Hospital Equity Data Toolkit
This webpage includes tools that hospitals and providers can use to improve equity in healthcare and participate in HCAI’s Hospital Equity Measures Program.
Overview
Assembly Bill (AB) 1204 (Chapter 751, Statutes of 2021) established the Hospital Equity Measures Reporting Program, which aims to enhance healthcare quality data and address long-standing health disparities by requiring hospital equity plans and more accurate racial and demographic data reporting.
To support the implementation of the Hospital Equity Measures Reporting Program, HCAI has developed a toolkit of resources for hospitals that outline best practices to enhance demographic healthcare quality data collection, analysis, reporting and equity planning.
The toolkit is organized by three different collections to support hospitals across the spectrum of activities needed for developing and implementing their health equity plans, starting with data collection and building towards actionable data driven equity plans. The tools are summarized here:
- Collecting patient demographic data
- Engaging patients around Health-Related Social Needs
- Developing health equity plans.
This collection of resources was developed in collaboration with the Hospital Equity Measures Advisory Committee during the April 10, 2024 meeting. Please reach out to hospitalequity@hcai.ca.gov with any questions around the implementation of these resources, or to suggest other resources to add to the library.
Tools for Collecting Patient Demographic Data
The way patient demographic data is collected can impact a patient’s willingness to share this data. This section includes resources to support hospitals and hospital systems collecting data on patient’s race, ethnicity, preferred language, sexual orientation, gender identity, and disability status in a culturally sensitive manner, while ensuring appropriate privacy and protection of personally identifiable information. Such information about patients helps to stratify healthcare measures to uncover disparities in outcomes amongst patient populations.
Key Insights
- Give patients options of private, electronic submission or speaking with a trusted clinician; self-reported data is always best and is patients’ preference
- Explain the “why” behind the data collection
- Provide for accessibility for language, ability, and more
- Whenever possible, follow-up with patients to let them know how their data has been used to improve health care quality and outcomes
- Employ research methods that are compatible with small groups, including, oversampling and the use of multi-year pooled data
- Provide clear standards for collecting detailed race, ethnicity, language, sexual orientation and gender identity demographic data
Race, Ethnicity and Language (REaL) Data
Self-identification is the preferred method for collecting information about an individual’s race and ethnicity. Establishing clear data standards and protocols can result in more accurate, comprehensive and quality data. The following are tools to support the collection of race, ethnicity, and language data to address disparities in healthcare access and outcomes.
Best Practice Guidelines for Data Collection & Reporting
State Documents:
- California Health and Human Services Agency Data De-Identification Guide – September 2016: CalHHS standards for deidentifying personally identifiable information, to limit the ability of reidentification. Hospital equity reports will need to be submitted in accordance with these standards.
Webinars and Recordings:
- HCAI Demographic Data Collection, 2024: Overview of resources to help hospitals collect data. Presented at HCAI’s Hospital Equity Measures Advisory Committee (HEMAC) meeting.
- Data Collection and Health Equity Screening Presentation, 2024: Scripps Health’s initiatives on health equity, focusing on data collection, training, and social determinants of health screening. Presented at HCAI’s HEMAC meeting.
- Leveraging Data to Improve Quality of Care, 2022: Hospital Quality Institute’s webinar on how hospitals can operationalize and execute actionable strategies to identify and address racial and ethnic disparities.
Guides/Briefs:
- Improving Health Equity through Data Collection AND Use: A Guide for Hospital Leaders, 2011: American Hospital Association’s guide providing hospital leaders with strategies for collecting and using patient race, ethnicity, and language data to improve health equity.
- Reducing Health Care Disparities: Collection and Use of Race, Ethnicity and Language Data, 2013: American Hospital Association’s guide outlining how to obtain an accurate and usable REaL data set, and how hospitals and health care systems can use that data.
- Celebrating the Advancement of Equitable Care in California Through PRIME, 2021: California Association of Public Hospitals and Health Systems’ guide on how to obtain an accurate and usable REaL data set to achieve clinical, operational, financial and population health benefits.
- Revision to the Federal Standards for Collecting and Reporting Data on Race and Ethnicity: What are They and Why do They Matter? Kaiser Family Foundation’s 2024 overview of the updated standards effective for all federal racial and ethnic data collection and reporting, including the changes and their implications.
