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Meritus spots health disparities: What happens now?

A Meritus study has reported six inequities in health care related to race, ethnicity and language preference.

"The reality is we've known this for years in health care, unfortunately," said Maulik Joshi, president and CEO of Meritus Health, which recently studied health disparities. "And it's not, again, a problem that has just surfaced over the last decade, but it's literally hundreds of years of systemic inequities. But now we have the data."

Professor Stephen B. Thomas, of the University of Maryland School of Public Health in College Park, praised Meritus for gathering and sharing that data. What's critical, he said, are the next steps to address those disparities. 

"Simply knowing is not enough. No," Thomas said. "We must do."

Joshi said the data in the 2020 Health Equity Summary is leading the hospital to make more moves, including training people about implicit biases, cultural competency and language barriers, to narrow disparities.

"We want to improve quality," Joshi said. "The next step is improving it for everybody. And that's what this is about."

According to the report, "disparities currently appear to exist in the following ways" at Meritus:

  • Sepsis measurement for evidence-based care delivery was 44% higher for white patients compared to Black patients.
  • The pre-term birth rate was 27% higher for Black and Hispanic or Latino patients combined compared to white patients, and 50% higher for Spanish-speaking patients compared to English-speaking patients.
  • Exclusive breast-milk feeding while in the hospital was at a 36% lower rate for Black newborns and Hispanic or Latino newborns combined compared to white patients.
  • Opioids were administered to white patients in the emergency department at a 21% higher rate than Black patients and Hispanic or Latino patients combined.
  • The rate of poorly controlled diabetes was 74% higher among Black patients and Hispanic and Latino patients combined compared to white patients.
  • Average time in the emergency department was 11% higher for Spanish-speaking patients than for English-speaking patients.

"We looked at well over a dozen measures, and these six are the ones where we found disparities in care," Joshi said. 

Similar disparities can be found throughout the country, Joshi said.

The hospital has established teams that are working to address the six items, he said, and it will continue to monitor them to measure progress.

'Things we should keep doing'

Thomas, director of the Center for Health Equity at UMD's School of Public Health, said he was not surprised by the findings.

"First, I'd like to commend the health system for being data-driven and being willing to share that information," he said.

Like Joshi, Thomas said many of the disparities start outside the hospital.

"It has its roots in the community, in the social determinants of health," he said.

According to the World Health Organization, those social determinants are non-medical factors that can include income, social protections, education, unemployment, housing, food insecurity and early childhood development. among others.

"Research shows that the social determinants can be more important than health care or lifestyle choices in influencing health," the WHO website states. "For example, numerous studies suggest that (social determinants of health) account for between 30-55% of health outcomes."

In Maryland, Thomas said, hospitals have a financial incentive to improve the community's overall health. Reducing the number of readmissions, for example, works to a hospital's benefit.

"The goal should be to keep people out of the hospital. ... That's where the sweet spot is for hospitals in the state of Maryland," Thomas said.

To that end, he urged health systems to heed lessons learned during the COVID-19 pandemic. Approaches such as mobile clinics and telemedicine can promote health overall.

"These are all things we should keep doing," he said.

'It's a very complicated world to a lot of people'

Meritus already is working on how it can address disparities in the hospital setting, according to Joshi.

"We have the best people in our industry," he said of health care workers. "We have people who care. It's the system behind it that has gotten us to where we are. And we have to fix that."

For example, he said Jenny Miller, language services advocate at Meritus, is working to fix some communication issues.

Part of the language-based delay in the emergency department is built into translations.

"Everything is essentially being said twice," Miller said.

But there could be other factors involved, such as having access to the video system, or using effective nonverbal communications across cultures.

"I think the most important thing is for a patient not to be afraid to state their needs," she said. "We can look at getting the tools necessary to help the patients."

Another factor could be the emergency room setting — an often-busy place filled with machines and people speaking in medical jargon.

"It's a very complicated world to a lot of people," she said.

'What matters to you?'

In a related move, Joshi said, Meritus will be asking a simple question of some patients. 

In addition to questions about medical history and symptoms, you might be asked what matters most to you. Perhaps your answer is being well enough to attend a family gathering. Perhaps it's having loved ones nearby. Perhaps it's watching the Baltimore Orioles on TV.

"It is good to know the whole person, right?" Joshi said. "That's the beauty of being a community health system. That's our job." 

Meritus is planning to make that a standard question throughout the hospital and make the answers part of a patient's record in its MyChart system.

"That changes why we're taking care of, not just your disease, but you as a person," Joshi said.

"So I think that gets to all this work on health equity. ... That's what we want to take care of, is you as a person."

This story was originally published in The Herald-Mail and online at HeraldMailMedia.com.

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