KAISER PERMANENTE NORTHERN CALIFORNIA REGION
Hospitals
Hospital Count: 21
- KAISER FOUNDATION HOSPITAL – FREMONT
- KAISER FOUNDATION HOSPITAL – OAKLAND/RICHMOND
- KAISER FOUNDATION HOSPITAL – SAN LEANDRO
- KAISER FOUNDATION HOSPITAL – WALNUT CREEK
- KAISER FOUNDATION HOSPITAL – RICHMOND CAMPUS
- KAISER FOUNDATION HOSPITAL – ANTIOCH
- KAISER FOUNDATION HOSPITAL – FRESNO
- KAISER FOUNDATION HOSPITAL – SAN RAFAEL
- KAISER FOUNDATION HOSPITAL – ROSEVILLE
- KAISER FOUNDATION HOSPITAL – SACRAMENTO
- KAISER FOUNDATION HOSPITAL – SOUTH SACRAMENTO
- KAISER FOUNDATION HOSPITAL – SAN FRANCISCO
- KAISER FOUNDATION HOSPITAL – MANTECA
- KAISER FOUNDATION HOSPITAL – SOUTH SAN FRANCISCO
- KAISER FOUNDATION HOSPITAL – REDWOOD CITY
- KAISER FOUNDATION HOSPITAL – SAN JOSE
- KAISER FOUNDATION HOSPITAL – SANTA CLARA
- KAISER FOUNDATION HOSPITAL & REHAB CENTER – VALLEJO
- KAISER FOUNDATION HOSPITAL – VACAVILLE
- KAISER FOUNDATION HOSPITAL – SANTA ROSA
- KAISER FOUNDATION HOSPITAL – MODESTO
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 NOBH
|
Age (excluding maternal measures) | 65 and older | 15.4% | 18 to 34 | 4.5% | 3.50 |
|
2.
HCAI 30-Day readmission
|
Age (excluding maternal measures) | 65 and older | 15.6% | 18 to 34 | 5.2% | 3.00 |
|
3.
HCAI 30-Day readmission NOBH
|
Expected Payor | Medicare | 15.8% | Other | 5.3% | 3.00 |
|
4.
HCAI 30-Day readmission NOBH
|
Age (excluding maternal measures) | 50 to 64 | 12.1% | 18 to 34 | 4.5% | 2.70 |
|
5.
HCAI 30-Day readmission
|
Expected Payor | Medicare | 16.1% | Other | 6.0% | 2.70 |
|
6.
HCAI 30-Day readmission
|
Age (excluding maternal measures) | 50 to 64 | 13.5% | 18 to 34 | 5.2% | 2.60 |
|
7.
HCAI 30-Day readmission MHD
|
Sex Assigned at Birth | Male | 15.3% | Female | 12.0% | 2.50 |
|
8.
AHRQ pneumonia mortality rate
|
Race and/or Ethnicity | Asian | 82.4% | White | 66.7% | 2.50 |
|
9.
HCAI 30-Day readmission MHD
|
Age (excluding maternal measures) | 65 and older | 15.5% | 18 to 34 | 6.5% | 2.40 |
|
10.
AHRQ PSI surgical death rate
|
Expected Payor | Medicare | 224.3% | Private | 93.6% | 2.40 |
2. Equity Plan
The Regional Readmission Health Disparity Action Plan is a coordinated strategy aimed at reducing inequities in hospital readmissions. It focuses on analyzing data by age, race, ethnicity, language, and disability status to identify disparities, standardizing how data is collected and reported, and providing clear guidelines for local medical centers to develop targeted interventions. The plan also emphasizes engaging patients and communities, improving language access and health literacy, supporting high-risk groups, and collaborating with community organizations. Its goal is to ensure that all patients receive equitable, culturally, and linguistically appropriate care throughout their healthcare journey.
Exclusive Breast Milk Feeding Action Plan: Drive utilization of Donor Human Milk to bridge lactation gaps by 10–20% in underserved ethnic groups, promoting health equity and neonatal outcomes. All 15 KP NCAL medical centers will be offering donor human milk to our newborn populations by end of 2025.
Pneumonia Mortality Action Plan: The regional action plan focuses on preventing non-ventilator hospital-acquired pneumonia (HAP), which affects approximately 1 in 100 hospitalized patients and carries a crude mortality rate of 15—30%, often leading to extended stays of up to 15 days, increased antimicrobial exposure, and ICU admission in nearly half of cases. To address this, the KP NCAL HAP Prevention Program implements the ROUTE bundle—Respiratory care, Oral hygiene, patient mobility (Up), Tube care, and Education—targeting oral flora reduction, aspiration prevention, and early mobilization. This evidence-based approach has demonstrated reductions in HAP incidence, attributable mortality, and antibiotic use without adverse effects. Surveillance includes patients with ICD-10 pneumonia diagnoses confirmed by imaging ≥48 hours post-admission, excluding pediatric, obstetric, comfort care, ventilator-associated pneumonia, and POA cases. Process measures emphasize functional interventions such as ensuring patients are out of bed for meals and maintaining oral hygiene through documented teeth brushing, with exclusions for patients on comfort care or with severely limited prior function. Together, these strategies aim to reduce pneumonia-related mortality, readmissions, and complications across the region.
The Regional Age Friendly Hospital System (AFHS) Core Team will be leading and supporting all 21 KP NCAL facilities to achieve IHI AFHS Level 1 Recognition status by the end of 2025 and then IHI AFHS Level 2 Recognition status by the end of 2026. The team will also ensure that all facilities have protocols in place to affirmatively attest to receive full credit for all 5 Domains of the CMA AFHS Measure by May 2025. This will position our hospitals to consistently and reliably provide high-quality care to all hospitalized elderly patients.
3. Web Address for Equity Report
4. 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.