Toolkits:
- Disparities Toolkit: American Hospital Association’s toolkit providing hospitals, health systems, clinics, and health plans information and resources for systematically collecting race, ethnicity, and primary language data from patients.
Best Practice Guidelines for Engaging Patients
State Documents:
- HCAI: Preferred Languages Spoken in California Facilities: Visualizations on patients preferred languages spoken in California statewide in 2021.
Guides:
- Language Identification Guide: Health Research and Educational Trust of New Jersey’s guide helping diverse patients identify their primary language.
Toolkits:
- Disparities Toolkit: American Hospital Association toolkit providing hospitals, health systems, clinics, and health plans information and resources for systematically collecting race, ethnicity, and primary language data from patients.
Training Tools (Paid):
- Educational Tools and Resources for Improving Collection of Patient Race, Ethnicity and Primary Language Data Collection: Health Research and Educational Trust of New Jersey’s educational tools for improving patient race, ethnicity, and primary language data collection.
Sexual Orientation and Gender Identity (SOGI) Data
It’s important to integrate SOGI data collection into routine processes, ensuring it’s voluntary and confidential, and train staff on the sensitivity and significance of the data. Gathering this information may allow policymakers and organizations to better understand health disparities within the LGBTQ+ community and help track progress toward better health outcomes. The following are tools to support the collection of SOGI data to address disparities in healthcare access and outcomes.
National and State Documents:
- California Health and Human Services Agency Data De-Identification Guide – September 2016: CalHHS standards for deidentifying personally identifiable information, to limit the ability of reidentification. Hospital equity reports will need to be submitted in accordance with these standards.
- Celebrating the Advancement of Equitable Care in California Through PRIME, 2021: California Association of Public Hospitals and Health System’s guide on how Public Hospital Redesign and Incentives in Medi-Cal (PRIME) supports quality of care for Medi-Cal patients.
- Ready Set Go: A Guide for Collecting Data on Sexual Orientation and Gender Identity, 2022: Resources and recommendations from Fenway Institute National LGBTQIA+ Health Education Center SOGI data collection, documentation and analysis.
Webinars and Videos:
- Sexual Orientation and Gender Identity Data Collection Demonstration Videos, 2018: Videos from Fenway Institute National LGBTQIA+ Health Education Center on best practices for frontline and clinical staff when asking patients about their sexual orientation and gender identity.
- REaL and SOGI Data Collection Presentation: Webinar on San Francisco Health Network’s efforts in collecting REaL (race, ethnicity, and language) and SOGI data, focusing on best practices and training programs.
Patient Disability Status Data
Collecting patient disability status data provides key insights into healthcare disparities, enabling providers to better understand the specific needs and challenges faced by individuals with disabilities. Statistically, this data reveals important trends, such as higher rates of preventable conditions, longer wait times for care, and lower utilization of healthcare services among disabled populations. It also highlights disparities in health outcomes, such as increased hospitalizations or reduced quality of care, allowing for targeted improvements. Tracking these insights can result in healthcare systems developing more inclusive policies, allocating resources more effectively, and ensuring that all patients, regardless of ability, have equitable access to care. The following are tools to support the collection and utilization of data on disability status to address disparities in healthcare access and outcomes.
National and State Documents:
- Charting Equality: Why Demographic Disability Data is Good for Everyone, 2024: Overview from Disability Rights & Education Fund on demographic disability data, common myths, current efforts by providers and states, and recommendations for data collection.
- Health Equity Certification Resource Center: Compilation of data collection and analysis resources from the Joint Commission.
- Compendium of Disability Data Collection Methods, 2022: List of data collection and analysis resources from Mathematica.
Tools for Collecting Patient Data on Health-Related Social Needs
The following are resources to support hospitals and hospital systems in effectively collecting data on patient’s health-related social needs. Health-related social needs represent both data points to stratify to evaluate disparities in healthcare and also key areas of intervention to address disparities caused by unmet needs.
Key Insights
- Consider the “whole person” and how where people live, work, and play affects their health
- Help patients understand the rationale for assessing needs related to food, housing, transportation, utilities, and interpersonal violence
- Understand how to recognize and introduce appropriate resources for patients with food insecurity, unstable housing, utilities access issues, and violence
- Apply resources to address these needs, especially during patient discharge and follow-up
Food Insecurity
Assessing food insecurity can improve health outcomes by identifying those at risk of malnutrition or diet-related conditions, allowing for targeted interventions. It has the potential to reduce healthcare costs by addressing preventable health issues linked to poor nutrition. Additionally, it can guide policymakers in allocating resources more effectively to ensure food access for vulnerable populations, fostering greater health equity. The following are tools to support the collection and utilization of health-related social needs data related to food insecurity to address disparities in healthcare access and outcomes.
