June 28, 2022
Patient Engagement Hit
By Sarah Heath
Fewer than 2 percent of the nearly 3,600 hospitals included in this year’s Lown Institute Hospital Index for Social Responsibility ranked among the best for health equity, value, and outcomes, the organization shared with PatientEngagementHIT via email.
The report, the first iteration of which was published back in 2020, also highlighted 15 exemplars that achieved top marks for social responsibility while also balancing extreme COVID-19 burdens, defined as going 26 or more weeks with at least 10 percent of inpatient beds filled by COVID-19 patients during the first year of the pandemic.
This second edition of the Lown Institute’s Hospital Index for Social Responsibility comes after two years of intense focus on health equity. It did not take long after COVID-19 ravaged the nation for steep racial health disparities to emerge. That inequity, paired with a nationwide reckoning with race and racism set off by the murder of George Floyd, sparked a renewed push for health equity across the medical industry.
Even still, some healthcare organizations are performing better on this metric than others, the Lown Institute reported. The Index for Social Responsibility comprises measures related to health equity, value, and outcomes.
Under the health equity umbrella, the Lown Institute looks at pay equity, inclusivity, and community benefits. In terms of value, the organization examines avoiding of overuse and cost efficiency. Finally, the Lown Institute measures outcomes such as patient satisfaction, patient safety, and clinical outcomes.
The Lown Institute uses information from Medicare claims, CMS hospital cost reports, IRS 990 forms, and other sources, the organization said.
Of the 3,600 hospitals included in this year’s assessment, 66 ranked among the most socially responsible, meaning they earned an “A” rating in at least three of the measurement categories, the Lown Institute said. That represents fewer than 2 percent of participating hospitals, indicating serious room for growth in terms of health equity.
Healthcare organizations need to continue their focus on health equity and better outcomes, according to Vikas Saini, MD, the president of the Lown Institute.
“Citizens put their lives and billions of tax dollars in the hands of America’s hospitals,” Saini said in a statement emailed to journalists. “We believe communities should have high expectations and the most socially responsible institutions should be lifted up as models for the system.”
The 20 hospitals leading the nation in social responsibility include”
- Adventist Health Howard Hospital (Willits, CA)
- Duke Regional Hospital (Durham, NC)
- Tristar Horizon Medical Center (Dickson, TN)
- Boston Medical Center (Boston, MA)
- Salinas Valley Memorial Hospital (Salinas, CA)
- Legacy Mount Hood Medical Center (Gresham, OR)
- Banner University Medical Center South Campus (Tucson, AZ)
- Saint Alphonsus Medical Center – Nampa (Nampa, ID)
- Saint Alphonsus Medical Center – Ontario (Ontario, OR)
- Denver Health & Hospital Authority (Denver, CO)
- Saint Rose Dominican Hospitals – Rose de Lima (Henderson, NV)
- Saint Mary Corwin Medical Center (Pueblo, CO)
- Saint Joseph Berea (Berea, KY)
- Saint Charles Prineville (Prineville, OR)
- Metrohealth System (Cleveland, OH)
- Stoughton Hospital Association (Stoughton, WI)
- Sutter Solano Medical Center (Vallejo, CA)
- Providence Milwaukie Hospital (Milwaukie, OR)
- North Suburban Medical Center (Thornton, CO)
- Baystate Wing Hospital (Palmer, MA)
Notably, 15 of the hospitals succeeding in social responsibility did so under dire pandemic straits, the Lown Institute pointed out. That means for at least half the year, 10 percent of hospital beds were taken by patients sick with COVID-19 during the first year of the pandemic.
That’s a massive feat, Saini said, considering the intense pressure the pandemic put on hospital operations.
“Achieving the trifecta of great outcomes, value, and equity is hard—especially under the pressures of a global pandemic,” Saini pointed out. “Hospitals that met the unprecedented challenges of COVID while staying committed to their social mission should be very, very proud.”
The Lown Institute issued its 2021 report back in September, again finding that few hospitals are excelling at enacting health equity. Only about 75 of the 3,000 hospitals included in the social responsibility index got top marks, the organization said.
Notably, very few of the hospitals that typically perform well on other public rankings, like the US News & World Reports hospital ratings, also scored well on the Lown Institute’s social responsibility index. Johns Hopkins stood out on both lists, appearing at 147 on the Lown Institute’s 2021 list, but otherwise about half of the US News top-performers didn’t even crack the top third for the Lown Institute.
