SONOMA VALLEY HOSPITAL
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
|
Sex Assigned at Birth | Female | 11.7% | Male | 11.4% | 1.00 |
2. Equity Plan
After applying the CalHHS Data De-identification guideline, one disparity was identified:
Every calculation associated with all report fields has been evaluated for our hospital. While this AB 1204 Equity Report may appear sparsely populated and lacking values in some areas, this reflects the complexity of the reporting requirements—not a deficiency in the report itself. The report incorporates the required calculations, stratifications, and the state's strict data privacy rules (including suppression under the California DDG), ensuring that it meets legal standards and equity reporting regulations.
Many blank cells are the result of limited availability of certain stratification variables—particularly Disability Status, Sexual Orientation, and Gender Identity—which hospitals are not currently required by HCAI to collect. Our hospital remains committed to advancing equity reporting and looks forward to additional regulatory guidance on whether and how these data elements should be collected in the future.
Even when the final numbers are few, the work behind them is substantial—and necessary for accurate and compliant reporting.
SVH data show women have higher all-cause, unplanned 30-day hospital readmission rates than men (rate ratio >1.0). The data showed that 100% readmitted patient's race is white. Sonoma County's older median age and women's longer life expectancy increase frailty and multimorbidity risk—both linked to readmissions. Women also face clinical differences (cardiac, pulmonary, surgical courses), mental health burden, and social vulnerability (caregiving, lower income, transportation gaps), which impede recovery. Local Community Health Assessments confirm economic and access disparities affecting post-discharge success. If women disproportionately face gaps in these supports, their readmission share will rise. Public health and health-equity guidance stress addressing SDOH in readmission reduction. If discharge instructions, medication reconciliation, or follow-up scheduling don't account for literacy, language, work/caregiver schedules, or mobility limitations, women who disproportionately shoulder caregiving or have constrained schedules may be less able to meet post-discharge requirements. SVH already tracks readmissions and posts equity data — this is the right place to dig deeper. To address the disparity, Standardize teach-back, ensure medication reconciliation with a pharmacy call within 48—72 hours, schedule follow-up appointments before discharge (or provide nurse navigator outreach), and provide written + bilingual instructions. EHR-based interventions and post-discharge phone/visit programs have reduced readmissions in RCTs/meta-analyses; Implement a brief SDOH screening (transportation, food insecurity, caregiving, housing instability) and provide targeted referrals (transport vouchers, community health worker follow-up, home health); Deploy targeted transitional care for high-risk women through collaboration with home health workers, social services and insurer's case management and social work teams; and Add sex-stratified readmission KPIs to the Board quality dashboard (30-day readmit rate by sex, adjusted for age and diagnosis), and set reduction targets with PDSA cycles. SVH already publishes health equity materials — use those channels to report progress publicly.
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.