SALINAS VALLEY HEALTH MEDICAL CENTER

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	Age (excluding maternal measures)	65 and older	16.3%	18 to 34	5.9%	2.80
2. HCAI 30-Day readmission	Age (excluding maternal measures)	50 to 64	15.9%	18 to 34	5.9%	2.70
3. HCAI 30-Day readmission	Expected Payor	Medicare	17.3%	Private	7.6%	2.30
4. HCAI 30-Day readmission	Age (excluding maternal measures)	35 to 49	12.9%	18 to 34	5.9%	2.20
5. HCAI 30-Day readmission	Race and/or Ethnicity	Black or African American	23.3%	Hispanic or Latino	13.8%	1.70
6. HCAI 30-Day readmission	Expected Payor	Medicaid	12.8%	Private	7.6%	1.70
7. HCAI 30-Day readmission	Preferred Language	Spanish Language	16.7%	English Language	13.1%	1.30
8. HCAI 30-Day readmission	Race and/or Ethnicity	Hispanic or Latino	13.8%	Hispanic or Latino	13.8%	1.00
9. HCAI 30-Day readmission	Race and/or Ethnicity	Hispanic or Latino	13.8%	Hispanic or Latino	13.8%	1.00

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2. Equity Plan

All disparity groups identified for Salinas Valley Health (SVH) were related to 30-day all cause readmissions. Although some of these structural and cultural drivers may reach beyond actionable opportunities from the perspective of an acute care hospital, this analysis does point to areas where the organization may enhance existing programs. Leveraging a Rapid Improvement Cycle methodology with the Age Friendly framework, the organization plans to address the identified disparities via a focused performance improvement project optimizing referrals to an existing Transitions of Care program.
Transitions of Care Program: Rapid Improvement Cycle. Plan: Establish baselines for the overall Transitions of Care Program referral rate, compliance with the referral algorithm and 30-day all cause readmission rate for patients who engaged with the Transitions of Care program following an index inpatient admission. Do: Refine the program referral algorithm to capture 95% of the patient population analyzed. Check: 60 days following implementation of the above interventions, reassess process and outcome measures against baseline values to analyze effectiveness of the intervention. Act: Adjust organization approach based on the learning and analysis from the initial rapid improvement cycle.
Disparity 1. Age: 65 and older disparity group compared to 18 to 34 reference group. Observed readmission rates at SVH were not statistically different from the state of California. Analyzing this population further, it was noted that patients in this disparity group who were discharged home with home health services following the index admission did experience readmissions within 7, 14 and 30 days at a higher rate than the state overall with these differences being statistically significant.
Disparity 2. Age: 50-64 disparity group compared to 18 to 34 reference group. Observed readmission rates at SVH were not statistically different from the state of California.
Disparity 3. Expected Payor: Medicare disparity group compared to private reference group. Observed readmission rates at SVH were not statistically different from the state of California. Similar statistically significant findings as noted above were observed with respect to the Hispanic patient population discharged to home with home health services. Readmission rates in this disparity group were also driven by patients over the age of 80 and diagnosed with chronic kidney disease and electrolyte imbalances.
Disparity 4. Age: 35 to 49 disparity group compared to 18 to 34 reference group. Observed readmission rates at SVH were not statistically different from the state of California. Analyzing this population further, the readmission rate was found to be influenced by patients between 40-49 within the disparity group, with Hispanic patients facing alcohol-related disorders and complications experiencing readmission rates that were statistically higher than those observed in similar patient populations across the state overall.
Disparity 5. Race/Ethnicity: Black or African American disparity group compared to white reference group. Observed readmission rates at SVH were not statistically different from the state of California.
Disparity 6. Expected Payor: Medicaid disparity group compared to private reference group. Observed readmission rates at SVH were not statistically different from the state of California. Of note, the 14-day all cause readmission rate for this disparity group was found to statistically better perform than the state overall for the equivalent patient population.
Disparity 7. Preferred Language: Spanish disparity group compared to English reference group. Observed readmission rates at SVH were not statistically different from the state of California. Similar patterns as noted above with respect to patients over of the age of 80 and discharged home with home health services were also observed to experience more frequent readmissions than benchmarked across California.
Disparity 8. Race/Ethnicity: Asian disparity group compared to Hispanic/Latino reference group. Observed readmission rates at SVH were not statistically different from the state of California. These readmission rates were not statistically different from the state as a whole.
Disparity 9. Race/Ethnicity: White disparity group compared to Hispanic/Latino reference group. Observed readmission rates at SVH were not statistically different from the state of California. Readmissions within 14 days were found to be statistically higher than the overall state. Similar patterns as noted above with respect to patients over of the age of 80 and discharged home with home health services were also observed to experience more frequent readmissions than benchmarked across California.
Disparity 10. Suppressed to prevent inadvertent patient identification.

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

SALINAS VALLEY HEALTH MEDICAL CENTER