uber super users implement the Eligibility Checklist and an Evaluation of Financial Need Questionnaire. MedStar Health bears the cost of these transportation services. The community health team maintains documentation of each patient’s need for transportation services, including a description of the patient’s treatment requirements and an explanation of the patient’s need for transportation assistance.

In FY23, $730,000 was invested to provide more than 34,000 rides to medical or social services appointments for financially vulnerable residents across the Maryland and DC region.

Hungry Harvest Partnership

MedStar Health’s community partners play a critical role in helping to address the SDOH, and for the past several community health needs assessments, food insecurity has been highlighted as a systemwide barrier. To address food insecurity, we leverage the Community Health Advocate Program to serve the needs of patients in a holistic way. Community Health Advocates are hired from the areas they serve, further boosting the connections between community and hospital. The program is intended to help patients manage their chronic conditions by addressing food insecurity.

MedStar Community Health Advocates are trained to identify patients in need of food assistance, enroll them in the Hungry Harvest program, and provide counseling

through Medstar Health’s partnerships with Uber and Hungry Harvest:

• 34,000+ rides provided to medical or social services appointments for residents experiencing barriers to transportation

• Nearly 72,000 pounds of food delivered and more than 4,600 healthy meal boxes provided to residents with food insecurity

on nutrition and healthy eating on a budget. Referred patients include discharged individuals who were screened positive for food insecurity and are at risk for readmissions or have been diagnosed with diabetes, hypertension, or congestive heart failure. Patients then receive a weekly or biweekly box of fresh vegetables, fruits, and grains from the nonprofit organization Hungry Harvest. Each box is estimated to support four to eight meals. Enrollment is for eight weeks, with an option for patients to be connected with longer-term healthy food programs such as Meals on Wheels, Moveable Feast, Food and Friends, and the federal Supplemental Nutrition Assistance Program (SNAP).

outcomes: The Hungry Harvest Partnership in fiscal year 2023 served 800 individuals, delivered nearly 72,000 pounds of food, and provided more than 4,600 boxes for meals. Under the Hungry Harvest & FoodRx partnership, our food pharmacy partnership provided over 1,800 pounds. of proteins and more than 150 families have been able to create over 11,000 healthy meals.

Identifies people experiencing food insecurity Allows care teams to:

• Make referrals to support access to healthy food

figure 1. Medstar Health’s strategic approach to food insecurity Approach Benefits screening patients for food insecurity in the hospital before discharge planning and in outpatient clinics

• Determine whether individuals are aware of and use federal nutrition programs or need information about applying for benefits

• Discuss other associated physical or social conditions

• Educate patients about good nutrition and strategies to improve food security

• Provide tailored clinical care based on a patient’s needs, food security status and financial stability

including food insecurity screening in electronic health records

distributing food on-site via food pharmacies, food pantries, mobile food pantries and produce markets referrals

Allows food insecurity status to be tracked

• Helps identify patients at the next visit in order to discuss changes or ongoing needs

•Allows the use of appropriate ICD-10 code

• Supports data analysis over time to measure readmissions and other health care utilization rates

• Helps determine a patient’s eligibility for SNAP, WIC, Temporary Assistance for Needy Families (TANF)

- Provides patients with immediate access to healthy food

- Referrals and connection to local food resources; including fresh produce box deliveries.

- Offers opportunities to collaborate with other health care staff, such as dietitians, to provide education about healthy eating habits.

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Medstar Health

balTiMoRe CiTy and MonTgoMeRy, PRinCe geoRge’s, and sT. MaRy’s CounTies

pRojeCt:: Equity, Inclusion & Diversity Focus Structure at MedStar Health

social & Community Context

In 2021, following guidance and support from the MedStar Health Board of Directors, MedStar Health developed a bold framework to more formally ingrain Equity, Inclusion & Diversity (EI&D) as a core component of its culture and strategic business priority for the organization. MedStar Health President & CEO Kenneth A. Samet, FACHE, and Executive Vice President & Chief People Officer Loretta Young Walker serve as co-chairs of a system-level EI&D Steering Committee, consisting of 33 appointees from across MedStar Health entities and functions, reflecting the diverse perspectives, demographics, and roles of the system’s associate population.

MedStar Health shared its EI&D Strategic Focus with all associates early last fiscal year, establishing the work as a strategic business priority for the organization. Developed by the MedStar Health EI&D Steering Committee and reviewed and approved by the MedStar Health Board of Directors EI&D Committee, the strategic framework expresses intentions to make an impact with a strategic focus in five domains: Workforce, Workplace, Community, Provider of Choice/Clinical Care, and Financial/ Operational Results. The EI&D Strategic Focus indicates the organization’s commitment to creating a workplace that helps all people feel appreciated, understood, respected, and connected. It affirms the system’s responsibility to nurture a strong community that builds trust and is grounded in equity and inclusion. The EI&D Shared Purpose, a key component of the EI&D Strategic Focus (See Figure-1) provides the lens through which the organization will view organizational decisions—both big and small.

Continuing to build a diverse and inclusive workplace where all associates feel a sense of belonging and accomplishment across the healthcare system, MedStar Health recognizes the need to bring EI&D efforts to the local entities where all associates have an opportunity to engage and contribute to the impact. In 2022, MedStar Health stood up EI&D Entity Councils across all entities, which are local change

Between Fall of 2021 and Fall of 2022, Medstar Health initiated its comprehensive equity, inclusion & diversity (ei&d) governance structure, which includes a Board level ei&d Committee, established its system ei&d strategy, and built and activated 15 local entity Councils to enable access to ei&d efforts for all associates across the Medstar Health system.

agents, responsible for identifying entity-specific priorities and opportunities for improvement. There are 15 Entity Councils now in place across the organization that execute plans for moving the EI&D Strategy forward within their respective locations.

The Entity Councils are responsible for engaging associates to operationalize EI&D at the local level, including the opportunity for associates to engage with their respective Entity Councils to illuminate challenges, submit ideas and recommendations, celebrate successes, and share opportunities to further enhance MedStar Health’s workplace, services, and communities. Entity Councils offer a multitude of associate engagement and leadership opportunities, including a focus on Awareness & Communication, Education & Development, Community Involvement, and Health Equity.

