Eliminating Disparities to Advance Health Equity and Improve Quality

MHA Keystone Center

The MHA Keystone Center encourages organizations to use this guide to assess the current level of hospital implementation around key strategies aimed at reducing disparities to achieve equity and improving quality. This resource will guide organizations to prioritize and act on identified gaps so that deliberate and purposeful action is taken to ensure that the outcomes across all patient populations are equitable. Sections of the guide include:

Section 1: Understanding Key Terms

Section 2: Why Equity in Care Matters

Section 3: Strategic Pillars on the Journey Toward Equity

Section 4: Recommendations for Action

Section 5: Levels of Implementation

Section 6: The MHA Keystone Center’s Dedication to

Achieving Health Equity

Section 7: Resource Compendium

Managing the Risks of Direct Oral Anticoagulants

The Joint Commission: Sentinel Event Alert

While DOACs offer ease of use to patients, stopping bleeding events in patients on DOACs is more complicated, requiring different strategies than those for patients on warfarin (Coumadin®) and heparin. Unlike the more widely available reversal agents for warfarin and heparin, reversal agents for DOACs are lesser known and may not be available in every care setting. Also, some DOACs have no FDA-approved reversal agent at this time. Therefore, bleeding complications can be severe if these patients are not assessed according to guidelines on the management of DOACs. Intracranial hemorrhage is the most serious emergent bleeding risk.

In response to an increase in adverse events related to these widely prescribed medications, this alert provides guidance on the safe use and management of DOACs to all medical practitioners and health care organization leaders, particularly chief medical officers, pharmacists, emergency department clinicians, and quality and safety officers.

Safer Together: A National Action Plan to Advance Patient Safety

Institute for Healthcare Improvement (IHI)

Safer Together: A National Action Plan to Advance Patient Safety provides clear direction that health care leaders, delivery organizations, and associations can use to make significant advances toward safer care and reduced harm across the continuum of care. This resource also includes a Self-Assessment Tool & Implementation Resource Guide. Resource also includes case examples on engaging patients and families in safety.

Leading a Culture of-Safety: A Blueprint for Success

American College of Healthcare Executives and Institute for Healthcare Improvement (IHI)/National Patient Safety Foundation (NPSF) Lucian Leape Institute

Leading a Culture of Safety: A Blueprint for Success was developed to bridge this gap in knowledge and resources by providing chief executive officers and other health care leaders with a useful tool for assessing and advancing their organization’s culture of safety. This guide can be used to help determine the current state of an organization’s journey, inform dialogue with the board and leadership team, and help leaders set priorities.

The high-level strategies and practical tactics in the guide are divided into two levels:

  • The foundational level provides basic tactics and strategies essential for the implementation of each domain.
  • The sustaining level provides strategies for spreading and embedding a culture of safety throughout the organization.

HHS Releases New Buprenorphine Practice Guidelines, Expanding Access to Treatment for Opioid Use Disorder

Health and Human Services (HHS) April, 2021

In an effort to get evidenced-based treatment to more Americans with opioid use disorder, the Department of Health and Human Services (HHS) is releasing new buprenorphine practice guidelines that among other things, remove a longtime requirement tied to training, which some practitioners have cited as a barrier to treating more people.

Signed by HHS Secretary Xavier Becerra, the Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder exempt eligible physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and certified nurse midwives from federal certification requirements related to training, counseling and other ancillary services that are part of the process for obtaining a waiver to treat up to 30 patients with buprenorphine.

The Role of Nutrition for Pressure Injury Prevention and Healing (White Paper): The 2019 International Clinical Practice Guideline Recommendations

European Pressure Ulcer Advisory Panel (EPUAP), National Pressure Injury Advisory Panel (NPIAP), and Pan Pacific Pressure Injury Alliance (PPPIA) Prevention and Treatment of Pressure Ulcers/Injuries.

Nutrition plays an important role in the prevention and treatment of pressure injuries (PIs). Macro- and micronutrients are required by each organ system in specific amounts to promote growth, development, maintenance, and repair of body tissues. The 2019 European Pressure Ulcer Advisory Panel (EPUAP), National Pressure Injury Advisory Panel (NPIAP), and Pan Pacific Pressure Injury Alliance (PPPIA) Prevention and Treatment of Pressure Ulcers/Injuries:
Clinical Practice Guideline (EPUAP/NPIAP/PPPIA CPG) provides guidance on the prevention and management of PIs. This guideline was a collaboration between the EPUAP, NPIAP, and PPPIA with the assistance of 14 associate organizations. The goal of this international collaboration was to provide an updated, comprehensive review of the research literature and develop recommendations
reflecting recent evidence. The intent is for health professionals around the world to use the recommendations generated to prevent and treat PI.

