Addressing Disparities in Heart Failure Admissions
The Brigham is committed to examining and eliminating the many impacts that racism has on the health and well-being of our patients. As part of our system's United Against Racism campaign, we support efforts focused on improving patient access and experience, community health and advocacy, and increasing the diversity of leadership.
Racism is one of the most important public health crises of our time. Results from a recent study found that patients with heart failure who self-identified as Black or Latinx were less likely than white patients to be admitted to the hospital’s specialized cardiology service, even after adjusting for demographic and clinical factors. Addressing this disparity is critical as admission to this service has been independently associated with lower readmission rates and mortality. To address this, the Brigham will soon implement a pilot program that aims to improve access for Black and Latinx patients who historically have not had equitable access to specialized cardiology care by providing educational notices to clinicians about this disparity when they are admitting patients with heart failure to the hospital.
Why are we instituting this program?
As part of our system's United Against Racism campaign, we support efforts focused on improving patient access and experience, community health and advocacy, and increasing the diversity of leadership. Structural racism, which has historically targeted people of color in the United States through institutional practices and public policies, perpetuates racial inequity and leads to disparities in health and disease for our patients of color.
The pilot program, which will focus on our heart failure patients, aims to address the longstanding racial inequities identified in a recent research study. This study found that patients who self-identified as Black or Latinx were less likely to be admitted to cardiology services, even after adjusting for demographic and clinical factors.
Over the course of a year, the pilot program aims to improve access for patients who historically have not had equitable access to specialized cardiology care. The research team plans to monitor the heart failure outcomes of this approach for all patients by race, ethnicity, and other demographics.
How does this program work?
For patients who self-identify as Black or Latinx, and present to the emergency department with heart failure, physicians will receive a prompt when a bed request is entered to admit the patient to the hospital’s general medical service unit. The prompt will educate the clinician about the fact that, historically, this population has had inequitable access to specialized cardiology care and offer a recommendation to consider changing admission to the cardiology service. The notice does not restrict clinicians’ individual judgment and decision-making in consideration of the best interests of the patient. Clinicians are always free to make judgments about appropriate triage based on illness severity, and there is flexibility to override the computerized recommendations where there is a compelling rationale.
Does this affect the care of patients who aren’t Black or Latinx?
No. The pilot program is not designed to create better or preferential care for some patients over others, but rather to address the inequities in care that have been identified. It is important to note that all patients with severe or complex cardiac problems are already triaged to the cardiology service, restricting the possibility that such a program will limit beds for severely ill cardiac patients. The pilot program aims to identify opportunities to improve access for patients who have historically not had access to specialized cardiology care due to longstanding racial health care inequities. The Brigham is committed to ensuring that all patients receive safe, compassionate, and high-quality care. Additionally, the Brigham is committed to eliminating any instances in which people are excluded because of race, color, national origin, citizenship, alienage, religion, creed, sex, sexual orientation, gender identity, age, or disability.
Why does it matter which service a patient gets admitted to?
Independent and observational studies have found that, depending on the patient’s condition and co-morbidities, admission to a hospital’s specialized cardiology service for heart failure is generally associated with lower readmission rates and mortality and an increased likelihood of cardiology follow-up. Therefore, these decisions should be made purely based on clinical evaluation and capacity issues in the cardiology service.
Who makes the final decision on where the patient receives care?
Ultimately, the decision of where the patient will be admitted is made by the clinical care team. During this process, this pilot program will educate and prompt clinicians to ensure they are aware of and considering this documented disparity when they make their decisions about patients with heart failure.