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Quality 101 – Part 6: “E” is for Equitable

In the first article in this series, we looked at the Institute of Medicine’s STEEEP acronym, which stands for care that is Safe, Timely, Effective, Efficient, Equitable, and Patient-Centered. Equitable care is the fifth pillar.

The Institute for Healthcare Improvement describes efficiency by stating, “…Race, ethnicity, gender, and income should not prevent anyone in the world from receiving high-quality care. We need advances in health care delivery to match the advances in medical science so the benefits of that science may reach everyone equally.”

It may be easy to look at modern medical practices and say, “there’s no discrimination against patients based on race, gender, ethnicity, etc.,” but there are other factors that determine whether care is equitable. In addition to the more obvious ethnic and socio-economic matters in health equity, there are additional questions to ask when evaluating a practice for truly equitable care:

  • Geography: Is it more challenging for rural patients to seek care? Are there mechanisms in place to assist them in making and keeping appointments? Is scheduling flexible when weather is poor?

  • Pain: Are patients with chronic pain welcomed, assessed, and treated the same way as someone who is coming in for a common cold (of course the medical treatment will be different, but what about the treatment of the patient themselves)?

  • Patient Engagement: Every practice has patients whom they find challenging to engaged in their care, keep appointments, and participate in their treatment plan. What words does the practice use to describe these patients? “Non-compliant” is the most common. How might healthcare change if we instead referred to them as “not yet engaged”? Listen carefully to the language used in medical practices – it is an indicator of how patients are viewed and treated.

  • Relationships: Do friends of the Board or friends of the doc get easier access to appointments and/or priority scheduling? Personal relationships should not create inequity in care.

There are many other factors in equitable care including insurance coverage, medical conditions, frequency of visits, etc. Assuring care is equitable creates improved patient relationships and engagement, improved access to care, and maintains the integrity of the healthcare world. Next time, we’ll finish out the series with patient-centered care.

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