As of June 30, 2023, there are now 15 Entity Councils operating, with 135+ leaders and associates leading the Entity Councils and Subcommittees; there are 447 members of Entity Councils, of which 56% are associates and 44% are leaders; they have hosted more than 150 local events and initiatives since October 2022 when their business plans were launched.

MedStar Health’s Equity, Inclusion & Diversity

Health’s Equity, Inclusion & Diversity

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Figure-1. Medstar Health’s equity, inclusion & diversity strategic Focus

Mercy Medical Center

balTiMoRe

pRojeCt:: Health Equity Qualifying Submission: Access to Healthy Foods neighborhood & built environment

Mercy has initiated multiple strategies designed to address the issues of food insecurity and access to healthy food options that many in our community lack. These initiatives aim to not only deliver fresh fruits and vegetables to patients who live in healthy food priority areas but also provide education on the long-term benefits of making healthy food choices. Mercy works closely with internal and external partners such as Hungry Harvest to put these into action and target patient and community populations most in need. Below is a description of three main programs that are currently in place.

Harvest Rx: In partnership with Hungry Harvest, Mercy enrolls eligible patients in a four-week program to have a fresh box of produce delivered once a week to their home. Participants are also provided with recipes and nutritional information on the produce they receive. After the initial four-week period, patients can continue their enrollment at a discounted rate. Patients who have financial barriers are provided with assistance from Mercy to continue enrollment if desired. From July 2022 – June 2023, over 650 patients were enrolled in this program. The target population includes patients with chronic conditions, including diabetes and hypertension, financial barriers, or difficulty accessing reliable transportation.

Community Market: Each week since fall of 2022, Mercy has hosted a Community Market featuring fresh produce supplied by a partner, Hungry Harvest. In this span, over 3,000 customers have purchased healthy fruits or vegetables at an affordable price. Knowing the challenges to accessing healthy food options in many Baltimore neighborhoods, this is seen as a valuable resource for patients, staff, and visitors. The market is staffed and promoted by the Population Health team. Other health and wellness initiatives such as blood pressure screenings and stroke education occur simultaneously. Cooking demonstrations: In fall of 2022, Mercy opened the new Preventative Care Clinic, a renovated space in the organization’s Mead Building. In addition to exam rooms and an infusion area, the space features an educational conference room with a fully equipped teaching kitchen. Since the clinic opened, Mercy’s Population Health team has hosted 30 cooking demonstrations with over 350 attendees. The team targets recruitment efforts toward patients with chronic conditions such as diabetes, heart failure, and hypertension. The sessions focus on easy recipes with healthy and affordable foods. Patients who attend the session are also provided with a bag of fresh groceries that match the meal they were taught to prepare. The feedback has been overwhelmingly positive, and the goal is to continue expanding the scope through more classes, live streaming, and an online library of recorded sessions.

Meritus Health

WasHingTon CounTy

pRojeCt:: LEAD Health Equity Improvement

Health Care access & Quality

In July 2020, Meritus Health’s President and CEO, Maulik Joshi, Dr.P.H. 1, published a call to action: Hundreds of Days of Action as a Start to Address Hundreds of Years of Inequity in the NEJM Catalyst. The first action was to identify disparities that exist in the health system and community. Meritus Health formed the Leadership in Equity and Diversity Council (LEAD) whose purpose is to identify and eliminate health disparities. LEAD analyzed data to identify six health disparities present in the current care provided out of 13 measures across race, ethnicity, language, gender, and age.

added to document variation, and updated sepsis core measure manual and educated providers.

Rate of sepsis Core Measure Compliance by Race

Meritus Health eliminated two health disparities since 2020 baseline data: non-compliance and preterm birth rate. data for sepsis noncompliance was non-white 41.8% vs. white 33%. patients improved and it completely mitigated the disparity reducing noncompliance after one year and sustained improvement at year two, non-white 16.3% vs. white 20.5%. data was non-white 12.1% vs. white 9.5%, and non-e speaking. Health disparities reducing the preterm birth rate to 6.9% non-white vs. 9.2% white, and non-e speaking.

Meritus Health standardized a process to reduce health disparities: 1. conduct data analysis, 2. form a team of subject matter experts to make improvements, 3. review disparate data and EB research, 4. test changes on Driver Diagrams, 5. set improvement goals and measure progress, 6. provide a monthly progress report, and 7. celebrate improvement.

For sepsis core measure noncompliance, Meritus Health made the providers aware of the significant disparity, and shared research that unconscious bias

Actions/steps taken

• Driver diagram completed with change concepts identified

• ED provider unconscious bias training sessions and educational resources/links supplied for utilization of all staff and shifts

• ED leadership providing ongoing data related to disparity

• Specifications manual updates reviewed:

- Providers discretion with documentation and changes in fluid bolus treatment for ESRD/CHF patients if appropriate

- Smart phrases created for providers to utilize in documentation of variation in treatment

- (FY20-10 patients could have possibly been removed as an OFI with documentation if applicable)

• Community outreach programs directed to areas of need. All MMG practices provided resources related to sepsis which included specific resources related to pneumonia

- (FY20-35% of black patients had pneumonia as their source of infection with sepsis presentation)

1 M. Joshi, 2020 https://catalyst.nejm.org/doi/pdf/10.1056/CAT.20.0362

• Unconscious Bias training with Metamorphosis Theatre group Spring 2022 to be made available for ED Providers

For preterm birth rate we identified the root cause as lack of prenatal care, tied to SDOH. The labor and delivery team participated in the Maryland Maternal Health Innovation Program (MDMOM) to provide prenatal care to at-risk women, identified perinatal needs including exclusive breastfeeding, and followed postpartum. Outreach provided at high-risk community locations for education and support. English and Spanish helped answer FAQs; how to obtain prenatal care, health insurance, and financial support.

