MemorialCare

1. Top 10 Disparities

2. Equity Plan

There are many actions at the hospitals to address our top 10 disparities which all relate to the 30 day readmission rate.

MemorialCare Long Beach Medical Center and MemorialCare Miller Children's and Women's Hospital are dedicated to continuously analyzing, evaluating, and adapting strategies to evaluate disparities in care and improve processes affecting those populations. Through this process, 30-day unplanned readmissions for the Black or African American, Asian, Medicaid, Medicare, 50- to 64-year-olds, 35- to 49-year-olds, and 65 and older populations at Long Beach Medical Center and also the Hispanic, Asian, White, and Female populations at Millers have been identified as an opportunity for improvement. Our leadership teams have committed to engaging a multidisciplinary team to evaluate improvement strategies. This team has developed the following strategies to address 30-day unplanned readmissions:

Identify patients at high-risk for readmission and work with those patients to address potential barriers to continued care post-hospitalization. Ensure access to prescription medications, pre-arrange follow-up appointments, create a structure post-discharge follow-up plan including telephone calls or home visits, particularly during the first days and weeks post-discharge to address potential complications early.

Ensure that patients at high-risk for readmission have an enhanced discharge plan including patient education tailored to their needs and information on their medication regime and follow-up care using clear, culturally and linguistically appropriate communication methods, including "teach-back." Prior to discharge, conduct medication reconciliation to prevent discrepancies and support adherence, as adverse drug events remain a leading cause of readmissions. Finally, connect patients with community resources that address social determinants of health, including transportation, housing, and food security, through collaboration with social workers and local organizations.

The multidisciplinary team will track and trend readmissions for the impacted populations over a 12-month period with an aim of reducing readmissions by 5%.

MemorialCare Orange Coast Medical Center and MemorialCare Saddleback Medical Center are committed to analyzing, evaluating, and adapting strategies to identify disparities in care and improve processes that impact those populations. Through this work, 30-day unplanned readmissions among the Black or African American, Asian, Medicaid, Medicare, Male, 50- to 64-year-old, 35- to 49-year-old, and 65 and older populations at Orange Coast as well as the Black or African American, White, Medicaid, Medicare, Male, 50- to 64-year-old, 35- to 49-year-old, and 65 and older populations at Saddleback have been identified as an opportunity for improvement.

Readmissions disproportionately affect patients with chronic conditions, older adults, and individuals from underserved communities who face barriers such as limited access to follow-up care, transportation, and health literacy challenges. Orange Coast provides standardized discharge planning with clear instructions, medication reconciliation, and culturally appropriate education. Post-discharge phone calls are conducted within 72 hours for high-risk patients to reinforce understanding and address concerns.

Social services and case managers collaborate with community services and local organizations to address specific needs related to the social determinants of health, and assist with transportation needs, access to medications, and follow-up appointments. Pharmacists conduct medication reviews for patients with polypharmacy, assisting with educational needs and medication management. Our goals include reducing 30-day readmission rates by 2% within 12 months; achieving 90% completion of post-discharge follow-up calls, and improving patient understanding of discharge instructions. Saddleback conducts multidisciplinary discharge rounds, provide standardized discharge planning with clear instructions, medication reconciliation, and culturally appropriate education. Telephone advice nurses perform post-discharge follow-up phone calls on complex medical diagnoses. The Social Services department collaborates with local organizations to address specific needs related to the social determinants of health and assists with transportation needs, access to medications, and follow-up appointments. Case managers collaborate with community services, high-performing home health care agencies and skilled nursing facilities upon discharge to ensure a smooth transition of care and maintain low hospital readmission rates. Our goals include reducing 30-day readmission rates by 2% within 12 months; improving patient understanding of discharge instructions; and helping connect patients to community resources. Readmission rates are monitored quarterly and stratified by population segmentation to identify disparities and trends.

3. Web Address for Equity Report

https://www.memorialcare.org/memorialcare-dei

4. Download Equity Measures Report

Click on the link below to download the equity measures report.