The first panel of Yale’s health equity summit focused on how the Yale New Haven Health's decisions helped reduce health disparities and explored what could have been done differently to improve outcomes for all populations.
“We must take the time to reflect on what we did and improve the next time,” Marcella Nunez-Smith, MD, said in a recorded message during the summit. “The lessons captured here today help make sure we don’t return to our pre-pandemic normal.”
Manisha Juthani, MD, who moderated the panel, shared some of the state’s efforts to partner with local and trusted organizations to expand vaccine access. The state mobilized vans that visited barbershops, churches, and community-based meetings, where people would feel comfortable learning more and getting vaccinated. Research later showed that Black and Hispanic individuals were much more likely to be vaccinated at mobile clinics vs. a stable office, which helped to increase equity in vaccination rates among different racial and ethnic groups. The state used that same network of trusted community organizations to distribute self-test kits to help reduce the spread of the virus.
“Our work highlights how you can use the principles we’re going to hear today at the local level and then at a state level and far beyond,” said Juthani.
Standardizing Inpatient Care to Improve Health Equity
In February 2020, leaders within Yale realized that many patients were entering the health system with the same symptoms. They saw that hospitals in Italy and elsewhere were unprepared for the increase in patients and wanted to do everything possible to avoid that outcome. Yale quickly began to make preparations to free up beds and expand staffing in intensive care units (ICUs) in all the hospitals in the system.
During his presentation, Jonathan Siner, MD, shared that Yale created a dedicated team to review emerging literature and create a standard treatment protocol. They developed a rubric that clinicians used with each patient across the health system to establish goals of care.
“This made it very simple to determine what care an individual should get based on obvious, easily defined clinical parameters that are not subjective,” Siner said. “That’s particularly important when family members are no longer in the hospital, and we’re talking to people by phone. That creates a huge psychological and emotional distance.”
As a result of this preparation and commitment to uniformity, the average mortality rate of patients seen throughout Yale New Haven Health was much lower compared to similar U.S. health institutions. While there were disparities in who became sick and came into the hospital, patients from all races and ethnicities had similar outcomes once patients were in the hospital.
Improving Care for Incarcerated Individuals
People who were incarcerated in jails or prisons had a higher rate of infection and mortality from COVID-19. Emily Wang, MD, MAS, also noted that federal and state guidance on social distancing was out of sync with the reality of incarceration facilities, which regularly experience overcrowding.
One of the policies that helped alleviate some of the burdens of the virus on this population was decarcertation. However, community health systems were unprepared for the needs of recently released individuals, many of whom had no jobs, no insurance, and minimal transportation options. To help people transition home, Connecticut worked with community leaders with experience in the field to set up a special COVID-19 response line for individuals transitioning from jail or prison back into the community. The response line helped find quarantine housing and appointments for immediate health needs.
Based on the experiences learned during the pandemic, Connecticut is piloting a program to systematically address this population's social and health needs, including triaging and coordinating social and health needs. Wang is hopeful this program will improve outcomes for people who were in prison but urged community health systems to better support those transitioning out of jails and prisons.
“Incarcerated people and correctional systems must be included in the public health infrastructure,” Wang said. “If we do not incorporate them now when the next pandemic happens, this will again be a place that does not have the oversight.”
Using Data to Focus Action
Harlan Krumholz, MD, SM, noted that people from vulnerable populations were already in a precarious place before the pandemic. He shared new research showing that from 1999 – 2020, there were 1.5 million excess age-related deaths among Black Americans, resulting in 80 million years of life lost. These disparities multiplied when the coronavirus hit. Vulnerable communities who already had underlying disparities experienced even more significant inequality as a result of the pandemic.
“We've got to dismantle the structural racism that creates the gradients of barriers and obstacles and challenges that are faced by people as they're trying to figure out how to live their lives,” Krumholz said.
Krumholz said that looking at this kind of data can help clinicians and health systems identify areas that need attention, set clear goals, and hold themselves accountable for progress.
He also called for clinicians to extend their reach beyond the hospital walls to advance health equity and ensure people can live healthy lives even after they are discharged.
Key Takeaways From Panel One:
- Standard treatment protocols can help eliminate health disparities. Health systems should develop standardized rubrics to minimize bias and ensure all patients get the same high-quality care.
- Data is essential to understand where inequities exist and if programs are helping – or hurting – specific populations. However, data must include all populations, including people who are incarcerated, to be truly useful.
- Providers must have the trust of the communities they serve. Leveraging trusted community health partners can help encourage the use of essential health services.
- Identify and address structural barriers to healthcare. To access care, patients may need childcare, transportation, economic assistance, or other support.
- Providers have a role in advocating for policy solutions, like expanding access to insurance and investing in communities, to advance health equity.