ALVARADO PARKWAY INSTITUTE B.H.S.

1. Top 10 Disparities

The following table lists the ten largest health equity disparities identified for this reporting period.

Disparities for each hospital equity measure are identified by comparing the rate ratios by stratification groups. Rate ratios are calculated differently for measures with preferred low rates and those with preferred high rates. Rate ratios are calculated after applying the California Health and Human Services Agency's "Data De-Identification Guidelines (DDG)," dated September 23, 2016.

The table below highlights the ten widest health equity disparities identified by hospitals and hospital systems during this reporting period. Measure names have been shortened for display purposes. To view each measure in full, please download the complete Hospital Equity Report using the link below.

Measure	Stratification	Stratification Group	Stratification Group Rate	Reference Group	Reference Rate	Rate Ratio
1. HCAI 30-Day readmission CO	Sexual Orientation	Choose not to disclose	3.5%	Straight or heterosexual	0.8%	4.40
2. HCAI 30-Day readmission MHD	Expected Payor	Medicaid	3.2%	Private	1.1%	2.90
3. HCAI 30-Day readmission	Race and/or Ethnicity	Black or African American	5.4%	Hispanic or Latino	2.2%	2.50
4. HCAI 30-Day readmission	Sexual Orientation	Choose not to disclose	4.5%	Straight or heterosexual	1.9%	2.40
5. HCAI 30-Day readmission CO	Age (excluding maternal measures)	35 to 49	2.5%	18 to 34	1.1%	2.30
6. HCAI 30-Day readmission CO	Age (excluding maternal measures)	50 to 64	2.4%	18 to 34	1.1%	2.20
7. HCAI 30-Day readmission CO	Race and/or Ethnicity	Black or African American	3.9%	White	1.9%	2.10
8. CMS IPFQR screening metabolic disorders	Race and/or Ethnicity	Multiracial and/or Multiethnic (two or more races)	50.0%	Black or African American	100.0%	2.00
9. HCAI 30-Day readmission	Expected Payor	Medicaid	3.8%	Private	2.1%	1.80
10. HCAI 30-Day readmission	Expected Payor	Medicare	3.8%	Private	2.1%	1.80

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2. Equity Plan

We are committed to reducing recidivism and disparities in treatment through an equity-focused approach. This plan addresses systemic factors influencing recidivism and quality of care, including race, payer type, sexual orientation, and age among patients with co-occurring and mental health disorders. We emphasize competent care, continuity of care, and psychosocial support to ensure all patients receive quality care, follow-up and resources. Strategies include integrating Social Determinants of Health screening upon admission, improving hand-off communication, and promoting trust through inclusive practices. Our approach to health equity ensures that all benefits of treatment such as assessments, screenings, treatment planning, and resources are provided for all patients in our system.
Our top 10 identified healthcare disparities are:
1. Co-occurring Disorders readmission rate where sexual orientation is not disclosed
2. Co-occurring Disorders readmission rate where payer type is Medicaid
3. Readmission in an IPF rate where race and/or ethnicity is Black or African American
4. Readmission in an IPF rate where sexual orientation is not disclosed
5. Co-occurring Disorders readmission rate where age is 35 to 49 years old
6. Co-occurring Disorders readmission rate where age is 50 to 64 years old
7. Co-occurring Disorders readmission rate where race and/or ethnicity is Black or African American
8. Screening for metabolic disorders rate where race and/or ethnicity is Multiracial and/or Multiethnic
9. Readmission in an IPF rate where payer type is Med
Population Impact:
The above populations may experience challenges accessing inclusive care options that respond to their specific needs. Patients with undisclosed sexual orientation may avoid disclosure due to fear of discrimination, impacting care planning. Medicaid and Medicare patients may suffer from severe persistent mental illness presenting additional obstacles to accessing care and often require acute care more frequently. The latter may overcome such obstacles with stable housing and ongoing care and structured treatment. Multiracial or Black/African American patients with mental health or co-occurring disorders may experience cultural barriers to treatment, stigma when seeking help, or concerns that providers will be insensitive to their needs.
Measurable objectives and time frames to reduce the top 10 healthcare disparities:
Goal 1 (disparities #1 and #4): Reduce recidivism rate of Mental Health and Co-occurring Disorders where sexual orientation is not disclosed by 10% by November 2026
Action Step 1: Ensure clinical staff receive training in competency pertaining to mental health and substance use treatment of LGBTQIA2S+/gender non-conforming patients.
Action Step 2: Refer LGBTQIA2S+/gender non-conforming patients to at least one community resource specializing in the treatment of LGBTQIA@S+/gender non-conforming patients.
Goal 2 (disparity #2, #9, and #10): Reduce recidivism rates for patients whose payer is Medicaid or Medicare by 10% by November 2026.
Action Step 1: Refer to outpatient programs specializing in mental health diagnoses within 7 days of discharge.
Action Step 2: Collaborate with housing partners who ensure stable housing and encourage outpatient program attendance for their residents.
Goal 4: (disparities #3 and #7): Reduce recidivism rates for Black/African American patients (with mental health or co-occurring disorders) by 5% by November 2026.
Action Step 1: Ensure clinical staff receive training in competency pertaining to treatment of Black/African American patients.
Action Step 2: Refer Black/African American patients to treatment providers and programs that are known to be inclusive and culturally sensitive.
Goal 5: (disparities #5 and #6): Reduce recidivism rates for patients between 35 and 64 years old for Co-occurring disorders by November 2026.
Action Step 1: Refer to outpatient programs specializing in mental health diagnoses within 7 days of discharge.
Action Step 2: Involve patients’ families in treatment planning, education, and discharge planning.
Goal 6: (disparity #8): Increase the screening for metabolic disorders rate where race and/or ethnicity is Multiracial and/or Multiethnic by 5% by November 2026.
Action Step 1: Ensure clinical staff receive training in competency pertaining to treatment of Multiracial and/or Multiethnic patients.
Action Step 2: Ensure language access and patient education materials tailored to diverse populations.

3. Structural Measures

Centers for Medicare & Medicaid Services (CMS) Hospital Commitment to Health Equity Structural (HCHE) Measure	Yes/No
Our hospital system strategic plan identifies priority populations who currently experience health disparities	Yes
Our hospital system strategic plan identifies healthcare equity goals and discrete action steps to achieve these goals	Yes
Our hospital system strategic plan outlines specific resources that have been dedicated to achieving our equity goals	Yes
Our hospital system strategic plan describes our approach for engaging key stakeholders, such as community-based organizations	Yes
Our hospital strategic plan identifies healthcare equity goals and discrete action steps to achieve these goals	Yes
Our hospital system has training for staff in culturally sensitive collection of demographics and/or social determinant of health information	Yes
Our hospital system inputs demographic and/or social determinant of health information collected from patients into structured, interoperable data elements using a certified EHR technology	Yes
Our hospital system stratifies key performance indicators by demographic and/or social determinants of health variables to identify equity gaps and includes this information in hospital performance dashboards	Yes
Our hospital system participates in local, regional or national quality improvement activities focused on reducing health disparities	Yes
Our hospital system senior leadership, including chief executives and the entire hospital board of trustees, annually reviews our strategic plan for achieving health equity	Yes
Our hospital system senior leadership, including chief executives and the entire hospital board of trustees, annually reviews key performance indicators stratified by demographic and/or social factors	Yes

ALVARADO PARKWAY INSTITUTE B.H.S.