Webinars and Recordings:
- Resources for Discussions Around Health-Related Social Needs, 2024: HCAI webinar on the importance of hospitals collecting data on social needs under new CMS rules, featuring resources from the AHA and UCSF’s Social Interventions Research Network.
Training Tools:
- Screening for Social Needs: Guiding Care Teams to Engage Patients, 2019: American Hospital Association’s strategic considerations for implementing a screening program, case examples, and a list of national organizations that can help connect patients with local resources.
- Social Determinants of Health Series: Food Insecurity and the Role of Hospitals, 2017: American Hospital Association’s strategic considerations for implementing a screening program.
- Food Insecurity, Health Equity, and Essential Hospitals, 2016: America’s Essential Hospitals’ research brief on how hospitals can take measures at the patient, system, and community levels to help improve food security and patient and population health.
- Social Interventions Research and Evaluation Network, Social Needs Screening Tools Comparison, 2019: University of California San Francisco’s compilation of the most widely used social health screening tools to facilitate comparisons.
- Health Equity Certification Resource Center: Data collection and analysis resources from the Joint Commission.
Housing and Utilities
Assessing housing and utilities for hospital patients can lead to better health outcomes by addressing social factors that impact recovery and treatment compliance. It has the potential to lower healthcare costs by minimizing preventable readmissions and emergency visits. It can also connect patients with crucial community resources, fostering long-term stability and promoting health equity for underserved groups. The following are tools to support the data collection for patient’s housing and utilities needs to address disparities in healthcare access and outcomes.
Training Tools:
- Screening for Social Needs: Guiding Care Teams to Engage Patients, 2019: American Hospital Association’s strategic considerations for implementing a screening program, case examples and a list of national organizations that can help connect patients with local resources.
- Social Interventions Research and Evaluation Network, Social Needs Screening Tools Comparison, 2019: University of California San Francisco’s compilation of the most widely used social health screening tools to facilitate comparisons.
- Social Determinants of Health Series: Housing and the Role of Hospitals, 2017: American Hospital Association’s guide on how hospitals can address the social determinants of health.
State Level Interventions:
- California Department of Community Services and Development, Low Income Home Energy Assistance Program: Federally funded program that helps low-income households pay for heating or cooling in their homes.
- California Department of Community Services and Development, Low Income Household Water Assistance Program: Federally funded program that helps low-income households pay for water and sewer bills.
Transportation
Assessing transportation needs for hospital patients can improve access to care by identifying barriers that prevent timely appointments or treatments. It has the potential to reduce missed appointments and improve health outcomes by ensuring patients can reliably access healthcare services. Additionally, it can help hospitals develop targeted solutions, such as transportation assistance programs, which can enhance patient satisfaction and reduce healthcare costs associated with non-adherence. The following are tools to support the data collection of patient’s transportation needs to address disparities in healthcare access and outcomes.
Training Tools:
- Screening for Social Needs: Guiding Care Teams to Engage Patients, 2019: American Hospital Association’s strategic considerations for implementing a screening program, case examples and a list of national organizations that can help connect patients with local resources.
- Social Interventions Research and Evaluation Network, Social Needs Screening Tools Comparison, 2019: University of California San Francisco’s compilation of the most widely used social health screening tools to facilitate comparisons.
- Social Determinants of Health Series: Transportation and the Role of Hospitals, 2017: American Hospital Association’s series on how hospitals can address the social determinants of health.
- Essential Hospitals and States: Confronting Transportation Barriers to Improve Health, 2019: America’s Essential Hospitals’ overview of the role of hospitals in addressing transportation issues and the social determinants of health.
- Health Equity Certification Resource Center: Data collection and analysis resources from the Joint Commission.
Interpersonal Violence
Assessing hospital patients for interpersonal violence can improve patient safety by identifying those at risk and connecting them with immediate support and resources. It has the potential to reduce long-term health complications by addressing trauma early and providing appropriate care. Additionally, it can enhance hospital protocols for handling abuse cases, promote a safer environment for patients, and foster greater overall health equity. The following are tools to support the collection of data on domestic/interpersonal violence to address disparities in healthcare access and outcomes.
