Driving equity in health care: Lessons from COVID-19


Editor’s note: third of a series on the impact of COVID-19 on communities of color and responses to improve health equity. Click on here read part one and here for the second part.

If there is one bright side to COVID-19, it’s that it has forced us to tackle monumental disparities in health care, especially racial and ethnic disparities. I have been working on health care disparities for over two decades, but I have never seen our health care system evolve so quickly. Across the United States, those of us working in healthcare are working to fill the gaps and better understand why COVID-19 is disproportionately impacting communities of color and immigrants – and, in fact, on anyone struggling with social determinants of health such as lack of housing, food insecurity and access to a good education.

A key lesson: lived experience should guide change

I came to this country as an undocumented immigrant when I was 13 years old. English was not my mother tongue. My mom was a single teenage mom and I’ve only seen my dad twice in my life. My childhood was filled with all the traumas we hear about in many of our patients: domestic violence, drug addiction, mental health issues, foster care, etc. So you can imagine that this all feels extremely personal to me and motivates me in the work I do as the director of the Disparities Solutions Center at Massachusetts General Hospital.

A key lesson is that there is no substitute for lived experience. We need people with first-hand experience to help us reshape our healthcare systems so that we can care for all of our patients and to help rethink emergency preparedness for future events like the COVID-19 pandemic. . Our healthcare teams should regularly include people from communities that are most affected by health inequalities. Currently, our healthcare system is designed by default for the English speaking person who has health and digital skills, and who has access to computers and / or smartphones – because she is the one who designs our systems. . As we work for change based on the lessons learned from the COVID-19 pandemic, and those we will continue to learn, we must keep this in mind.

If you’re a member of the communities hardest hit by the pandemic, you can help by sharing your experiences – what worked, what didn’t – and by advocating with healthcare facilities, community leaders and via social media for approaches that address COVID. -19 disparities in health care. The ones I describe below are common themes from the hospitals we’ve worked with, as well as what we’ve seen in our own healthcare system.

Take the necessary steps to build community confidence

Trust is essential for messages about reducing the spread and impact of COVID-19 to resonate with the community. But trust is often shaped by historical events. Healthcare organizations need to carefully consider the ways in which historical events have led to mistrust within the communities they serve. The messenger of each community should be a trusted member of the community, and outreach should take place in the community, not just in your health facility.

Invest time to eliminate language barriers

Integrating interpreters during a medical visit, whether in person or via a virtual platform, is not easy. And in fact, it’s not intuitive in most American healthcare systems. At the MGH, we saw it with the intercom system used to communicate securely with our COVID hospital patients and the virtual tour platform used for outpatient visits. Adding a third-party medical interpreter to these systems has proven difficult. Feedback from an advisory board of bilingual interpreters and staff who participated in the redesign of workflow, telehealth platforms and electronic health records helped.

Ensuring that educational materials are available in multiple languages ​​goes beyond their translation. We also need to be creative with modalities that support health literacy, like videos, to help people understand important information. Ideally, our workforce would include bilingual health care providers and staff who could communicate with patients in their own language. In the absence of this, the integration of interpreters into the workflow and telehealth platforms is essential.

Understand that the social determinants of health still impact 80% of COVID-19 health outcomes

COVID-19 is having a disproportionate impact on people who are essential frontline workers who cannot work from home, cannot quarantine in isolation and depend on public transportation. So yes, the social determinants of health still matter. If tackling the social determinants seems overwhelming (say, solving Boston’s affordable housing shortage), maybe it’s time for us to reframe the challenge. Rather than assuming that the onus is on a health care system to solve the housing crisis, the question really needs to be: how are we going to provide care to patients who are homeless and living in a shelter? , or who surf the couch with friends and family, or live in inexpensive hotels or motels?

Use racial, ethnic and linguistic data to focus mitigation efforts

Invest time in improving the quality of race, ethnicity and language data in health care systems. Additionally, stratifying quality measures based on these demographics will help identify disparities in health. At the MGH, already having this database was the key to quickly developing a COVID-19 dashboard that identified real-time patient demographics on the floors of COVID-19 hospital patients. At some point during our first outbreak, more than 50% of our patients on COVID units needed an interpreter, as the majority came from the heavily immigrant communities in the Boston area of ​​Chelsea, Lynn and Revere. This information was crucial to our mitigation strategies and would help inform any health care system.

Address privacy and immigration issues

The overwhelming majority of our health center providers, interpreters and immigration advocates tell us that immigrant patients are reluctant to participate in virtual visits, register for our patient portal, or visit to our healthcare facility because they are afraid that we will share their personal information with Immigration. and customs enforcement (ICE). We worked with a multidisciplinary group and our legal advisor to develop a low literacy script in multiple languages ​​that describes to these patients how we protect their information, why we are legally required to protect them (HIPAA) and in what scenario we would share it with law enforcement (if there is a valid warrant or court order).

Additional strategies include educating providers to avoid documenting a patient’s immigration status and educating patients about their rights and protection under the U.S. Constitution. In short, it goes back to the first point of building trust between the health care organization and the community it serves.

Equitable care is a journey, not a single goal. Only by taking critical steps to achieve it can we hope to achieve this, correcting the course with new lessons learned from this pandemic as we go.

The message Promoting Equity in Health Care: Lessons from COVID-19 first appeared on Harvard’s health blog.

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