As more health care organizations work toward achieving equitable care for all patients, accurate and useful measurement of your efforts are critical. A measurement framework focusing on equity will help your organization understand what changes are reducing inequities and whether any of your work might actually be increasing disparities.
You can read more about the pros and cons of different measurement approaches in IHI’s recent White Paper, Achieving Health Equity: A Guide for Health Care Organizations. To get you started, here are six tips to consider as you develop (or refine) a measurement strategy:
- Allocate organizational resources to support efforts to measure inequities. Measurement efforts will fail without adequate supportive systems, resources, and structures.
- Collect relevant data on sociodemographic characteristics of individuals. While more and more organizations have data systems to collect this information and are now required to report race/ethnicity and primary spoken language data, collecting this data is a key first step to being able to measure inequities. Income and education data are more difficult to collect routinely, but you can find relevant information from state or local public health departments, hospital associations, resources such as County Health Rankings or the Dartmouth Atlas of Health Care, or from other information such as US Census data. Organizations should not only review clinical outcome measures, but also examine measures related to the social determinants of health.
- Select health outcome(s) of interest to measure improvements in health equity over time. Some examples of health outcomes are mortality, self-reported health and functional status, or life expectancy. Once this process is more robust, consider adding structure and process measures.
- Select demographic characteristics of interest to examine against your health outcome of interest (e.g., race/ethnicity, socioeconomic status [income, education], gender).
- Examine “raw” data in tabular and graphical form. Look at both relative and absolute differences (pairwise comparisons) between different subpopulations, and examine changes over time. Select a reference point for each relative comparison that is the most advantaged (or favored) group.
- Calculate stratified measures of disparities for different health outcomes and social indicators of interest. This includes examining within-group differences in addition to between-group differences, such as Asian subpopulations (e.g., Chinese, Indian) and black subpopulations (e.g., US-born black vs. Haitian vs. Nigerian). Only examining differences for the overall group may mask marked differences that would identify the particular populations that could benefit from a targeted intervention.
Has your organization been measuring health equity? Leave your tips in the comments below.
You may also be interested in:
Achieving Health Equity: A Guide for Health Care Organizations
IHI's two-year Pursuing Equity initiative
Addressing Race in Practice
Equity is a featured track at the 2017 IHI National Forum.