Prescription Drug Monitoring Programs (PDMPs): Drug Overdose:

Center for Disease Control and Prevention (CDC)

Clinical practice guidelines encourage use of the PDMP prior to prescribing to assess a patient’s history of controlled substance use. It is possible to improve the way opioids are prescribed, reducing the number of people who misuse, abuse, or overdose from them, while making sure patients have access to safe, effective pain management. A prescription drug monitoring program (PDMP) is an electronic database that tracks controlled substance prescriptions. PDMPs can help identify patients who may be misusing prescription opioids or other prescription drugs and who may be at risk for overdose.

Preventing Hospital-Associated Venous Thromboembolism: A Guide for Effective Quality Improvement

Agency for Healthcare Research and Quality (AHRQ)

Pulmonary embolism resulting from deep vein thrombosis—collectively referred to as venous thromboembolism—is the most common preventable cause of hospital death. Pharmacologic methods to prevent venous thromboembolism are safe, effective, cost-effective, and advocated by authoritative guidelines, yet large prospective studies continue to demonstrate that these preventive methods are significantly underused. Based on quality improvement initiatives undertaken at the University of California, San Diego Medical Center and Emory University Hospitals, this guide assists quality improvement practitioners in leading an effort to improve prevention of one of the most important problems facing hospitalized patients, hospital-acquired venous thromboembolism.

Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guidelines

European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance

In 2019, a full set of Clinical Practice Guidelines were developed, by the European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guidelines, The International Guideline and can be purchased for a fee. In addition, a Quick Reference Guide (QRG), which provides a summary of the recommended guidelines can be downloaded for no charge.

Training and the Culture of Learning: Health Equity Resource Series

American Hospital Association (AHA) Institute for Diversity and Health Equity (IFDHE)

To support hospitals and health systems starting from different points on their journey to achieve health equity, the AHA’s Institute for Diversity and Health Equity (IFDHE) is releasing a series of toolkits to share evidence-based practices to inform organizational next steps for the following topics:

  • Data collection, validation, stratification and application of patient information to address disparate outcomes
  • Cultural humility and implicit bias training and education
  • Diversity and inclusion in leadership and governance roles
  • Sustainable community partnerships focused on improving equity

Each toolkit is designed to be informative, whether organizations have already deployed health equity tactics and strategies or if they are at the early stages of implementation. Each helps lay the groundwork for an in-development equity roadmap to support hospitals’ and health systems’ efforts toward achieving high-quality, equitable care for all. This toolkit focuses on training and education strategies and approaches to encourage cultural humility and overcome implicit bias.

Building a Team to Reduce CLABSI and CAUTI

Prepared by the HAP Quality Initiatives Department
Healthcare Associated Infection Prevention Managers
September 2019

The purpose of this tool kit is to teach you the key elements that are essential in building a successful team to reduce central line associated bloodstream infections (CLABSI) and catheter associated urinary tract infections (CAUTI) on your unit. The tool kit will provide you with information on how to develop a team, assess your work practices, develop an action plan, implement changes, and evaluate your success.

Building a Team to Reduce Surgical Site Infections

This material was prepared by The Hospital & Healthsystem Association of Pennsylvania. It is redistributed by the IPRO HQIC, a Hospital Quality Improvement Contractor, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS).

The purpose of this toolkit is to lead hospitals through the key elements that are essential in building a successful team to reduce surgical site infections (SSI). The toolkit will provide information regarding how to develop a team, assess work practices, identify gaps, develop an action plan, implement changes, and evaluate success.

Person and Family Engagement and Health Equity – Summary

This material was prepared by American Institutes for Research (AIR). It is redistributed by IPRO HQIC, a Hospital Quality Improvement Contractor, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS).

This is a summary table that describes the six strategies for engaging with patients and families in equitable and meaningful ways. Although the order of the strategies in the table is based on hospitals’ experiences, hospitals do not need to implement all six strategies at once, or in this order.

Hospital Roadmap for Person and Family Engagement (PFE):Achieving the Five PFE Best Practices to Improve Patient Safety and Health Equity

This material was prepared by American Institutes for Research (AIR). It is redistributed by IPRO HQIC, a Hospital Quality Improvement Contractor, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS).

A growing body of work—captured in peer-reviewed
literature and the experiences of hospitals and health
systems across the United States—highlights the benefits
of PFE, suggesting that successful implementation of PFE
practices can contribute to better outcomes. This PFE Roadmap provides practical guidance to help hospitals implement five PFE best
practices.

PfP Strategic Vision Roadmap for Person and Family Engagement (PFE)

This material was prepared by American Institutes for Research (AIR). It is redistributed by IPRO HQIC, a Hospital Quality Improvement Contractor, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS).

The purpose of the revised Roadmap is to provide practical guidance to help the Hospital Improvement Innovation Networks (HIINs), hospitals, and other PfP partners achieve a shared vision of PFE and meet the five PFE metrics.

The Roadmap contains information about:
• definition and core principles of PFE;
• role of PFE in patient safety;
• the intersection of PFE and health equity;
• definition, intent, and benefits of each PFE metric, as well as tips and resources to help
meet each metric and hospital success stories; and
• six PFE strategies to meet the five PFE metrics.