MERCY MEDICAL CENTER – MERCED

1. Top 10 Disparities

2. Equity Plan

HCAI All-Cause Unplanned 30-Day Hospital Readmission Rate
Measurable Objectives: Reduce 30-day all-cause readmissions by 15% over the next 2 years.

• Disparity: 1, 2, & 3 Stratification: Age-Related Readmit Disparities (65+, 50-64, and 35-49 Vs. 18-34) Population Impact: Adults 35-65+ experiencing higher unplanned readmissions compared to younger patients (18-34).
• Action Plan: Enhanced chronic disease management education during hospitalization for older patients, including tailored content on medication adherence and symptom recognition specific to their conditions. All patients to be discharged home with disease specific Zone tools, with clear instructions and educational reinforcement provided by nursing staff prior to discharge. Increase utilization of Rural Health Clinics as transitional clinics to bridge the gap for high risk/older patients, ensuring seamless communication and information transfer between hospital and clinic teams. Follow up phone calls within 48-72 hours after discharge, providing an opportunity to address immediate post-discharge concerns and reinforce discharge instructions. Ensure discharge follow-up appointment is scheduled prior to discharge, with transportation and scheduling barriers proactively addressed for vulnerable populations.
• Disparity: 4 & 5 Stratification: Expected Payor Related readmit Disparities (Medicare and Medicaid VS Private Insurance) Population Impact: Adults over 65, persons with disabilities, and persons of all ages with state/federal funded healthcare
• Action Plan: Enhanced chronic disease management education during hospitalizations for patients with high risk factors and/or complex comorbidities, tailoring educational materials to address common barriers faced by Medicare and Medicaid recipients, such as health literacy and access to resources. Increase utilization of Rural Health Clinics as transitional care clinics, telemedicine, and home health to bridge the gap and ensure a smoother transition to recovery, proactively addressing financial and logistical barriers that might prevent Medicare and Medicaid patients from accessing these vital services. Follow up phone calls within 48-72 hours after hospital discharge, specifically inquiring about medication access, understanding of discharge instructions, and identifying any new social determinants of health barriers. Ensure discharge follow-up appointment is scheduled with providers who accept their specific insurance plans and are geographically accessible. Use of Mobile care clinics for population needs, bringing essential healthcare services directly to underserved communities with high rates of Medicare and Medicaid enrollment.
• Disparity: 7 & 8 Stratification: Sex Assigned at Birth Related Readmit Disparities Population Impact: Males
• Action Plan: Provide male-centered health education focusing on medication adherence, lifestyle management, and follow-up care, utilizing communication styles and materials that resonate more effectively with male patients. This education will also address potential male-specific barriers to seeking care or disclosing symptoms. Strengthen discharge planning with clear, simplified instructions and early outpatient follow-up for high-risk male patients, ensuring follow-up appointments are scheduled conveniently and transportation assistance is offered if needed. Furthermore, we will explore incorporating "peer support" or male-centric health coaching programs to foster accountability and engagement in their post-discharge recovery.
• Disparity: 6, 9 & 10 Stratification: Race and/or Ethnicity Readmit Disparities (Black or African American, White and Asian VS Hispanic or Latino) Population Impact: Black or African American, White and Asian populations
• Action Plan: Provide discharge instructions and health education in culturally relevant formats and languages, ensuring that these materials are not merely translated but also culturally adapted to resonate with the specific health beliefs and practices of Black or African American, White and Asian communities. This includes utilizing diverse patient educators and community health workers who can build trust and effectively communicate critical information. Address barriers such as housing, food security, and access to medications that disproportionately affect Black or African American, White and Asian populations, by establishing robust partnerships with community-based social services and providing direct referrals to support organizations during hospitalization and follow-up. We will also integrate social determinants of health screenings into the admission and discharge processes to identify and proactively address these needs. Collaborate with outreach events for these populations, to offer health screenings, educational workshops, and direct access to healthcare navigators who can assist with post-discharge planning and resource connection.

3. Structural Measures

4. Web Address for Equity Report

https://tinyurl.com/3ukvjpxf

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 Fair Billing Policies
• Hospital Profile