IHI Forum: Massachusetts General Hospital Makes Health Equity Progress

The Boston-based hospital is gaining ground on a racial hypertension disparity.

Community health workers are playing a leading role in addressing health equity among primary care patients at Massachusetts General Hospital, according to a presentation yesterday at the Institute for Healthcare Improvement Forum in Orlando, Florida.

Health equity has emerged as a pressing issue in U.S. healthcare during the coronavirus pandemic. In particular, there have been COVID-19 healthcare disparities for many racial and ethnic groups that have been at higher risk of getting sick and experiencing relatively high mortality rates.

Community health workers can be pivotal in efforts to address health equity, Sarah Matathia, MD, MPH, associate medical director of primary care equity at Massachusetts General Hospital said at the IHI forum. "One of the potential solutions for having diverse representation in the workforce is to include community health workers in your workforce and integrate them as part of the care team."

Community health workers are well-suited to help health systems and hospitals tackle health equity issues, she said. "Community health workers are public health workers with shared life experience, who apply that unique experience such as language or culture or specific issues such as substance use disorder. They try to provide culturally appropriate health education, and they serve as a bridge. They are able to bridge between individuals, families, and the community that they are a part of and the healthcare system."

At Boston-based Massachusetts General Hospital, community health workers are well established, Matathia said. "We are lucky to have a group of community health workers that has grown over the past 25 years. They are working in several key domains. The community health workers help find health-related social needs resources for patients, so they develop expertise in areas such as healthy food and job-finding programs. They are working on system navigation—community health workers help patients get to their appointments by calling patients and giving reminders. They provide care coordination—they help patients make appointments. And increasingly, we have been working with community health workers on models for chronic disease management."

Addressing racial hypertension disparity

Community health workers are an essential element of an effort to address a racial hypertension disparity among Massachusetts General Hospital primary care patients, she said. "We felt it was important for the program to be led by community health workers. We did not just want the community health workers to be helping with medications because we felt this was an opportunity to get to the root causes of hypertension. We incorporated more education around lifestyle, and we built modules such as why high blood pressure matters, what is too high and too low for blood pressure, how do you take blood pressure, medication adherence, nutrition, physical activity, stress management, and sleep."

The community health workers lead patient engagement in the blood pressure program, Matathia said. "We helped the community health workers in facilitating conversations by building them motivational interviewing guides and trying to put everything on one page so they could use the guidance as they were working with patients. For every patient who entered the program, they got a blood pressure cuff, the community health workers met with the patients and taught them how to use the cuff, and the community health workers helped to collect the readings. For each patient doing blood pressure monitoring, community health workers distilled those numbers down to a single value, and they could escalate to the primary care provider and the care team if there was a need for medication changes."

The blood pressure program was launched seven months ago, and so far, the results are promising, she said. "As we have been following our blood pressure control month-to-month, we have seen a 4.8% improvement in blood pressure control in our Black patient population, a 6.4% improvement in our Hispanic patient population, and 4.2% improvement in our non-English speaking population."

While there are challenges in the program such as carving out time for primary care providers to participate in the effort, progress is being made, Matathia said. "These types of initiatives can move the needle in real time, and community health workers are uniquely poised to help bridge the gaps for patients who are not as well served by traditional population health strategies."

Related: Dartmouth Health Leads Effort to Address Rural Healthcare Disparities