Engaging patients and communities to take surveys is always a challenging task for provider organizations of all shapes and sizes, regardless of who they serve. But in some communities, gaining population-based insights is critically important, despite the challenges.

THE PROBLEM

With any survey, efforts must be made to best explain the end result and how it will impact overall patient satisfaction and outcomes. As such, paper-based polls may not be the best form of engagement, since they're usually time-consuming and demand extended quantification.

"The time taken during the transfer of information from the point of collection to analysis can be a laborious effort that can greatly impact deadlines," said Gwendolyn Lewis, DNP, RN, vice president of ambulatory services at Interfaith Medical Center, part of the One Brooklyn Health System.

"Additionally, paper surveys can be translated incorrectly, and usually have a low response rate, also known as a nonresponse error, which occurs when the potential participant is unwilling to participate or impossible to contact," she continued. "Nonresponse can result in a reduction in precision of the study and may bias results."

Prior to the start of a new research project, One Brooklyn Health did not have a tool to measure health equity. While it had the Press Ganey tool, which provides the health system with a mechanism to obtain feedback about the patient experience, that tool did not tell staff patient feelings or experiences with inequitable care and treatment.

The Brooklyn Health Equity Index tool, developed as a result of this survey, was designed to enable the health system to identify through patient feedback and address inequities.

"The use of the automated outreach technology provided through vendor CipherHealth enabled us to reach a large number of patients without the need for staff to conduct the survey, get faster turnaround of data and receive survey information in a format that provided greater ease of data analysis," Lewis said.

PROPOSAL

The Brooklyn Health Equity Index is different from other patient experience surveys, Lewis said.

"We take this tool a step further than Press Ganey's tool regarding patient experience," she explained. "Press Ganey's tool does address whether a patient is discriminated against. Press Ganey's tool does not address whether the patient's needs beyond a hospitalization or a clinic visit are taken into consideration.

"The Press Ganey tool does not address whether the patient could comply with the medical regimen that was decided in either their hospital or outpatient encounter," she continued. "Our survey tells us what real-life experiences are like."

CipherHealth is a healthcare technology platform that connects providers, patients, caregivers and communities through automated, scalable and omnichannel communication technologies that are highly personal. These tools are designed to help patients understand their care and provide contextualized, actionable insights for care teams. CipherHealth works with vendor Twilio to manage the communication capabilities.

"The user-friendly survey platform, accessible by text or phone call, walked community members through a survey process of collecting data often missed from existing patient experience tools such as discrimination, implicit bias, medical mistrust and patient safety," Lewis explained. "By leveraging the automated phone call and text message technology, we were able to dramatically extend our Brooklyn Health Equity Index reach rate capabilities.

"Once patient enrollment parameters were set, the system automated the Brooklyn Health Equity Index delivery," she continued. "CipherHealth Outreach capabilities aligned with the study requirements – automated calls and texts, participant anonymity, demographic data inclusion and daily raw Excel file exports allowing for quick analysis."

MEETING THE CHALLENGE

The automated technology made the survey tool easy to access and complete, Lewis said. Patients who visited One Brooklyn Health between May 15 and June 15 were called and sent a text providing them with a link that led them directly to the survey tool, which consisted of 10 questions.

The Brooklyn Health Equity Index has been deployed in two stages. In the first stage, more than 4,000 surveys were sent to One Brooklyn Health patients. In the second stage, more than 10,000 surveys were sent out to One Brooklyn Health patients.

RESULTS

"The survey provided the opportunity to address issues such as inequities in access to care, treatment and discrimination based on a variety of factors including race, ethnicity, sexual orientation, gender identity, disease type, age, staff attitudes and responsiveness, and organization's ability to address social determinants of health issues," Lewis explained.

"We have, through the use of automated outreach technology, reached more than 14,000 patients, and of that number we have received more than 1,700 completed surveys between Phase 2 and Phase 3 of the project," she continued. "We were able to get patient respondents representative of all of the One Brooklyn Health sites. This information will help identify systemic gaps and trends in care."

ADVICE FOR OTHERS

The use of this type of technology enables an organization to obtain information through a fast and easy process without the need to engage staff to collect data. Staff time can be spent on data analysis and determining the implications of the data received for the organization, specifically actions and interventions that need to be undertaken by the organization to reduce health disparities and improve the patient experience and health outcomes, Lewis advised.

"Tools such as the Brooklyn Health Equity Index survey and the use of automated technology can provide institutions with fast and valuable knowledge based on patient voice to develop training, policies and procedures to address structural and institutional racism until patient voices are heard and addressed," she concluded.

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