LEAD membership is a diverse multi-disciplinary representation from across the organization. To date, LEAD has created a charter, quality dashboard,

of pre-term Births by ethnicity & Race

improvement process, is governing organization EDI policies, increasing diversity and cultural competence among the workforce, and has implemented changes proposed by employee resource groups (ERGs). LEAD developed an interactive education program with the Metamorphosis Performance Group to provide unconscious bias training to all employees. Evaluations and feedback following education demonstrated that the unique interactive theater presentation was extremely impactful on team members. All improvement is summarized in the Health Equity Report posted on the Meritus Health website to allow greater transparency of progress that helps keep community stakeholders wellinformed.

pre-term Births

of pre-term

Actions/steps taken

• Driver diagram completed with change concepts identified

• Began meeting the community in a setting that meets the needs of a more diverse population

• Staff working in Community Centers to establish contact venue for education and support

• All staff unconscious bias training through metamorphosis in spring 2022

• Mandatory education for all staff on disparities in maternal care

- MDMOM state initiative

• In process of developing brochure with contacts, frequently asked questions, and support info

- Includes Spanish speaking support

Mt. Washington Pediatric Hospital

Baltimore Project:: Cultural Competency Organizational Assessment

education access & Quality

Health Care access & Quality

Social & Community Context

Mt. Washington Pediatric Hospital (MWPH) completed a Cultural Competency Organizational Assessment (COA360®) that provides a 360 view of how the organization’s cultural competence is perceived by surveying administrators, clinical, and nonclinical team members in conjunction with patients and community partners/suppliers.

The survey had a 49.5% completion rate, and hospital staff scored 77.11% on average across all survey domains—similar to several other local hospital COA360® participants.

MWPH’s highest performing domains among surveyed staff were:

• Notice of availability of services

• Collecting patient background data

• Patient trust

Based on identified areas of opportunity for improvement, MWPH implemented the following process enhancements and interventions:

Annual CLAS Reporting:

• Completed a review of current communication practices regarding culturally and linguistically appropriate services (CLAS) and added related training and resources for staff on the hospital intranet

• Annual language services report of clients served to be made available both internally and externally— benefiting the public, employees, and external partners

Cross-Cultural Conflict Resolution:

• Completed a review of MWPH policies and practices from a culturally competent lens to determine if they are equitable and inclusive

• To address cross-cultural conflicts in cultural competency training, MWPH updated its equity, diversity, and inclusion presentation for new employee orientation and requires annual unconscious bias training for all staff.

• MWPH hired a new organizational development specialist with an EDI background to provide teams with cultural competency education and individual coaching for leaders.

outcomes / impact

The baseline data captured in the current assessment serves as a foundation for MWPH to determine signs of tangible improvement based on the interventions that have been implemented. By following a regular cadence of follow-up surveys, MWPH will track performance over time and benchmark progress in delivering culturally competent care.

suburban Hospital, part of johns Hopkins Health system

MonTgoMeRy CounTy

pRojeCt:: MobileMed/NIH Heart Clinic at Suburban Hospital Health Care access & Quality

Almost 7.1% of Montgomery County residents are uninsured with significant insurance gaps in racial and ethnic populations while the age-adjusted mortality rate for heart disease is 115.9 and 39.5 for Blacks and Hispanics, respectively. Improving access to care and chronic disease management for the uninsured is critical to meeting community health needs. Suburban aims to achieve this by increasing access to specialty care to uninsured, high-risk Montgomery County safety-net clinic patients and managing associated risk factors with coronary heart disease.

The MobileMed/NIH Heart Clinic at Suburban Hospital opened in October 2007. In collaboration with Suburban Hospital, Mobile Medical Care, Inc. (MobileMed), and the National Heart, Lung and Blood Institute (NHLBI), the goals of the clinic are to expand access to specialty care to those who are uninsured or underinsured and reduce the number of deaths associated with coronary heart disease in Montgomery County.

Held once a week at Suburban Hospital, cardiologists, nurses, and other staff from the three institutions volunteer their time ensuring that uninsured individuals benefit from expert cardiac specialty care.

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in 16 years, the clinic has delivered free cardiovascular care to over 3,400 uninsured patients resulting in over 5,700 clinic visits.

Referred by MobileMed, patients have access to cardiovascular specialty care such as diagnostic, interventional, lab and inpatient services along with free cardiac rehabilitation services supported by Suburban Hospital. For those who require further care, Suburban cardiovascular surgeons and staff donate their time and expertise in performing complex open-heart surgeries.

of those evaluated in the Heart Clinic since 2007, over 75 MobileMed patients have undergone advanced treatment, including heart surgery, vascular/cardiac device placement or coronary angioplasty at no cost to the patient.

In addition, Suburban covers all costs and expenses associated with specialty cardiovascular diagnostic tests, laboratory services, medical examinations and surgeries.

In FY22, there were 324 total patient visits, with 195 unique patients served by the MobileMed/NIH Heart Clinic at Suburban Hospital. Out of the 195 patients who were treated, 62.1% reported their Ethnicity as Hispanic and Latino, with an additional 2.1% Unreported. Of the specialty care received in FY22, 279 cardiac diagnostic tests were performed, including 251 echocardiograms, eight stress tests and 20 cardiac MRI/CTs, which are elective tests that low-income, uninsured patients would otherwise be unlikely to be able to access.

In 16 years, the clinic has had over 3,400 patient visits through 5,700 uninsured patients in need of cardiovascular specialty care.

Each year, the clinic measures its success by whether the number of patients it serves increases (shortterm goal); whether effective treatment of the different conditions that put the patients at risk for cardiovascular disease is reduced (mid-term goal); and by improving their quality of life while reducing their risk from premature coronary heart disease mortality (long-term goal).

suburban Hospital, part of johns Hopkins Health system

MonTgoMeRy CounTy

pRojeCt:: Dine, Learn & Move (DLM)

Health Care access & Quality

social & Community Context

Dine, Learn & Move (DLM) is a multifaceted, interactive program to prevent and manage cardiovascular risks associated with poor diet and physical inactivity. The success in this monthly program, run continuously since 2008, is the collaborative approach to leverage innovative efforts to improve health outcomes across vulnerable populations experiencing health disparities.

