Leveraging Ethnic Backgrounds to Improve Collection of Race, Ethnicity, and Language Data.

INTRODUCTION: Healthcare disparities may be exacerbated by upstream incapacity to collect high-quality and accurate race, ethnicity, and language (REaL) data. There are opportunities to remedy these data barriers. We present the Denver Health (DH) REaL initiative, which was implemented in 2021. METHODS: Denver Health is a large safety net health system. After assessing the state of REaL data at DH, we developed a standard script, implemented training, and adapted our electronic health record to collect this information starting with an individual's ethnic background followed by questions on race, ethnicity, and preferred language. We analyzed the data for completeness after REaL implementation. RESULTS: A total of 207,490 patients who had at least one in-person registration encounter before and after the DH REaL implementation were included in our analysis. There was a significant decline in missing values for race (7.9%-0.5%, p < .001) and for ethnicity (7.6%-0.3%, p < .001) after implementation. Completely of language data also improved (3%-1.6%, p < .001). A year after our implementation, we knew over 99% of our cohort's self-identified race and ethnicity. CONCLUSIONS: Our initiative significantly reduced missing data by successfully leveraging ethnic background as the starting point of our REaL data collection.

A Discharge Planning Template for the Electronic Medical Record Improves Scheduling of Neurology Follow-up for Comanaged Seizure Patients.

OBJECTIVE: We examined whether the addition of a standardized discharge planning template (DPT) for the electronic medical record facilitated scheduling of outpatient neurology follow-up appointments in children hospitalized with seizures. METHODS: We reviewed medical records of patients discharged from a children's hospital with a diagnosis of seizures between January 2012 and June 2013. The study cohort included children who were admitted to the hospitalist service with neurology service comanagement. To facilitate interdisciplinary communication around discharge planning, a DPT was added to the neurology consult note in July 2012. Multivariate regression was used to determine whether the postimplementation time period was associated with the primary outcome (scheduling of outpatient neurology follow-up before discharge). RESULTS: The final cohort included 300 patients, of whom 101 (34%) were discharged before implementation of the DPT, and 199 (66%) were discharged postimplementation of the DPT. The odds of having a neurology follow-up appointment scheduled before discharge was significantly higher after implementation of the DPT (adjusted odds ratio 2.8, 95% confidence interval 1.7-4.8) and for weekday as compared with weekend discharges (adjusted odds ratio 2.2, 95% confidence interval 1.2-3.9). CONCLUSIONS: A discharge planning template for the electronic medical record can standardize the flow of discharge-related information between disciplines and may help expedite transitional care planning for hospitalized children, especially those with multiple consultants involved in their care. Given the inherent barriers to arranging outpatient services over the weekend, additional strategies may be necessary to enhance transitional care planning for patients going home over the weekend.

Development of a discharge readiness report within the electronic health record-A discharge planning tool.

BACKGROUND: With increasingly complex pediatric inpatients, efficient and effective hospital discharge requires optimal interdisciplinary care coordination and communication. We describe the development of a discharge readiness report (DRR) for the electronic health record (EHR), an integrated summary of discharge-related information organized into a highly visible and easily accessible report. METHODS: We used interviews and process mapping to understand the roles of all disciplines involved in discharge planning and identified key drivers affecting our aim of designing a discharge tool in the EHR. Based on identified key drivers, we designed the DRR and made changes to the report using rapid improvement cycles. The final report includes information necessary for discharge planning organized into 4 domains: potential barriers to discharge, transitional care, home care, and discharge criteria. RESULTS: The DRR was activated in June 2012. As planned, the final product incorporated previously existing discharge-related information from within the EHR, organized into 1 report. Shortly after its introduction, the DRR was included in daily care coordination rounds (CCRs) for medical and medical subspecialty patients. End users found the report to be completely populated and accurate. We measured time to completion of CCRs and found no difference between duration of CCRs pre- and postuse of the DRR. CONCLUSIONS: Given widespread adoption, EHRs should be optimized to improve healthcare delivery. A discharge planning tool in the EHR may improve the efficiency and effectiveness of care transitions by allowing for proactive discharge planning and improved interdisciplinary communication.

The role of community-academic partnerships: implications for medical education, research, and patient care.

PROBLEM: Despite several studies demonstrating the benefits of community-academic partnerships, their value to academic health centers (AHCs) is often viewed with skepticism by some in the academic community. PURPOSE: This paper examines the roles of community organizations and the mechanisms by which they can enhance the AHC missions of education, research, and patient care. KEY POINTS: As lay educators, community organizations can contribute to medical education by exposing students to diverse cultural perspectives. As community advocates, they can facilitate the research process by helping to frame culturally relevant research questions, by ensuring that research survey instruments are culturally and linguistically appropriate, and that research findings are disseminated to community stakeholders. As lay health workers, they can facilitate health care delivery by providing a link to hard-to-reach populations through their outreach and referral initiatives. CONCLUSION: Forming partnerships between community organizations and AHCs can support the missions of AHCs and simultaneously develop and strengthen community capacity.

Shaping garments of care: tools for maximizing adherence potential.

There is a tendency in health care to treat clients' maladies in accordance with two basic premises: (1) the medical needs of the client (as perceived by the clinician) can be successfully addressed by focusing solely on that aspect of the client's life and (2) if the client is not able or ready, then there will be someone in the client's support system to take responsibility for administering prescribed therapy. In many cases these assumptions hold true, but for certain sub-populations they do not, notably: individuals with substandard/chaotic lives, those with multiple confounding diagnoses (mental health, substance abuse, disability, addiction, domestic violence) who have neither personal adherence ability nor adequate support systems. They are rarely seen in ambulatory care settings, engaging with the health care system only through emergency rooms and hospital admissions. Such a group makes up a large proportion of urban, HIV positive clients. For them, successful adherence can only be accomplished by rethinking what constitutes 'care' and 'tailoring' that care to the individual. In this context adherence requires the interweaving of three sets of needs: (1) needs perceived by the client, (2) client needs as observed by an objective recorder and assessed for impact on the client's ability and willingness to be adherent and (3) medical needs identified by a clinician. Extensive work with this population has led to the creation of a Cluster of Tools (HIVCOT), designed to quantitatively assess the severity of the varied needs (Health Importance Level or HIL), the adherence ability of the client (Adherence Functional Level or AFL) and how difficult it is to adhere to a given treatment (Level of Adherence Difficulty or LAD). Through the application of these tools it becomes possible for the medical providers to make individual adjustments to the design of care so that it closely fits the needs and abilities of the client. In this way the likelihood of adherence is maximized.