Development of a health equity journal club to address health care disparities and improve cultural competence among emergency medicine practitioners.

Health care disparities have been magnified by the COVID-19 pandemic. Only recently has the medical community acknowledged implicit bias and systemic racism as a public health emergency. Graduate medical education has been slow to adopt curricula beyond lecture-based formats that specifically address social determinants of health (SDOH) and its impact on communities. Curricula addressing unconscious (implicit) biases and their influence on patient care has not been widely adopted. The emergency department (ED) has a unique role in addressing health care disparities. Approximately 69% of emergency medicine residency programs incorporate cultural competency training in their curricula. Most are primarily lecture-based without a longitudinal component, and gaps exist in content, quality, and expertise of the presenters. Lecture-based formats may not be best suited to manage the nuanced conversations necessary to dismantle biases and socialized beliefs that result in disparities for marginalized communities. Reporting little or no education in medical school related to SDOH, residents acknowledge that barriers to care exist, but have limited or no knowledge of what those barriers are or how mitigate them. To improve health equity, understanding and competence in caring for culturally and ethnically diverse populations, we developed a monthly, longitudinal, SDOH- and cultural competency-based "health equity journal club" (HEJC) for all levels of ED staff. Four educational domains were developed, and specific content within each domain was selected based on predetermined criteria. Content for each session was mapped to the ACGME program and core competency milestone requirements, ACGME Clinical Learning Environment (CLER) mandates, and The Joint Commission's institutional recommendations for culturally competent care. The HEJC series has been successful in reducing barriers to identifying biases in health care; translating literature to clinical care; generating initiatives and interdisciplinary research; and cultivating interest in community health, health advocacy, and public policy.

The predictive validity of the HERO Scorecard in determining future health care cost and risk trends.

OBJECTIVE: To determine the ability of the Health Enhancement Research Organization (HERO) Scorecard to predict changes in health care expenditures. METHODS: Individual employee health care insurance claims data for 33 organizations completing the HERO Scorecard from 2009 to 2011 were linked to employer responses to the Scorecard. Organizations were dichotomized into "high" versus "low" scoring groups and health care cost trends were compared. A secondary analysis examined the tool's ability to predict health risk trends. RESULTS: "High" scorers experienced significant reductions in inflation-adjusted health care costs (averaging an annual trend of -1.6% over 3 years) compared with "low" scorers whose cost trend remained stable. The risk analysis was inconclusive because of the small number of employers scoring "low." CONCLUSIONS: The HERO Scorecard predicts health care cost trends among employers. More research is needed to determine how well it predicts health risk trends for employees.

Reliability and validity testing of the CDC Worksite Health ScoreCard: an assessment tool to help employers prevent heart disease, stroke, and related health conditions.

OBJECTIVE: To develop, evaluate, and improve the reliability and validity of the CDC Worksite Health ScoreCard (HSC). METHODS: We tested interrater reliability by piloting the HSC at 93 worksites, examining question response concurrence between two representatives from each worksite. We conducted cognitive interviews and site visits to evaluate face validity of items and refined the instrument for general distribution. RESULTS: The mean question concurrence rate was 77%. Respondents reported the tool to be useful, and on average 49% of all possible interventions were in place at the surveyed worksites. The interviews highlighted issues undermining reliability and validity, which were addressed in the final version of the instrument. CONCLUSIONS: The revised HSC is a reasonably valid and reliable tool for assessing worksite health promotion programs, policies, and environmental supports directed at preventing cardiovascular disease.