DLM is supported by two health system partners, Suburban Hospital and the University of Maryland Capital Region Health (UMD). The Prince George’s County (PGC) Health Department and the Maryland-National Capital Park and Planning Commission, Department of Parks and Recreation Prince George’s County (PG Parks) are also key partners of DLM. All partners are invested in improving equitable solutions to address health disparities and promote healthy lifestyles through nutrition, physical activity, and health education.

The target audience is adults wanting to gain strategies to adopt and maintain a healthy and empowered lifestyle. Demographically, the average DLM participant is African American, female, age 65 or greater, and lives in PGC. While nearly 97% of PGC residents live near exercise opportunities, just 50.5% of adults in the county participate in the recommended amount of aerobic activity per week. Additionally, 23% of adults aged 20 and over report no leisure-time physical activity at all. Lack of physical activity, as well as poor diets, has led adults in PGC to suffer from higher rates of obesity than those across the state and nation.

This 90-minute, virtual program operates in three separate but cohesive sections, combining both nutrition and fitness education; most programs offer one or the

other. The first is a 20-minute live movement session, sponsored by PG Parks and led by a certified instructor. The next segment is led by a registered dietician from the Health Department. Each 20-minute segment is filled with guidance on the importance of reading nutrition labels, adhering to portion sizes, shopping in season, and eating in color, for example. The final segment is a 40-minute live cooking demonstration. This segment is sponsored by Suburban Hospital and UMD and conducted by a local chef. Each demo offers recipes that are heart healthy, diabetes-friendly, with easily accessible and affordable ingredients.

DLM is free and virtual, removing barriers to access. Each session ends with an evaluation that impacts planning and sustainability efforts for future sessions. Questions measure behavior change; key outcomes from 2022 are summarized below. In the prior year, 100% of the 543 participants said they would recommend DLM to a family member or friend. Sixty-nine percent of respondents marked “yes” to the question, Since the last time I attended DLM, I have done at least one healthy thing that I learned at that event. From there, they were asked what they incorporated. Thirty-three percent exercised for 10 or more minutes; another 33% decided based on reading a nutrition label; and 26% tried a DLM recipe. These responses indicate that participants remain engaged in healthy behaviors outside of the monthly program, further impacting positive health improvement behaviors.

Dine, Learn & Move participants take part in the program.

suburban Hospital, part of johns Hopkins Health system

MonTgoMeRy CounTy

pRojeCt:: MobileMed/NIH Endocrine Clinic at Suburban Hospital

Health Care access & Quality

Montgomery County is the most populous and diverse county in Maryland. Considering the abundance of ethnic and racial groups that connect and tie many communities together, there are also notable disparities in socioeconomic circumstances and health status. For example, when comparing the age-adjusted mortality rate due to diabetes, Blacks and Hispanics have a higher rate of death per 100,000 because of diabetes at 22.86 and 10.14, respectively, compared to Whites at 9.88 and the overall rate of 9.5 per 100,000 population in the county.

The MobileMed/NIH Endocrine Clinic at Suburban Hospital was created in 2010 to provide specialty care to those who are uninsured and living with diabetes and other endocrine conditions. The objective of the clinic is to increase access to specialty care to individuals who would not otherwise receive care and to reduce the incidence of complications due to endocrine diseases, including diabetes. Suburban aims to achieve this by increasing access to specialty care to uninsured, highrisk Montgomery County safety-net clinic patients, and managing risk factors associated with diabetes.

The MobileMed/NIH Endocrine Clinic is in collaboration with Mobile Medical Care Inc., and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Physicians, nurses, staff, and administrators from the three partners volunteer one night a week at Suburban Hospital. Referred by MobileMed, uninsured individuals who live in the county meet with an NIH endocrine fellow who reviews the patient’s labs, progress, and individual care plans. Individuals also can meet with a Suburban Hospital Certified Diabetes Educator and address

i

For the past 12 years, the MobileMed/niH endocrine clinic at suburban Hospital has cared for over 2,500 uninsured patients who may have otherwise not had access or resources to treatment.

further barriers to diabetes management further needs, such as diet or medication management. As part of its commitment to serving the community, Suburban Hospital defers all costs associated with the clinic, including in-kind support.

For the past 12 years, the MobileMed/NIH Endocrine clinic at Suburban Hospital has cared for over 2,500 uninsured patients who may have otherwise not had access or resources to treatment. In FY22, 174 patients received specialty care services and out of the 80 patients who were treated, 65.0% reported their Ethnicity as Hispanic and Latino.

Each year, the clinic measures its success by continued improvement of Hemoglobin A1C among diabetic patients. In FY22, 61% of clinic patients living with diabetes mellitus saw improvements of their Hemoglobin A1C levels.

tidalHealth peninsula Regional

WiCoMiCo CounTy

pRojeCt:: Rural Equity and Access to Community Health (REACH) Project

Health Care access & Quality

TidalHealth was awarded a two-year Pathways to Health Equity Grant through the Maryland Community Health Resources Commission beginning May 1, 2022, to implement the Rural Equity and Access to Community Health (REACH) Project. REACH specifically addresses disparities related to diabetes and hypertension experienced by the Black and Haitian populations on the Lower Eastern Shore. The project supports multi-level, cross-sector strategies to build community capacity to advance health equity by addressing the social determinants of health factors that drive disparities. The collaborative project is driven by a coalition of stakeholders from TidalHealth, Atlantic General Hospital, the three local health departments, a federally qualified health center, the local Area Agency on Aging, the Wicomico Library, and local nonprofit organizations serving the Black and Haitian communities.

REACH takes an evidence-based approach to improve health outcomes. The program specifically aims to prevent and reduce hospital encounters caused by unmanaged hypertension and diabetes particularly among African American and Haitian populations. The key strategies implemented to address the health disparities include:

• Mobile integrated health and social services provided in homes and neighborhoods in a culturally and linguistically sensitive manner.

• Mobile screenings that link residents to primary care for better prevention and management of health conditions.

