Mass General Report Describes Initiatives to Reduce Disparities

Oct. 13, 2022
Annual report monitors access to and quality of clinical care by race, ethnicity, and language

In its 12th Annual Report on Equity in Health Care Quality (AREHQ), Mass General Hospital (MGH) in Boston identified some ongoing disparities as well as several new improvement initiatives, including one for patients with Sickle Cell Disease and a new Center for Immigrant Health.

The AREHQ monitors access to and quality of clinical care by race, ethnicity, and language. It also identifies areas for quality improvement and reports on the progress of current initiatives to address disparities at MGH. 

The 2021 report notes that MGH continue to see disparities in adult preventive care and chronic disease management within its primary care population at Mass General, including:

• Significantly lower rates for breast, cervical and colorectal cancer screening for patients of color, and lower rates of breast and colorectal screening for LEP (low English proficiency) patients. It also sees significantly lower rates across allcancer screenings among patients with Medicaid.

• Significantly lower rates of depression screenings for patients of color and patients with LEP, compared to White, English-speaking patients, as well as Medicaid patients not managed by the organization’s ACO.

Lower rates of tobacco screening for patients of color and patients with Medicaid, compared to White patients and those with commercial insurance.

Among patients with diabetes, racial and language disparities were identified in all three outcome measures. These disparities were also present in the traditional Medicaid population.

Within the cohort of patients with hypertension, disparities are evident by race, language, and traditional Medicaid coverage.

In response, the Division of General Internal Medicine recently launched a multidisciplinary effort to advance equity in primary care with the following aims:

• Increase awareness of health disparities by race, ethnicity, language, and payer.

• Identify and narrow these gaps using Population Health Coordinators (PHCs) and Community Health Workers (CHWs) working with primary care teams.

Decrease hypertension blood pressure control disparities by race and language for primary care patients.

In March 2021, Mass General launched the Comprehensive Sickle Cell Disease Treatment Center to provide SCD patients and their families with a true medical home staffed by an interdisciplinary team of experts who deliver comprehensive care from childhood to adulthood. The program also offers a dedicated social worker and nurse navigator, infusion space for treatments, the latest medical advances, and access to community resources.

Immigration status is increasingly recognized as a social driver of health. Mass General launched the Center for Immigrant Health (CIH) in 2020 with the mission to foster excellence in clinical care, education, advocacy, and research aimed at improving the health and well-being of immigrants. The Center’s programming focuses on both patients and Mass General staff, to ensure that all staff has the knowledge to effectively serve immigrant patients in culturally sensitive ways, and that patients have access to high-quality and patient-centered care, regardless of immigration status.

The Disparities Solutions Center at MGH recently launched the Collaboration Catalyst and Equity Innovation Grant programs to fund projects to eliminate disparities in clinical care. The Collaboration Catalyst program funds larger projects involving multidisciplinary teams, and the Equity Innovation program provides micro-grants for smaller improvement projects.

Disparities in patient experience
In 2020, as part of a Mass General Brigham system-wide initiative, Mass General implemented a new patient
experience survey process that enables feedback to be captured in real-time. The new approach offers many advantages over our previous methods, resulting in feedback from a larger and more diverse group of patients.The new system includes a universal opportunity to provide feedback, “real-time” patient outreach within 1–3 days of an encounter, shorter surveys that are easier to complete, and surveys offered in multiple languages (English, Spanish, Portuguese, Mandarin, Russian, Haitian-Creole, Khmer, and Arabic).

In 2021, 8,387 patients provided feedback on their hospital stay via the inpatient survey; 20 percent were patients of color, and 8 percent answered the survey in a language other than English. There are disparities by race and ethnicity, and language for 12 of 13 inpatient survey questions, many with large gaps of 10 percentage points or more.

In 2021, Mass General received feedback from 182,922 patients regarding their in-person office visits; 19 percent were patients of color, and 6 percent answered the survey in a language other than English. These results show significantly lower scores across all race and ethnicity groups and patients speaking other languages on every measure. These are large gaps of at least 5 percentage points, and in many cases, 10 or more percentage points.

In 2021, Mass General received feedback from 64,196 patients regarding their virtual office visit; 15 percent were patients of color and 3 percent answered the survey in a language other than English. The telehealth survey includes several questions about the technical experience. Patients of color and LEP patients reported significantly lower scores on ease of connection with provider, ease of logging in, technical support, connection quality, and ease of scheduling. Patients of color and LEP patients also reported significantly lower scores across all measures of the virtual clinical experience, relative to White and English-speaking patients.

Mass General also conducted a qualitative analysis of over 3,000 comments from Asian patients to better understand the improvement opportunities within this growing population Although Asian patients left many positive comments about their experience, they also described experiences of bias, cultural insensitivity, and feelings of invisibility. Patients also described experiences of high quality, culturally sensitive, and culturally appropriate care. Together, the report says, the feedback provides a roadmap for how to improve care for all patients of color by offering an environment that is welcoming and respectful, where diverse patients feel truly seen.

Speaking to Healthcare Innovation last year, Aswita Tan-McGrory, director of the Disparities Solutions Center at MGH, said the organization has been doing this work for more than 10 years and it has made its results publicly available. Some hospitals say they’re committed to reducing disparities, but have not made the effort yet to collect accurate racial and ethnic data from patients or are reluctant to publicly share their dashboards. “We can do a lot of measurement, but eventually you have to do something about it, right? And doing something about it requires money and resources,” Tan said. “The last year has provided that catalyst for boards to realize that they have to put some money into this — like serious money.”

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