LUCILE PACKARD CHILDREN’S HOSPITAL STANFORD
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
|
Expected Payor | Medicaid | 37.5% | Private | 20.2% | 1.90 |
|
2.
HCAI 30-Day readmission
|
Sex Assigned at Birth | Female | 27.8% | Male | 21.0% | 1.30 |
|
3.
HCAI 30-Day readmission
|
Expected Payor | Other | 24.7% | Private | 20.2% | 1.20 |
|
4.
Pediatric survey recommend hospital
|
Race/Ethnicity | Multiracial and/or Multiethnic (two or more races) | 75.8% | Hispanic or Latino | 88.6% | 1.20 |
|
5.
HCAI 30-Day readmission
|
Race/Ethnicity | White | 27.3% | Hispanic or Latino | 23.9% | 1.10 |
|
6.
HCAI 30-Day readmission
|
Race/Ethnicity | Asian | 25.0% | Hispanic or Latino | 23.9% | 1.00 |
|
7.
Pediatric survey recommend hospital
|
Race/Ethnicity | Black or African American | 84.6% | Hispanic or Latino | 88.6% | 1.00 |
|
8.
Pediatric survey recommend hospital
|
Race/Ethnicity | Asian | 85.4% | Hispanic or Latino | 88.6% | 1.00 |
|
9.
Pediatric survey recommend hospital
|
Sex Assigned at Birth | Male | 87.3% | Male | 87.3% | 1.00 |
|
10.
Pediatric survey recommend hospital
|
Expected Payor | Medicaid | 87.4% | Medicaid | 87.4% | 1.00 |
2. Equity Plan
The rate ratio for most of the metrics identified is very close to or equal to 1, which means that there is very little difference between the disparity group and reference group. The most notable disparity based on our data is the difference in the readmission rate between patients insured by Medicaid and those with private insurance. Previously published studies highlight that publicly insured patients have higher admission and readmission rates due to a myriad of factors including 1) the influence of social risk factors and health related social needs which can make the hospital-to-home transition challenging, 2) inequitable access to follow up services, 3) the disproportionate number of children with medical complexity insured by Medicaid, and 4) the lack of access to care coordination support. We also serve a large proportion of families who use a language other than English (LOE) to communicate with their healthcare team. Communication failures can contribute to higher readmission rates, especially if families are not given information that adheres to health literacy principles and in their preferred language. We hope to address the disparity in readmissions by addressing upstream factors that impact health. We will continue to place significant emphasis on health-related social needs screening and response efforts. We are working closely with our Social Work and Care Management teams to reliably identify patients who would benefit from additional support through programs like CalAIM. We will continue to prioritize our enterprise-wide efforts to consistently provide language concordant care. Our ambulatory missed appointment pilot will help us identify patients and families with specific barriers to attending ambulatory appointments. Additionally, we work hand in hand with our Family Centered Care and Patient and Family Experience teams to ensure every patient and family who receives care at Stanford Medicine Children's Health feels seen, heard, respected, and valued. Our specific aims to address the identified gaps are as follows:
Language Concordant Care: Increase the delivery of spoken language concordant care to patients and families with a preferred language other than English seen in the ambulatory and inpatient setting from a baseline of 87.5% to 90% by the end of FY26.
Health Related Social Needs Screening and Response: Implement a reliable and empathic health related social needs (HRSN) screening and response processes that 1) promotes self-disclosure of HRSN by patients and families; 2) effectively connects families with support and resources based on their needs. We are specifically focusing on developing a core HRSN screener that includes questions about food insecurity, housing insecurity, financial strain, and transportation barriers. We have integrated FindHelp into the electronic health record and will pilot closed loop referrals with specific community-based organizations. Finally, we are currently screening for food insecurity in the inpatient setting and 3 ambulatory clinics. We will be working in partnership with Ronald McDonald House to provide caregivers of hospitalized children access to food via storage of non-perishable items on specific acute care units.
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 |
4. Web Address for Equity Report
5. Download Equity Measures Report
Click on the link below to download the equity measures report.
Click on the link below to download all equity measures reports.