Measuring Health Equity for Ambulatory Care Sensitive Conditions in a Large Integrated Health Care System: The Development of an Index

Abstract

Disparities in outcomes for preventive and primary health care services often result when vulnerable patients rely on episodic encounters for emergency services that do not meet their long-term health needs. Understanding health outcomes in socially or economically disadvantaged subgroups is crucial to improving community health, and it requires innovative analytics and dynamic application of clinical and population data. While it is common practice to use proxy indicators, such as quality of life and mortality, when discussing health equity, these have shown limited utility and are rarely applied at a population-level within a health system. Therefore, we designed and implemented an index, calculated as the ratio of observed-to-expected encounters, to identify and quantify health inequalities in health care systems. Providing equitable care, as measured by health outcomes, is analogous to precision medicine applied to social determinants. For health systems, the use of this index will facilitate the development of specially-tailored interventions to address inequity and provides a tool to measure the impact of such programs.

Measuring health equity in the ASEAN region: conceptual framework and assessment of data availability

“…The WHO primary health care measurement framework considers health equity from a systems-level perspective, yet focuses on primary healthcare rather than all levels of service provision [ 33 ]. One recent study by Pressman et al focuses on the development of a health equity index but uses only a disease-specific approach [ 34 ]. In country-level studies, the assessment of health equity is generally domain-specific.…”

Measuring and Promoting SARS-CoV-2 Vaccine Equity: Development of a COVID-19 Vaccine Equity Index

“…The index is a novel innovative metric that provides information to identify and quantify disparities where they exist. Based upon concepts of equity previously deployed by the authors in the creation of the HEI, 20 used to address disparities for ambulatory care sensitive conditions, this tool facilitates targeting of interventions to achieve high-quality equitable health care outcomes for COVID-19. It is the authors' desire that the index be further developed, validated, and widely implemented.…”

“…We propose to use real-time readily available EHR data to derive a vaccine equity index that accounts for disproportionate burden of illness and can be used to guide health system vaccine mitigation strategy. The index presented, building on concepts from our prior health equity index (HEI), 20 is intended to provide insight into the impact that thoughtful vaccination strategies can have on addressing disparities. The goal is to promote more equitable outcomes among racial/ethnic groups, thus reducing overall morbidity and mortality as we pursue the collective goal of herd immunity through mass vaccination.…”

Piloting and Scaling a Good Health Equity Evidence Base From Big Data

“…Thus, the first step was to create a novel metric-a health equity index (HEI)-to identify and quantify inequity within health care organizations and develop targeted interventions to enhance equity. 4 Sutter Health's HEI is the first health equity metric to be implemented that uses real-time EHR data combined with external demographic, prevalence, and utilization statistics to identify inequitable outcomes, reveal their underlying causes, and help illuminate interventions. Applied initially to ambulatory care-sensitive conditions, the HEI has been deployed and studied at Sutter Health for 3 years.…”