Why 1 hospital president is focusing equity efforts on post-discharge

Alison Brown, RN, president of University of Maryland Medical Center's Midtown Campus in Baltimore, knows that it takes data to move the needle forward on health equity in a measurable way. 

As she puts it, "If you don't have the data that says here's the outcome for a person with congestive heart failure, who's Black versus white, then you don't really know whether you're making a difference with the interventions that you put in place."

One example of how data has informed intervention at her specific organization involves discharge and follow-up care.

Ms. Brown said University of Maryland Medical Center is able to access certain data through The Vizient Clinical Data Base healthcare analytics platform, and it became clear that patients discharged from the hospital with congestive heart failure have comparable outcomes irrespective of race. 

"But we also know that when we use our data to say what percentage of people discharged from the hospital with congestive heart failure are actually getting a follow-up — not just an appointment for follow-up care with their primary care physician or a cardiologist, but actually are seen by a primary care physician or cardiologist — there continues to be variation," she told Becker's.

Ms. Brown said these findings resulted in implementing a new approach in which every patient being discharged from the hospital — either in the emergency room or being discharged after having an inpatient stay — with that diagnosis is tracked to ensure they are seen by a provider within 14 days. 

The tracking extends beyond patients with congestive heart failure. University of Maryland Medical Center also tracks other clinical conditions to ensure at least 80 percent of the people who need intervention are being seen. 

"That means you have to work with the primary care practices," Ms. Brown explained. "You have to work with the cardiology practice and make sure that when we say this patient needs an appointment within 14 days or 12 days, that's actually happening."

Ms. Brown has been focused on health equity work since being named to the top role at UMMC's Midtown Campus in 2018. This includes also addressing access to healthcare in West Baltimore, particularly for those with heart disease, diabetes, obesity, hypertension, kidney disease, asthma, mental health disorders and cancers.

Over the last three years, her organization has made substantial investments in expanding the number of primary care providers and the number of subspecialists, Ms. Brown said. And the hospital now has a connected care model among primary care and specialists on the campus.

Through this model, "We make sure our diabetes patients can be seen by a kidney specialist, an eye specialist and a foot specialist all in the same day. And the folks who sit at our check-in and check-out desk make sure we don't send them out with a long list of instructions and say, 'Go make all these appointments.' We send them out with all those connections made," Ms. Brown said.

Overall, it's a way to help shepherd people through what can be a disconnected, uncoordinated, challenging way of getting the care they need, and from a financial standpoint, helps those who can't afford parking for three separate visits, she said.

This is the approach Ms. Brown set out to achieve with the opening of the medical center's Midtown outpatient tower in 2021, Tiffani Washington, a hospital spokesperson, told Becker's. The 10-story building adjacent to the main hospital was designed to allow academic physicians, nurses, therapists, social workers, pharmacists and community health workers to come together under one roof.  

"Early data confirms that linking all the experts involved in a patient's care — from diagnosis, to tailored treatment, to a host of wraparound services and support — drives significant improvements to health outcomes and patient experience," Ms. Washington said.

Ms. Brown is retiring from her role on Sept. 19. But she said she plans to continue to be involved in addressing issues like food insecurity, economic instability, housing instability, transportation and other social needs directly related to health outcomes in West Baltimore. 

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