by Kathy Whitney
In March, Vanderbilt University Medical Center leaders established a command center on campus to address the myriad issues that the Medical Center would face in the coming days, weeks and months as the COVID-19 pandemic encroached on Tennessee, then Nashville and finally on campus.
The interdisciplinary team gathered regularly — and continues to do so — to make important decisions and design strategy around operations, communications, systems management and risk. It recognized early on that health equity needed to be represented with a seat at the table and that any data it gathered would need to be disaggregated by race, ethnicity, language and ZIP code.
Nationwide, it quickly became obvious that many people from racial and ethnic minority groups were at increased risk of getting sick and dying from COVID-19.
In a paper published Dec. 16 in NEJM Catalyst, first author Consuelo Wilkins, MD, MSCI, Vice President for Health Equity at VUMC, and co-authors outline five key, early lessons learned by prioritizing health equity in VUMC’s pandemic response. The authors hope these lessons can help others implement a systems approach and immediately begin addressing COVID-19 health equity.
Of the first 45,954 patients tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at VUMC, 2,310 had limited English proficiency (LEP). The positivity rate for patients with LEP was 26% compared with 6% for patients with English as a primary language. In addition to alerting local and state health departments of these higher rates, VUMC created multilingual resources, assessed its interpreter services capacity, and engaged trusted community organizations.
“This describes how we expanded our command center to include health equity as a specific focus,” Wilkins said. “We’re not the only ones who have done this, but I would say as a major academic medical center we have probably been more intentional than most and had more resources put toward it than many.”
The paper outlines the key lessons so far:
- Executive leaders should clearly state that achieving health equity is a priority and allocate resources, including people, to do this important work. In the case of VUMC, institutional funds totaling more than $1.5 million annually were committed to the OHE prior to Covid-19, facilitating our ability to pivot and rapidly respond;
- Health equity-related goals and programs should be integrated into the health system’s organizational readiness and response with clear expectations for accountability and action;
- Race, ethnicity and language (REAL) data must be available in real time, and new processes may be needed to collect and aggregate accurate data;
- The COVID-19 Command Center includes a wide range of clinical, administrative, and operations leaders, some of whom have limited knowledge of health equity. This exposure could facilitate culture change and different ways of advancing health equity in the long term; and
- Health systems must work closely with public health departments and trusted organizations that are closely connected to communities.
“The impacts of the COVID-19 pandemic will be felt for a long time and, without intervention, racial and ethnic minorities will likely bear a higher burden of the disease and greater socioeconomic loss,” the authors write. “It is not too late for health systems to take systematic and intentional steps to prioritize health equity. By setting clear health equity objectives, disaggregating data by REAL, and implementing strategies informed by social context, we may prevent or lessen health inequities and be better positioned to address the underlying contributors to health that require more equitable infrastructure and broad changes in policies.”
Co-authors include Elisa Friedman, MS, André Churchwell, MD, Jennifer Slayton, MSN, RN, Pam Jones, DNP, RN, NEA-BC, FAAN, Jill Pulley, MBA, and Sunil Kripalani, MD, MSc, SFHM. Others members of the Covid-19 Health Equity Team include Terrell Smith, MSN, RN, Tiercy Fortenberry, RN, CPPS, Larry Prisco, MSW, Brian Carlson, Cynthia Manley, and Amber Humphrey, MBA.