• Expand access to culturally and linguistically competent and evidence-based health education for diabetes prevention and control, hypertension control, and other chronic disease self-management education provided in partnership with health departments, faith-based organizations, and local nonprofits.

• Expanded workforce of Community Health Workers (CHWs) trained and skilled in navigating and coordinating health and social service supports.

• Optimization of findhelp, an integrated software platform, to improve social care coordination in the community.

The REACH Program addresses the five strategic goals of The Maryland Health Equity Resource Act, including:

1. Improve health outcomes

2. Reduce health disparities

3. Improve access to care

4. Reduce total cost of care/hospital admissions and readmissions

5. Increase primary and secondary prevention services

In less than 2 years, the project has served more than 3,000 unduplicated individuals and touched thousands more through mobile screenings and outreach activities. The project improved coordinated care and increased the number of patients screened for social determinants of health needs such as food, transportation and housing and improved the ability of service providers to receive referrals, coordinate social care, and address SDOH insecurities identified.

Preliminary data from CRISP indicate a significant reduction in readmissions for diabetes. More time is needed to review clinical outcomes of the multifaceted interventions. Additional quality indicators being tracked include the number of grant participants who have controlled A1CS and blood pressure, as well as those who are newly linked with a primary care provider and/or enrolled into health insurance coverage.

University of Maryland Medical system

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pRojeCt:: Eliminate Race from Kidney Function Estimates

Health Care access & Quality

social & Community Context

In July 2022, the University of Maryland Medical System (UMMS) sought to remove race as a variable in the evaluation process for kidney function and staging of chronic kidney disease. The corrective action in calculating the estimated glomerular filtration rate (eGFR) is permanent.

This is a global intervention that will, retrospectively, most impact Black patients (particularly those on kidney transplant lists) and, prospectively, level the clinical playing field for equitable assessment of kidney function.

The initiative’s primary objective was to address the systemic disparities prevalent in health care, especially concerning Black patients, who historically faced disproportionate challenges in accessing equitable kidney care. By eliminating the consideration of race in

kidney function assessments, the program aimed to level the clinical playing field, ensuring fair and unbiased evaluations for all patients.

All reference laboratories at hospitals across UMMS are now using the corrected calculation. UMMS is working with the United Network for Organ Sharing to assess recalibration of the waiting list for patients already in the kidney transplantation queue. CKD is one of the system’s core Equity in Patient Care (EPC) metrics and is being tracked on its EPC Dashboard. As a chronic condition with a protracted course of expression, UMMS does not expect to realize quantitative clinical outcomes linked to this intervention for some time.

This is now permanent clinical policy and practice endorsed by every constituency and enterprise associated with the system, including its academic partner, the University of Maryland, Baltimore; specifically, the University of Maryland School of Medicine.

Corrective action and educational process was thoroughly shared, vetted, and disseminated across all stakeholders including governance, academic partners, external partners, and the public.

The science had already been adjudicated by the American Society for Nephrology; the innovation has been implemented across a large and diverse health care system as standard of care.

University of Maryland Medical system

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pRojeCt:: Eliminate Race and Ethnicity from Childbirth Calculator

Health Care access & Quality

social & Community Context

In 2022, the University of Maryland Medical System launched an initiative to address disparities in childbirth. This initiative aimed to remove race as a factor in predicting the likelihood of a successful vaginal birth after cesarean (VBAC), making the process fairer for all birthing individuals, regardless of their race or ethnicity.

The primary goal of this initiative was to ensure that access to a trial of labor after cesarean (TOLAC) was not influenced by race or ethnicity. By eliminating race as a variable in the VBAC clinical calculator, the aim was to level the playing field and provide equal opportunities for all individuals seeking TOLAC.

The impact of this initiative was evident across obstetric practices in all hospitals within the health care system. Obstetricians, midwives, and other health care providers now utilize the revised calculator, which no longer includes race or ethnicity-based considerations. The previous version of the calculator, which relied on race/ ethnicity, has been completely removed from electronic health records (EHR), ensuring that providers rely solely on the revised calculator and its supporting evidence.

UMMS plans to monitor the impact of this intervention on VBAC rates and cesarean section rates, with a specific

focus on how these rates vary across different racial and ethnic groups.

The sustainability of this initiative is ensured by its adoption as permanent clinical policy and practice, supported by all stakeholders, including the academic partner, the University of Maryland, Baltimore, and the UM School of Medicine.

The initiative to remove race as a variable in the VBAC clinical calculator represents a significant step towards equitable access to childbirth options. By eliminating racial disparities in TOLAC access, the system paves the way for a future where all birthing individuals receive fair and dignified care, irrespective of their race or ethnicity.

University of Maryland Medical system

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pRojeCt:: Using Personal Care Products for Patients with Highly Textured Hair

social & Community Context

UMMS has partnered with Oyin Handmade, a locally owned Black business specializing in hair care products, to provide tailored hair care amenities. The project implemented these specialized products across all 11 of its hospitals, ensuring patients of all backgrounds, particularly those with highly textured hair, receive personalized care that respects their culture and needs. UMMS hospitals serve a patient population that is up to 70% Black. The System-wide Diverse Products Workgroup recognized an unmet need to provide hair care products that are equitable, diverse, inclusive, and patient-centered.

Following a pilot at the University of Maryland Medical Center, the system worked with Oyin Handmade, a Black-owned business in the Greenmount West

neighborhood of Baltimore, to provide patients with Honey Wash Shampoo, Honey Hemp Conditioner, and Hair Dew Leave-In Conditioner. All hospitals across the system now use the Oyin Hair Shampoo Product.

UMMS continues to solicit and collect patient feedback. In response to a survey, three hair accessories were made available for textured hair, including a wide-toothed comb, a hair pick, and a brush. All are acceptable for toddlers through adults. The system continued to view and track our patient needs through an equity, diversity, and inclusion lens to ensure that we provide care to the total person.

Equity, diversity, and inclusion is an ongoing focus for UMMS. Establishing these initiatives shows care for patients and their needs and concerns beyond their medical issues.

