323 - Community Perspectives on Hospital Accountability to Equity: A Qualitative Analysis

Publication Number: 323.4128

Lindsey M. Maclay, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Katherine Nash, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Fajah Ferrer, Northern Manhattan Perinatal Partnership, Inc., New York, NY, United States; Rachel Shelton, Columbia University, Mailman School of Public Health, Brooklyn, NY, United States; Anne Sperling, NewYork-Presbyterian, New York, NY, United States; Dodi Meyer, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Jennifer Woo Baidal, Stanford University School of Medicine, Palo Alto, CA, United States; Linda Weiss, New York Academy of Medicine, New York, NY, United States; Sakinah C.. Suttiratana, Yale School of Medicine, New Haven, CT, United States; Naomi Bardach, University of California, San Francisco, School of Medicine, San Francisco, CA, United States

Background: Quality, accreditation, and accountability programs are beginning to incorporate equity into assessment of hospital performance. Community perspectives are needed to inform prioritization of equity measure concepts for use in hospital performance assessment.

Objective: Characterize community perspectives on hospital actions that signify commitment to health equity.

Design/Methods: 32 focus groups of 210 individuals were conducted as part of our hospital’s 2022 Community Health Needs Assessment (CHNA). Participants included residents living in NewYork-Presbyterian Hospital’s large service area, with purposeful sampling for diversity by race/ethnicity, age, gender identity, and sexual orientation.
We undertook a qualitative thematic analysis of focus group transcripts, convening a diverse, multidisciplinary team including a community partner. We focused our analysis on the 6 (of 23) questions included in the focus group guide most pertinent to our research objectives. We followed Braun and Clarke’s six phases of reflexive thematic analysis. Our a priori coding tree was based on the National Committee for Quality Assurance (NCQA) Health Equity Measurement Framework for Medicaid Accountability, which outlines six domains (and corresponding measures) by which to assess payor/plan performance on equity. Two researchers coded transcripts using Dedoose software and reviewed coded data iteratively; the full research team convened to develop themes using exemplary quotes to illustrate key findings.

Results: We organized codes and identified key candidate measure concepts within each of the NCQA Health Equity Measurement Framework’s six domains. In the data, two domains were most salient: (1)“experiences of care” and (2)“access to care” (Figure 1, Table 1). Within “experiences,” participants described two themes, accommodation and inclusivity, as determinant of equitable experiences of care. Within “access”, participants described four primary themes: (1) physical access to services; (2) financial access to services; (3) language access; and (4) navigability without undo effort or delay.

Conclusion(s): Our adaptation of the NCQA equity measurement framework identifies accommodation and inclusivity, and improved communication, system navigability, and physical and financial access and as candidate equity measure concepts reflecting community perspectives. Engaging communities ultimately affected by healthcare inequities in the design of equity measurement efforts can ensure that those efforts accomplish their intended goals.

Figure 1.
Using community perspectives to adapt the National Committee for Quality Assurance (NCQA) Health Equity Measurement framework for Medicaid Accountability to a framework for Hospital Accountability.

Table 1.
Two salient domains of equity measurement with demonstrative codes and exemplary quotations

Figure 1.
Using community perspectives to adapt the National Committee for Quality Assurance (NCQA) Health Equity Measurement framework for Medicaid Accountability to a framework for Hospital Accountability.

Table 1.
Two salient domains of equity measurement with demonstrative codes and exemplary quotations