MERCY HOSPITAL OF FOLSOM

1. Top 10 Disparities

2. Equity Plan

Race & Ethnicity
Population Impact: Racial and ethnic minorities often face systemic barriers to healthcare access, language barriers, cultural insensitivity, and higher prevalence of chronic conditions, leading to health inequities and higher readmission rates.
Objective: Reduce the 30-day all-cause unplanned hospital readmission rate among [Black/African American, White, Asian, and/or American Indian/Alaska Native] patients by 2.5% within the next 12 months.
Actions:
-Conduct cultural competency training for all patient-facing staff, focusing on implicit bias and respectful communication.
-Assess current availability and utilization of professional medical interpreters for all languages spoken by patient population, ensuring 24/7 access.
-Develop and disseminate patient education materials in multiple languages relevant to the patient population, culturally adapting content where appropriate.
-Partner with community leaders and organizations serving specific racial/ethnic groups to understand unique health needs and build trust
-Address social determinants of health that disproportionately affect these groups through referral networks.
-Utilize health equity dashboards to track progress on racial/ethnic disparities and identify areas for targeted interventions.
Age
Population Impact: Among older adults, multimorbidity, polypharmacy (five or more medications concurrently), and reduced functional capacity are key drivers of increased readmission risk. Notably, significant disparities in readmission rates also extend to the 50-64 and 35-49 age groups, likely reflecting challenges in chronic disease management and the impact of complex social determinants of health.
Objective: Reduce the 30-day all-cause unplanned hospital readmission rate among patients aged 35-49 yrs., 50-64 yrs. and 65+ by 2.5% within the next 12 months.
Actions:
• Utilize patient data to assess age-specific risks for readmissions (e.g., cognitive impairment, frailty, social isolation for 65+; chronic disease progression, addiction for 35-64) to develop targeted interventions to address this disparity.
• Integrate mental health screening and referral pathways as behavioral health diagnosis often impacts readmissions.
• Strengthen coordination with skilled nursing facilities and rehabilitation centers for appropriate post-acute care for older adults.
Expected Payor:
Population Impact: Medi-Cal and Medicare patients, a substantial segment of our population, face complex medical needs, socioeconomic barriers, and systemic hurdles to continuous preventive and follow-up care. This confluence drives high readmission rates, indicating a significant healthcare burden and elevated risk of poor health outcomes
Objective: Reduce the 30-day all-cause unplanned hospital readmission rate among patients with Medi-Cal and Medicare by 2.5% within the next 12 months.
Actions:
• Leverage patient data to identify common medical conditions, social challenges, payor, and primary care affiliation that correlate with higher readmission rates. This analysis will directly inform the development of targeted interventions to address this disparity.
• Strengthen partnerships with Enhanced Care Management providers, Federally Qualified Health Centers and other primary care practices, and payors to enhance coordinated care and improve transitions to effectively reduce readmission rates across our shared patient population.
• Conduct patient screening for social determinants of health, then employ the Unite Us platform to bridge gaps in care by addressing identified needs and ensuring their successful resolution through a closed-loop referral process.
• Implement strategies to increase patient knowledge and utilization of Cal-AIM benefits, specifically prioritizing enrollment in ECM and arranging for medically-tailored meal delivery prior to discharge.
Sex assigned at birth:
Population Impact:Consistent data indicates higher hospital readmission rates among males, often attributed to factors such as differing health-seeking behaviors, reduced adherence to medical advice, and the prevalence and treatment considerations for male-specific health conditions.
Objective: Reduce the 30 day all-cause unplanned hospital readmission rate among male (sex assigned at birth) patients by 2.5% within the next 12 months.
Actions:
• Utilize patient data to identify common medical conditions, social challenges, and health behaviors that contribute to higher male readmission rates.
• Explore implementation of staff training programs focused on gender-sensitive communication and motivational interviewing techniques, specifically tailored to enhance engagement and adherence among male patients.
• Enhance discharge planning by ensuring the provision of accessible, male-specific health resources.

3. Structural Measures

4. Web Address for Equity Report

https://tinyurl.com/yzyaaw7v

5. Download Equity Measures Report

Click on the link below to download the equity measures report.

6. Looking for Related Reports?

• Community Benefit Plan
• Hospital Supplier Diversity Plan
• Hospital Profile
• Hospital Fair Billing Policies