University of Maryland Medical system

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pRojeCt:: Health Equity Challenge

Health Care access & Quality

social & Community Context

On Oct. 13, 2023, the University of Maryland Medical System (UMMS) acknowledged the diverse ways in which health inequities manifest across different care settings and communities. Recognizing the need for tailored approaches to address these disparities, UMMS launched the “Health Equity Challenge,” a systemwide initiative aimed at promoting equity in patient care through the identification and reduction of disparities in health outcomes and experiences.

The target audience for this initiative includes UMMS hospital leadership, staff, and the communities they serve. To tackle health inequities effectively, UMMS developed a systemwide dashboard to monitor eight key metrics, focusing on areas such as severe maternal morbidity, pediatric asthma-related emergency department visits, diabetes, and unplanned readmissions.

Over a four-month period, UMMS hospitals collected quantitative and qualitative data, analyzed root causes of disparities, and established milestones and targets for improvement. On March 8, 2024, all hospitals convened for a celebratory event to present draft health equity plans and provide feedback on proposed next steps.

Moving forward, hospitals will finalize their health equity action plans, incorporating clear performance metrics, and begin implementation. The UMMS Health Equity Challenge will unfold over several monthly phases, offering resources and technical assistance to support hospitals and ensure accountability for desired results. Collaboration is fundamental to the success of this initiative, with multidisciplinary teams working together to ensure diverse voices are heard in addressing root causes of health inequities. System leaders emphasized the need for a standardized framework incorporating root cause analyses for all performance metrics, a requirement that all UMMS hospitals are now addressing.

Key lessons learned include the importance of leveraging diverse data types, engaging team members from various disciplines, and facilitating discussions to identify underlying root causes of health inequities. By embracing these principles, UMMS strives to bridge gaps in patient care and promote equity across its health care system.

How MHA Assesses Policies Through an Equity Lens

MHA equity Assessment process

MHA’s advocacy before state and legislative bodies has wide-reaching impacts, and the Association’s work on behalf of the field in promoting policies to advance health equity efforts carry significant weight.

To assess equity impacts of priority issues, policies, and bills, MHA created an Equity Policy Assessment tool to illuminate blind spots and raise awareness of how decisions have the potential for adverse impacts to individuals and communities. The process allows for considerations to mitigate unintended consequences of policy decisions. Additionally, the assessment can inform new policies and practices that promote health equity and can contribute to improving the overall health of communities.

How to use the Results of an equity assessment:

• Inform how policy priorities and legislative agendas are formed

• Support the field in embedding health equity into organizational and operational practices

• Guide development of community partnerships

• Guide external communication

policies MHA and MHA Members Assessed with Health equity lens

HsCRC efficiency Recommendations ed Wait times “Fair Wage” Act of 2023 MHA Board Competency Matrix Model progression: Readmissions HB133: Medical Bill Reimbursement

assessment Criteria:

• Impacts on Health

• Equity Considerations

• Magnitude of Impact

• Relevance

• Feasibility

• Workforce Diversity

• Public Interest

Components of the Process:

step 1

Prepare Team

step 2

Conduct Assessment

Materials/documents:

- Background and research

step 3

Materials/documents:

- Assessment tool

Evaluation and Presentation

Materials/documents:

- Synthesis of assessment findings and documentation of key points

Materials/documents:

- Post-assessment survey for process refinement

- Summary for MHA governance bodies

pRepARe

Send out pre-assessment materials (e.g., research articles, comment letters, and/or MHA testimony) to participants 3 business days before assessment appointment.

ReVieW

Send out post-assessment survey to participants within 48 hours after assessment completion and use feedback to refine assessment process.

equity Assessment Questions:

1. What is the issue under consideration?

(a) What is the intent of the policy?

(b) What are the specific desired results/ outcomes?

2. What are the racial and other equity impacts of this policy?

(a) Does the proposed policy potentially create new disparities in outcomes by race/ethnicity or other demographic categories/identities?

(b) Does the policy create new disparities in exposures and opportunities?

(c) Does the proposed policy exacerbate existing disparities?

(d) How does the proposed policy address historic inequities?

(e) Who is most impacted (neighborhoods, regions, racial/ethnic groups, income groups)?

Assess

Schedule 1-hour appointment with subject matter experts and Team Leads to complete assessment.

CoMpile

Review notes from assessment, refine completed Tool, and create summary slide for integration into Council presentation slide deck.

3. Who will benefit from or be burdened by this decision?

(a) Are there potential negative impacts or unintended consequences?

(b) Are there strategies to mitigate the unintended consequences?

4. Have affected community members or leaders been engaged in the development or vetting of the proposal?

(a) What has your engagement process told you about the factors that produce or perpetuate racial inequity related to this proposal?

(b) What has your engagement process told you about how the proposed policy will be perceived by affected groups?

5. Can the policy be successfully implemented and evaluated for impact?

(a) Is there adequate funding, required community engagement, mechanisms for accountability, data collection, and reporting to track progress?

Partnerships to Promote Health Equity

leaders in equity and diversity (leAd) Collaborative launches

In 2022 Meritus Health applied for a grant with AARP to launch the Leaders in Equity and Diversity (LEAD) Collaborative. MHA joined Meritus Health as a co-sponsor, along with Luminis Health and Advancing Synergy.

This Collaborative assembled a diverse group of 34 regional organizations including MHA and several hospitals and health systems to mitigate health disparities disproportionately affecting diverse and aging populations.

oRgAniZAtions

• 10 Maryland Hospitals/Health systems

• 2 State Hospital Associations (Md, nj )

• 2 State Agencies

LEAD members were required to submit clear and specific goals, or aim statements to represent their commitment to specific, swift and measurable change in one or more of these focus areas:

• Addressing social determinants of health

• Increase the diversity of leadership to reflect the communities they serve

• Reducing health disparities in the community they serve

Ascension St. Agnes CalvertHealth

Increase utilization of home-based high blood pressure selfmonitoring through e ective process design and provider education.

Improve screening impact for social determinants of health and include plan in care.

