Brooklyn Health Equity Index Seeks to Uncover Discrimination

April 5, 2023
Survey instrument being developed by SUNY Downstate Health Sciences University, One Brooklyn Health System, and the Arthur Ashe Institute for Urban Health

Healthcare stakeholders are developing a Brooklyn Health Equity Index (BKHI), which goes beyond traditional patient experience surveys in seeking to uncover experiences with discrimination in the healthcare setting, provider empathy, cultural humility, structural racism, and more.

Tailored to the needs and experiences of residents of Central and Northeast Brooklyn, N.Y., the BKHI is being developed by SUNY Downstate Health Sciences University, One Brooklyn Health System (OBHS), and the Arthur Ashe Institute for Urban Health.

During an April 4 webinar hosted by the New York Health Foundation, leaders of the effort described the goals behind the index’s creation.

Gwendolyn Lewis, D.N.P., R.N., is chief nursing officer and senior vice president, patient care services, at OBHS’  Interfaith Medical Center, and principal investigator for One Brooklyn Health for this project. She said the three institutions that came together to work on this project are SUNY Downstate, the only academic medical center in Brooklyn; the Arthur Ashe Institute for Urban Health, which was founded in 1992 by tennis player Arthur Ashe, who was an advocate with those people living with HIV and AIDS. It's been one of the pioneers in building community infrastructure to address health equity, Lewis said. The last partner is One Brooklyn Health, a health system that was established in 2016 with the merger of three central Brooklyn hospitals that serve approximately 1.2 million mostly Black and Brown community residents.

OBHS also has an extensive network of primary behavioral health and specialty care locations located throughout central Brooklyn. The health system is exploring how to integrate the index into its routine patient experience evaluations to guide equity-focused quality improvement efforts.

Aimee Afable, Ph.D., M.P.H., associate dean for community engagement at SUNY Downstate School of Public Health, explained that in January 2023, the Joint Commission, recognizing the importance of raising the quality of healthcare amongst underserved populations and communities, developed new quality standards to create a consistent national baseline related to the equitable care of all patients. In doing this, the Joint Commission compels all healthcare organizations to address health equity. “There are many tools available to measure patient satisfaction, such as the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey, but these tools currently don't measure health equity,” she said. “The Brooklyn Health Equity Index is being developed to measure how hospitals and healthcare systems are addressing equity with the long-term vision of providing healthcare organizations with a tool that will enable the organization to make systemic changes to promote health equity.”

Tenya Blackwell, DrPH, director of community engagement and research at the Arthur Ashe Institute for Urban Health, said that the lived experiences of populations in central Brooklyn are driving the project. Central Brooklyn is one of three New York City Department of Health priority areas that have had a history and experience of marginalization with regard to death, disease and disability and poverty. It experiences lower life expectancy compared to the rest of New York City. It also experiences a disproportionate burden of poverty and high proportions of unmet medical care. Unmet medical care is defined as the percentage of adults ages 18 and older who report not getting the needed medical care at least once in the past 12 months.

“The goal of the Brooklyn Health Equity Index is to develop a health system metric that quantifies how healthcare systems are working to achieve health equity,” Blackwell said. “We envision that health systems might use this metric to inform quality improvement initiatives, as well as potentially have healthcare payers use it for consideration in reimbursement mechanisms.”

She said a strong emphasis of the project is to elevate patients and community voices to help foster systemic change. “We de-centered academia and the traditional approaches to survey developments and we really centered the community and the patient voices. And we do that because we want to be able to have a more participatory process that will inform the path to foster hospital, systemic changes. Our theoretical framework is that if we empower the patient or the members of the community to be advocates or to be knowledgeable of their own health conditions, that's the foundation for improving health outcomes within the community and addressing health equity.”

She said it was important to engage members of the community, including community-based organization leaders, barbershops and hair salons with which Arthur Ashe was conducted other outreach work. “It was important for us to build this multi-stakeholder model, using a community-based participatory research approach,” Blackwell said.

This work has been carried out in three phases. Phase one was the formative research phase, where they conducted a lot of community-driven qualitative research. In phase two, they analyzed that data and developed the survey instrument and did pilot testing and conducted psychometric testing. They are currently in phase three with the scale-up of the index, and wider dissemination throughout the One Brooklyn Health System.

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