That was largely due to poor performance on health equity; these hospitals scored well in value and outcomes but are lagging in addressing health inequities.
“It’s not enough for hospitals to say they’re committed to social responsibility,” Saini said at the time of the 2021 report. “They need to put their commitment into action.”
The rate of Americans diagnosed with diabetes isn’t slowing down, and the Covid-19 pandemic only exacerbated the risks and concerns for this debilitating chronic disease.
According to the American Diabetes Association, 1.5 million people will be diagnosed with diabetes this year. So why aren’t more people talking about it? The pandemic may have shifted the collective focus. After all, a nation in health crisis mode can only focus on so many problems at once. Yet hospitalizations and deaths due to diabetes or related complications were right behind the elderly and nursing home residents.
Aside from the pandemic pileup, the disease was not getting the attention it warranted, partly because of how the stigma attached to diabetes impacts our concern, even as it affects more people each year.
Between 1980 and 2014, the number of people with diabetes rose from 108 million to 422 million. “Prevalence has been rising more rapidly in low and middle income countries,” reports the World Health Organization. Diabetes can lead to blindness, kidney failure, heart attacks, stroke, and lower limb amputation.
Why Aren’t More People Talking About This?
“Diabetes is always swept under the rug because, in so many people’s minds, they just associate it with bad health habits and being overweight,” says Deena Fink of New York City. The Long Island native bartends in the West Village in addition to running a small online knitting business.
Most days, her Type 1 Diabetes doesn’t slow her down. It’s a disease she has been living with for sixteen years. “What really has to change is the stigma of diabetes,” Deena explains in an interview with Wealth of Geeks.
She is grateful for her health care plan, despite the roadblocks she often faces to receive her medication. “They have to start actually treating it as a chronic illness.”
Like many others during the first months of the pandemic, Deena was afraid to leave her house. “I didn’t even want to leave the house to go grocery shopping,” she says. The risks are different for someone with a chronic illness. “Just getting a cold, I am knocked out for several days.” She also could not get to a doctor’s office.
“You’re supposed to get your A1C done every quarter,” she explains, but she couldn’t see her doctor for a year and a half. So instead, Deena had to estimate what those numbers would be. The A1C test provides a three-month average of what blood sugar levels should be. It’s how a person with diabetes keeps themselves in range.
Deena faces a monthly battle with the insurance company just to receive her regular dosage of three insulin vials. Without insurance, she would have to pay $175 per vial.
The Global Factor
While lifestyle changes such as maintaining a healthy weight and diet, engaging in physical activity, and not smoking may decrease the health risks associated with diabetes, it does not guarantee that the disease won’t have harmful symptoms over time. Additionally, Covid-19 increases these risks across the globe.
Diabetes was responsible for 6.7 million deaths in 2021, according to the International Diabetes Federation. In addition to the 537 million adults living with diabetes today, an additional 541 million have Impaired Glucose Tolerance, a condition that places them at high risk of Type 2 Diabetes.
And what about the financial side? WHO reports that “diabetes caused at least 966 billion dollars in health expenditure – a 316% increase over the last fifteen years.”
As more people are diagnosed, the opportunity for visibility and change grows. Those with diabetes often become advocates for change.
“Stigma can result when you take an ‘invisible’ condition like diabetes out into the open,” says diabetes advocate Michael Donohoe of Ohio. When he was diagnosed with Type 2 Diabetes, he was also diagnosed with a heart condition. “I try to improve awareness and understanding by being as open about my diabetes as possible. I also advocate loudly for people who are newly diagnosed or severely impacted,” he says.
Covid Collision
Although the elderly and nursing home residents were hit hardest by the virus, people with diabetes were right behind them. This news comes to light as the total number of deaths in the United States nears one million.
“People with poorly controlled diabetes are especially vulnerable to severe illness from Covid, partly because diabetes impairs the immune system but also because those with the disease often struggle with high blood pressure, obesity, and other underlying medical conditions,” reports the New York Times.
Those with diabetes have to keep up with their disease constantly. “It’s a disease that’s a pain,” says Deena, “because you never stop taking care of yourself. Every decision you make for every day of your life will affect your diabetes.”
“It’s so much work,” she says, “but it keeps you alive.”
With diabetes diagnoses soaring across the globe, it is only a matter of time before the world stops hiding from this health crisis and confronts it head-on.
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