Training Tools:
- Screening for Social Needs: Guiding Care Teams to Engage Patients, 2019: American Hospital Association’s strategic considerations for implementing a screening program, case examples and a list of national organizations that can help connect patients with local resources.
- Social Interventions Research and Evaluation Network, Social Needs Screening Tools Comparison, 2019: University of California San Francisco’s compilation of the most widely used social health screening tools to facilitate comparisons.
Webinars and Other Tools:
- National Health Resource Center on Domestic Violence: Blogs, webinars, and fact sheets to improve health care’s response to domestic violence from Futures Without Violence.
Tools for Health Equity Planning
The following are resources to develop and monitor actionable health equity plans. Such plans can be used to provide transparency and accountability to meeting equity goals.
Key Insights
- Use available tools for action plans, dashboards, and interventions to address disparities.
- Implement strategies such as culturally appropriate care, collection and use of data to drive action, community collaboration for solutions, and enhanced diversity in leadership.
- Involve patients and community members throughout the process; continue to re-evaluate and refine.
Developing and Monitoring Health Equity Plans
Developing and monitoring health equity plans helps hospitals identify and address disparities in care, ensuring all patient populations receive fair and accessible treatment. By promoting equity, hospitals can improve health outcomes, enhance patient satisfaction, and reduce disparities in care delivery, leading to better overall community health and compliance with regulatory standards. Additionally, this commitment can enhance the hospital’s reputation and strengthen relationships with diverse communities.
Webinars and Recordings:
- Resources to Support Hospitals with Developing Health Equity Plans Video: HCAI’s presentation on resources available to hospitals for advancing health equity beyond the minimum reporting requirements to HCAI. Presented at HCAI’s HEMAC meeting.
Training Tools:
- Health Equity, Diversity & Inclusion Measures for Hospitals and Health System Dashboards, 2020: American Hospital Association’s guide on measures designed for easy integration into existing dashboards and supporting tools and resources provide briefs, guides, and toolkits to help hospitals and health systems advance toward the measures.
- Health Equity Roadmap, 2022: American Hospital Association’s health equity strategies to understand capabilities to improve performance.
- Health Equity Certification Resource Center: Data collection and analysis resources from the Joint Commission.
Guides/Briefs:
- Equity of Care: A Toolkit for Eliminating Health Disparities, 2015: American Hospital Association’s “how-to” guide to help accelerate the elimination of health care disparities and ensure hospital leadership reflect the communities they serve.
Toolkits:
- Disparities Impact Statement: U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services Office of Minority Health’s action plan worksheet to promote efforts in identifying and addressing health disparities.
Data Utilization Resources
Utilizing data resources allows hospitals to make evidence-based decisions, improve patient outcomes, and streamline operations through more accurate diagnostics, treatment plans, and resource allocation. By harnessing data, hospitals can identify trends, reduce costs, and enhance the quality of care while personalizing treatment for patients. Effective data utilization also supports compliance with regulatory requirements and facilitates continuous improvement through real-time insights.
Webinars and Recordings:
- Data Stratification and Development of Interventions Presentation, 2024: Natividad Medical Center’s presentation on the organization’s approach to defining workflows, ensuring data capture accuracy, and implementing meaningful data stratification. Presented at HEMAC meeting.
- Leveraging Data to Improve Quality of Care: Hospital Quality Institute’s actionable strategies to identify and address racial and ethnic disparities.
Guides/Briefs:
- Improving Health Equity through Data Collection AND Use: A Guide for Hospital Leaders, 2011: American Hospital Association’s guide on how to move beyond data collection to analyze and use the data to develop targeted interventions.
- Reducing Health Care Disparities: Collection and Use of Race, Ethnicity and Language Data, 2013: American Hospital Association’s guide on how to obtain an accurate and usable REaL data set to achieve clinical, operational, financial and population health benefits.
Training Tools:
- Reducing Health Disparities in California’s Public Health Care Systems, 2019: California Association of Public Hospitals and Health Systems’ brief on reducing health disparities.
Feedback
HCAI strives to continue adding and curating additional tools for the toolkit over time. HCAI wants your feedback about how you use these tools and if other resources should be added to the toolkit. Share your feedback with HCAI staff by clicking the button below.
