UCI HEALTH-ORANGE

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)	35 to 49	14.3%	18 to 34	9.5%	1.50
2. HCAI 30-Day readmission	Age (excluding maternal measures)	50 to 64	14.1%	18 to 34	9.5%	1.50
3. HCAI 30-Day readmission	Age (excluding maternal measures)	65 and older	13.3%	18 to 34	9.5%	1.40
4. HCAI 30-Day readmission	Race and/or Ethnicity	Black or African American	15.4%	White	11.3%	1.40
5. HCAI 30-Day readmission	Preferred Language	Asian/ Pacific Islander Languages	16.2%	English Language	12.2%	1.30
6. HCAI 30-Day readmission	Expected Payor	Medicare	14.1%	Private	11.1%	1.30
7. HCAI 30-Day readmission	Preferred Language	Spanish Language	15.1%	English Language	12.2%	1.20
8. HCAI 30-Day readmission	Race and/or Ethnicity	Black or African American	15.4%	White	11.3%	1.20
9. HCAI 30-Day readmission	Race and/or Ethnicity	Asian	13.9%	White	11.3%	1.20
10. HCAI 30-Day readmission	Expected Payor	Medicaid	13.3%	Private	11.1%	1.20

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2. Equity Plan

We have identified the top disparities using a rate ratio methodology in which the value illustrates how much higher the rates are for a given patient population stratification in comparison to another. For instance, a rate ratio of 1.5 would indicate that the former comparison group is 50% more likely to have the specified event when compared to the latter.

We recognize important limitations in the current method of identifying disparities. The performance metrics are not risk-adjusted, meaning they do not account for expected variation by age or other clinical factors. Because younger patients generally experience fewer complications and hospitalizations, observed differences in readmission rates by age group likely reflect, in part, underlying differences in patient risk profiles rather than inequitable care. Consequently, it is not unexpected that there are disparities involving higher readmission rates among older age groups compared to younger patients.

Disparity: Readmission rates between ages 35-49 vs 18-34 (1), 50-64 vs 18-34 (2), and 65 and older vs 18-34 (3) age groups demonstrated by 1.5, 1.5 and 1.4 rate ratios.

Action Plan: To address the age-related disparity in readmission rates, we plan to assess and strengthen efforts around patient health literacy. Patients' ability to understand discharge instructions, follow-up plans, and medication guidance-typically conveyed through discharge paperwork-is a key component of reducing readmissions. We will explore implementing age-tailored discharge education programs and integrating teach-back methods to ensure comprehension.

Additionally, we recognize that vision and hearing impairments may further limit understanding, and we aim to develop strategies to accommodate these needs during patient education and communication.

Disparity: Readmission rates between Black or African American vs White (4) patient population with a rate ratio of 1.4. Additionally, Asian vs White (5) and Hispanic or Latino vs White (6) patient populations both have a rate ratio of 1.2.

Action Plan: To reduce the identified disparity above, we plan to conduct equity-focused readmission case reviews within our existing readmission work groups and task forces. By closely examining processes and data through an equity lens, we aim to identify targeted opportunities for improvement. As an academic health system, we can leverage the engagement of medical students and residents-who are required to complete quality improvement projects-to participate in this work. We also plan to collaborate with community organizations to strengthen relationships with immigrant populations, better understand cultural barriers and preferences, and enhance patient navigation services. Additionally, we will provide refresher and explore requiring implicit bias training for all team members to promote equitable care practices.

Disparity: Readmission rates between Asian/Pacific Islander languages vs English (7) and Spanish language vs English (8) which have rate ratios of 1.3 and 1.2, respectively.

Action Plan: We aim to ensure that discharge instructions are culturally and linguistically appropriate for all patients. This includes implementing MyChart communications in patients' preferred languages and exploring the use of AI technologies to more efficiently and accurately meet the diverse language needs of our communities. Additionally, we plan to collaborate with Asian and Pacific Islander language groups to enhance the availability and quality of language support services.

Disparity: Readmission rates between Medicare payors vs Private payors (9) demonstrated by a rate ratio of 1.3, and Medicaid payors vs Private payors (10) shows a rate ratio of 1.2.

Action Plan: With a rate ratio of only 1.3, our goal is to eliminate this disparity and close the gap between the two patient populations. To achieve this, we will examine all potential contributors to readmissions, including confusion around medication use. Health literacy may play a key role, as some patients may have difficulty understanding medication instructions. We plan to collaborate with our School of Pharmacy to enhance patient education, provide medication coaching and support, and strengthen medication adherence.

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

UCI HEALTH-ORANGE