Increase matching dollars at Calvert County Farmers markets for families who participate in Supplemental Nutrition Programs.

Frederick Health

Reduce readmissions for patients with a high Patient Adversity Index (PAI) from the baseline.

Holy Cross Health

Health

Improve income inequality for participants in the Holy Cross Health Career Pathways Program.

Mercy Medical Center

Increase screening of patients for social determinants of health needs and referred to appropriate resources.

Meritus Health

Reduce disparity between white and non-white patients for well controlled hA1c

Increase the total number of racially / ethnically diverse supervisor and above.

Increase the total number of residents in the Care Caller program

TidalHealth Peninsula

Implement a standardized health-related social needs screening tool throughout the health system

By March 2024, 75% of policy or advocacy issues discussed during MHA council meetings and MHA Executive Committee meetings would include an equity assessment

Track and reduce disparity in total joint replacement patient outcomes between non-Hispanic White and Black/African American patients

Reduce disparity in NTSV C-section rates between non-Hispanic White and Black/African American patients

GBMC HealthCare

Increase diversity of leadership

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Increase access to care at the Jonestown community

Luminis

MHA

Brand Identity

MHA’s Historically Black Colleges and Universities (HBCU) nurse Consortium

OFFICIAL ACADEMIC MARKS

MHA’s 2022 State of Maryland’s Health Care Workforce Report recommended strategies to expand the hospital workforce pipeline and ease barriers to health care education. Inherent in these recommendations is the need to ensure a sustainable and diverse workforce through a strong talent pipeline. It is well documented that historically Black colleges and universities make significant contributions to the education and development of Black nurses. Equally well documented are the challenges faced by programs at HBCUs relative to non-HBCU institutions.

MHA formed an HBCU Nurse Consortium that includes educational partners at Morgan State, Coppin State, and Bowie State universities and hospital leaders focused on identifying common challenges and opportunities to address them collectively.

• Rear admiral aisha K. Mix, Chief Nurse Officer of the u.s. Public Health service, who advises the Office of the Surgeon General and the U.S. Department of Health and Human Services on the recruitment, assignment, deployment, retention, and career development of nurse professionals engaged with the HBCU Nurse Consortium to understand the issues they are experiencing, discuss barriers to address those issues, and examine solutions and opportunities to collaborate. Admiral Mix committed to being an advocate for this work with the Administration.

There are three primary elements that make up the Coppin State University brand identity - the shield, wordmark and seal. The shield and wordmark combined, make up the university trademark (commonly known as logo).

• MHA worked with hospitals and nursing organizations to share issues expressed by the programs and understand options for addressing the concerns.

The shield may be used as a graphical element with the wordmark, but must be done in good taste and not compromise the integrity of the university trademark (logo). None of the marks may be altered, distorted or recreated.

SHIELD

WORDMARK SEAL

VERTICAL

HFMA inclusion and equity Conference

Growing demands for the health system to ensure health equity and close the health disparity gap will require significant internal and external approaches. Hospitals and health systems cannot be successful in this work alone; thus, collaboration and partnerships are essential.

MHA sponsored and partnered on the Healthcare Financial Management Association (HFMA) Maryland’s 2nd Annual Inclusion & Equity in Health Care Conference 2023. The theme of the conference was “Partnerships & Technology for Advancing Health Equity.” Seventy-five health care leaders, innovators, local business leaders, and community members came together to explore how to address health equity systemically. Cross-sector stakeholders shared best practices, strategies, and solutions to address some of health care’s biggest issues.

MHA joinMdHealth Campaign Aims to grow, diversify Hospital Workforce

MHA launched a digital marketing campaign in January 2023 to address historic workforce shortages in health care. The effort, JoinMdHealth, invites students as well as those looking for new opportunities, to pursue careers in health or educational opportunities that lead to hospital careers.

In addition to growing the hospital workforce, the campaign also aims to diversify it. Key audiences include Hispanic/Latinx and Black Marylanders, who are underrepresented in hospitals. The campaign messaging and targeted outlets are intended to reach diverse audiences who may not have previously considered a career in a Maryland hospital.

JoinMdHealth reminds Marylanders that no matter your skill set, your interests, your goals, your background, or your age, there is a career in health care waiting for you. The six-month pilot campaign used digital outreach through a website, social media, and search and Google advertising. (Follow JoinMdHealth on ).

9.7 million impressions

Across social media channels, video ads have been played to completion more than 4 million times.

In January 2024, the next phase of the campaign began to gather content from hospital members to showcase different aspects of hospital work.

A 2022 GlobalData report, commissioned by MHA, reveals the current shortfall of nurses in Maryland and predicts the shortage will grow worse. Estimates show a statewide shortage of 5,000 full-time registered nurses and 4,000 licensed practical nurses. That data aligns with projections showing that, without intervention, shortages could double or even triple by 2035. Gaps between need and the supply of talent are also seen in many other hospital care roles.

2.7 million impressions 82,000 click-throughs and Google Search drove strong traffic to the JoinMdHealth landing pages. The top search phrases include the pilot campaign (January – June 2023) and nearly on tiktok alone, the campaign surpassed work in healthcare CnA programs hospital careers hospital service jobs nursing financial aid surgical tech programs nursing programs near me reached to the website— exceeding industry average for similar campaigns.

The Road Ahead: Vision for the Future

equity in Model Progression

Equity should be a fundamental consideration when developing the progression of Maryland’s Total Cost of Care Model (the Model) and implementing measures for monitoring and evaluation of our performance. Embedding equity in the Model requires a comprehensive approach that considers the unique needs of communities and patient populations across the state. To guarantee that all individuals have a fair and just opportunity to achieve their full health potential, regardless of their race, ethnicity, gender, income, or other social determinants of health, we must ensure that our structures and processes will support improved outcomes over time.

Opportunities to incentivize hospital performance on equity and disparity reduction are being developed within state and federal policies. An evaluation of Maryland’s performance will rely on its comparability to the nation. To determine whether adequate capacity exists to engage in efforts to address equity and generate stakeholder buy-in/accountability, data collection and analysis is necessary for understanding gaps, drivers, and related-costs.

