MEMORIAL HOSPITAL OF GARDENA
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.
HCAHPS survey-recommend hospital
|
Race and/or Ethnicity | Black or African American | 65.0% | Hispanic or Latino | 75.5% | 1.20 |
|
2.
HCAHPS survey-recommend hospital
|
Race and/or Ethnicity | White | 54.5% | Hispanic or Latino | 75.5% | 1.40 |
|
3.
HCAHPS survey-recommend hospital
|
Age (excluding maternal measures) | 35 to 49 | 57.6% | 65 and older | 74.3% | 1.30 |
|
4.
HCAHPS survey-recommend hospital
|
Age (excluding maternal measures) | 50 to 64 | 61.3% | 65 and older | 74.3% | 1.20 |
|
5.
HCAHPS survey-recommend hospital
|
Expected Payor | Private | 52.0% | Medicaid | 70.3% | 1.40 |
|
6.
HCAHPS survey-received information
|
Race and/or Ethnicity | Black or African American | 67.0% | Hispanic or Latino | 86.0% | 1.30 |
|
7.
HCAHPS survey-received information
|
Race and/or Ethnicity | White | 72.4% | Hispanic or Latino | 86.0% | 1.20 |
|
8.
HCAHPS survey-received information
|
Age (excluding maternal measures) | 35 to 49 | 69.0% | 50 to 64 | 80.6% | 1.20 |
|
9.
HCAI 30-Day readmission
|
Race and/or Ethnicity | Black or African American | 26.2% | Hispanic or Latino | 20.2% | 1.30 |
|
10.
HCAI 30-Day readmission
|
Preferred Language | English Language | 23.8% | Spanish Language | 17.8% | 1.30 |
2. Equity Plan
Memorial Hospital of Gardena will address the identified disparities through a coordinated, systemwide improvement plan focused on strengthening communication, discharge processes, and care transitions. Our internal strategy includes reinforcing AIDET and teach-back across all units, implementing payer- and age-stratified dashboards to support operational decision-making, and integrating the Elixhauser comorbidity index into case management huddles to proactively identify high-risk patients. We will expand staff competencies in culturally responsive and generational communication, improve documentation standards, and increase social work involvement for patients with identified SDOH needs. These efforts will be supported by quarterly performance reviews, cross-department accountability, and targeted interventions designed to reduce variation in patient experience, information and education, and readmissions. Collectively, these actions will drive measurable improvement in equity, quality, and patient outcomes across the organization.
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 |
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.