Colleen O'Toole
President,
Greater Cincinnati Health Council

This month's Progress Report will provide an update on Cincinnati Aligning Forces for Quality (AF4Q) efforts to address the quality and equity of medical care in the inpatient setting. I thank Colleen O'Toole, president of the Greater Cincinnati Health Council, for providing this report.
- Craig Brammer, Director, Cincinnati AF4Q

AF4Q work in this area has two major focuses:

• Identify and prepare to address racial, ethnic and language disparities in Greater Cincinnati hospital care through our local Cincinnati Expecting Success project.
• Encourage local hospitals' participation in national learning collaboratives offered by the Robert Wood Johnson Foundation (RWJF), such as Transforming Care at the Bedside and Speaking Together, and support the spread of collaborative learnings throughout the region.

While hospitals continually strive to improve the quality of their care, we do know that too often patients in American hospitals receive inadequate care or inappropriate care. For patients in a racial or ethnic minority, the quality of care can be even worse. Numerous research studies have shown that African Americans and Hispanics are likely to receive a lower standard of care than their white counterparts - even when health coverage, income levels, education and other social and economic factors are equal.

Cincinnati Expecting Success, an AF4Q initiative in partnership with the Greater Cincinnati Health Council (GCHC) and funded in part by the Health Foundation of Greater Cincinnati, aims to address this reality.

CINCINNATI EXPECTING SUCCESS

The goal of Cincinnati Expecting Success is to assist GCHC member hospitals in decreasing disparities in treatment and health outcomes for selected conditions. This will be achieved by helping hospitals to first obtain highly reliable race, ethnicity and language (REL) data so that they can then see where disparities are occurring and be better positioned to address any inequities.

Phase I (April - August 2009): We at GCHC are currently engaging in dialogue with local hospital leaders about this important regional initiative. GCHC's board, made up of eight hospital CEOs and senior executives, fully endorsed the project at our March meeting. A workgroup is being formed that includes a representative from each participating hospital who will shepherd the work at their institution.

During the next five months, AF4Q will assess the current practices and information technology capabilities of each of the participating acute care hospitals for collecting REL data. A report, including an analysis of findings, will be issued for hospital and GCHC use.

Phase II (Summer 2009 - February 2010): AF4Q, with the support of national experts in quality improvement methodology including those from George Washington University and the RWJF, will assist the workgroup in developing parameters around consistent, common data collection.

An action plan to re-engineer data collection practices will then be developed. Existing toolkits will be used to ensure data collection practices are consistent with national standards, and will include the technical and operational requirements to collect REL data consistently with agreed-upon criteria. AF4Q will also assist hospitals in training frontline staff to capture these data in a standardized manner.

Expected Outcomes

Leaders of participating hospitals will gain an invaluable understanding of the composition of their patient base, which provides an opportunity to better serve them. This data collection effort will also enable hospital leadership to see where their hospital consistently meets or does not meet evidence-based care metrics, and to clearly identify and address any racial and ethnic disparities.

In addition, these participating hospitals will be well-positioned to apply for an invaluable cardiac care quality improvement opportunity in 2010, when the RWJF is expected to invite hospitals from seven AF4Q communities to apply for participation in its national learning collaborative, Expecting Success: Excellence in Cardiac Care.

This national disparities program was first launched in 2005 to improve the quality of cardiac care for racial and ethnic minority populations in the United States, and it has demonstrated dramatic improvements.

In the pilot, ten hospitals across the country participated in a 30-month initiative focused on ensuring equity in their cardiovascular care. Expecting Success hospitals uniformly measured the quality of care provided to patients based on race, ethnicity and preferred language, which most hospitals in the country have either not done, or not done in consistent ways. Doing so allowed the hospital teams to identify existing disparities and implement changes that improved the quality of care being provided to their heart failure and heart attack patients.

Getting Started

As we kick off Phase I of the Cincinnati Expecting Success initiative, I believe local hospital leaders will embrace the work for several reasons:

• Improving care is aligned with the mission of all of our hospitals, and increasing equity in care is the right thing to do.
• The "Expecting Success" model was developed and tested by the RWJF and perfected at hospitals with proven results. Each hospital made quantifiable improvements under the Expecting Success model. (View video of one hospital's experience.)
• Hospital CEOs that participated in Expecting Success said that implementing procedures to ask patients their race, ethnicity and primary language was far easier than anticipated. The data provided clarity about patient demographics and helped identify whether disparities occur and, if so, where they occur. (View Program Achievements video.)
• Improving quality can drive financial success. If the cardiac care provided by a hospital is of the highest quality and free of racial, ethnic or language disparities, the effect can be beneficial to the bottom line.

OUR HOSPITALS: AN OPPORTUNITY
FOR INNOVATIVE NATIONAL TRAINING

It is because of Greater Cincinnati's involvement in AF4Q that our local hospitals are offered the opportunity to participate in elite training through national AF4Q learning collaboratives, such as the previously mentioned Expecting Success: Excellence in Cardiac Care that will kick off in 2010 and Speaking Together, which is focused on improving the quality of language services and will begin later this year. Another collaborative already underway is Transforming Care at the Bedside (TCAB).

Most of us would agree: nurses and hospital staff who spend the most time directly caring for patients are the key drivers of quality improvement.

Mercy Hospital Anderson has been selected by the RWJF to participate in its Transforming Care at the Bedside national collaborative, the nurse-led effort that will help nurses and other frontline staff identify, test and implement changes to improve the quality and safety of patient care in their medical and surgical units. (Click here to view press release.) Previously, Cincinnati Children's and Bethesda North participated in national TCAB collaboratives.

The program is based on the successful TCAB pilot efforts by the RWJF to transform care at the bedside. (Click here to view TCAB toolkit, video or program evaluation.) Mercy Hospital Anderson's involvement will benefit our entire region, as they learn innovative ways to improve care and through GCHC, share their learnings with hospitals across Greater Cincinnati.

Making sure that everyone gets the right hospital care at the right time... that is what these AF4Q initiatives are all about, and the Health Council is pleased to facilitate this important work.

Colleen K. O'Toole, PhD President, Greater Cincinnati Health Council For More Information: To learn more about Cincinnati Expecting Success or the national collaboratives, please call Nancy Strassel, Senior Vice President, Greater Cincinnati Health Council at (513) 531-0200 or Lisa Sloane, AF4Q Project Manager at (513) 558-5138.