Highlights/developments: When considering what must be done differently to embed equity in Model goals and outcomes, the following areas must be addressed:

• Expand the collection, reporting, and analysis of standardized data

• Assess causes of disparities within Maryland Hospital Quality Program and address inequities in policies and operations to close gaps

• Build capacity of health care organizations and the workforce to reduce health and health care disparities

• Advance language access, health literacy, and the provision of culturally tailored services

• Increase all forms of accessibility to health care services and coverage

• Identify opportunities for field wide collective action to drive success on anticipated AHEAD Model goals

look ahead: Closing gaps in outcomes and ensuring individuals have access to resources and opportunities for optimal health, will require near term strategies to ready the field for long term measurement and success. Near term areas of focus include the development and adoption of both structural and process measures.

MHA Health equity dashboard

To help track and measure the success of Maryland hospitals’ progress toward health equity, MHA and member hospitals established an internal Statewide Health Equity Dashboard. The dashboard includes metrics relating to quality, data completeness and accuracy, organizational personnel, and governance. Hospitals have access to the data to track their progress and benchmark against others in the field.

This tool helps MHA’s Board of Trustees and member hospitals set goals and benchmarks and show progress and areas for improvement.

As the field moves forward with this important work, the dashboard will be a key part of ensuring hospitals leaders are making measurable progress and creating real change—both in their organizations and in their communities.

HCAHps

Acknowledgments

MHA HEALTH EQUITY ADVISORY COMMITTEE

sherita Hill golden, M.d., M.H.s.

Professor of Medicine

Vice President & Chief Diversity Officer

Johns Hopkins Medicine, Baltimore

Marilyn lynk, Ph.d., Associate Vice President, Learning, Leadership, & Organizational Development Equity, Diversity, & Inclusion Adventist HealthCare, Gaithersburg

Renee blanding, M.d.

Vice President Medical Affairs, Medical Director, Operating Room

Johns Hopkins Bayview Medical Center, Baltimore

ernest Carter, M.d., Ph.d Director of Health, Equity, Research & Innovation

Kennedy Krieger Institute, Baltimore

John b. Chessare, M.d., M.P.H.

President & CEO

Greater Baltimore Medical Center, Baltimore

denise Clark

Human Resources Services Manager Holy Cross Health, Silver Spring

annice Cody

President, Holy Cross Health Network Holy Cross Health, Silver Spring

olivia farrow

Director of Community Engagement & Government Relations

Ascension Saint Agnes, Baltimore

Kathryn fiddler, dnP, Mba, Rn Vice President, Population Health TidalHealth, Salisbury

Jessica galarraga, M.d., M.P.H.

Assistant Vice President of Health Equity MedStar Health, Columbia

Janet Harding

Director, Cultural Awareness & Inclusion Frederick Health, Frederick

Kara Harrer, Pharmd

Associate Vice President, Clinical Ancillary CalvertHealth Medical Center, Prince Frederick

sandra Harris

Vice President, Equity, Inclusion, & Diversity MedStar Health, Columbia

debra illig, dHa, Mba, Rn, ClnC, CPHQ

Vice President of Clinical Effectiveness & Patient Safety

Adventist HealthCare, Gaithersburg

Tammy Janus

Senior Vice President, Human Resources

Mercy Medical Center, Baltimore

brendan Johnson

Senior Vice President, Chief Human Resources Officer

Adventist HealthCare, Gaithersburg

Roderick King, M.d.

Senior Vice President, Chief Equity, Diversity & Inclusion Officer

University of Maryland Medical System, Baltimore

Tonya Kinlow

Vice President, Community Engagement, Advocacy, & Government Affairs

Children’s National Hospital, Washington, D.C.

Heather Kirby

Vice President of Integrated Care

Delivery & Chief Population Health Officer Frederick Health, Frederick

andrea limpuangthip, M.d

Medical Director, Quality & Patient Safety

Mercy Medical Center, Baltimore

Joseph Maraña

Director, Leadership & Culture

Mercy Medical System, Baltimore

sharon McClernan

Vice President, Community Health & Integration

LifeBridge Health Carroll Hospital, Westminster

Mary Miller

Chief Financial Officer

Mt. Washington Pediatric Hospital, Baltimore

dawn o’neill

Senior Vice President, Population Health

Ascension Saint Agnes, Baltimore

Jacqueline ortiz

Vice President, Health Equity & Cultural Competency

ChristianaCare, Union Hospital, Elkton

sybil Pentsil, M.d., M.P.H.

Chief Diversity Officer

LifeBridge Health, Baltimore

Michael Reyka, Phd, Rn

Chief Operating Officer

Brook Lane, Hagerstown

deneen Richmond

President

Luminis Health Doctors Community Medical Center, Lanham

bryan Rogers

Chief People Officer

LifeBridge Health, Sinai Hospital & Grace Medical, Baltimore

Monique sanfuentes

Director, Community Health & Wellness

Suburban Hospital, Bethesda

Tina simmons

Director of Population Health

Atlantic General, Berlin

angela Thomas, drPH, MPH

Vice President, Health Care Delivery

Research

MedStar Health Research Institute, Hyattsville

natalie Torres

Director, Inclusion & Diversity

ChristianaCare, Union Hospital, Elkton

lisa Walker

Chief Diversity & Learning Officer

Greater Baltimore Medical Center, Baltimore

OTHER ACKNOWLEDGMENTS

Melony G. Griffith

President & CEO

Maryland Hospital Association

Meghan McClelland

Chief Operating Officer & Senior Vice President

Maryland Hospital Association

brian sims

Vice President, Quality & Equity

Maryland Hospital Association

Johnny Tolbert

Director, Association Affairs

Maryland Hospital Association

diana Hsu

Senior Analyst, Policy

Maryland Hospital Association

erin Cunningham

Director, Communication

Maryland Hospital Association

erika McMullen

Founder & CEO

Moxie Consulting Group, LLC

nicole Rochester, M.d.

CEO

Your GPS Doc, LLC

steve Rochlin

Founder & CEO

Impact ROI