'It can be hard to know where to begin': How data forges the path to health equity at NorthShore - Edward-Elmhurst Health

At Evanston-based NorthShore - Edward-Elmhurst Health, data, strategy and health equity are indivisible. 

Annette Kenney, the system's chief strategy officer, and Raj Iyer, director of business intelligence and analytics for Edward-Elmhurst Health, work side by side with the health equity committee — headed by two hospital CEOs — to improve community health. 

"COVID, George Floyd and a lot of things happening in 2020 really shone a light that we're missing the boat," Ms. Kenney told Becker's. "If we're really serious about advancing the health of our communities, we need to look at things through a lens of health equity and understand the diversity of our patient populations." 

The goal itself is not uncommon — an eye for the greater good is a hallmark of healthcare. However, by using data to zero in on its own pain points, NorthShore - Edward-Elmhurst is able to move toward resolution with more precision. 

"Data gives a clear strategy, a plan," Mr. Iyer said. "It's become second nature for our data team to say, 'Hey! Can we find health equity insights in this measure? Let's look at it.'" 

For example, the health system's data analytics team noticed that Hispanic patients with a primary or secondary diagnosis of diabetes had a higher admission rate and more emergency room visits than other populations. 

The team probed further to identify the ZIP codes where these patients lived and sought care. Then, they hired a Spanish-speaking, culturally sensitive diabetes educator at a primary care office in a community with a large Hispanic population. After six months, they have seen an increase in diabetic patients receiving interventions and a more robust diabetes education, getting connected with payment sources, and being more care compliant, according to Ms. Kenney. 

"We were able to justify financially what an intervention would do, and really target a population," Ms. Kenney said. 

But when looking at data through an equity lens, you can't focus only on who is coming to your hospital. You also have to look at who isn't showing up — who may be left behind. This means looking beyond national metrics and paying close attention to your own backyard. If the demographics of your patient population do not match the demographics of your service area, that could point to a larger issue. 

Plus, averages rarely tell the whole story, Ms. Kenney said, using the example of hypertension. A health system's average patient population may be well within national guidelines for hypertension. But when looking at outliers, a trend could appear. Patients of a certain race or patients living in a certain ZIP code may be largely outside of goal ranges. 

When nationally reported metrics are manually divided up by race, payment method or gender, sometimes disparities will appear that need to be addressed. 

"Data sometimes brings amazing insights that you never thought about," Mr. Iyer said. "You always have this gut feeling, but then data sometimes validates it or disproves and says, 'Nope, not really, let's move onto the next one.'" 

There are roadblocks, however, such as the quality of data that is available, Mr. Iyer said. Patients with completely different gene pools may be lumped into the same ethnicity — like Indian and Chinese patients both being listed as "Asian," or Ecuadorian and Mexican patients both being listed as "Hispanic." Plus, it can be difficult for nurses and physicians to approach difficult topics like gender identity and food security in the brief time frame of a visit. 

And for a recently merged system like NorthShore - Edward-Elmhurst, there is the additional challenge of navigating separate data sets and methods of record-keeping. 

Despite these challenges, data presents a path forward that may not be forged yet at many health systems. 

"I think most health systems want to be addressing health equity in a meaningful way, but it can be hard to know where to begin." Ms. Kenney said. "That's where data is critical."

"We cannot be in reactive mode anymore," Mr. Iyer said. "We have to be proactive with health equity. It cannot be an afterthought — just like data and analytics cannot be an afterthought. It's part and parcel of everything that we do." 

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