Health Equity Institute

New Nine-Month Study Seeks to Understand COVID-19 in Pregnancy among Minorities

Posted on Oct 26, 2020 in Health Equity Institute, Scroll Images

SACRAMENTO, Calif. – Little is known about COVID-19 in pregnancy and particularly whether it disproportionately impacts minorities. Now researchers with Northern California-based Sutter Health have launched a study to help shed light on the prevalence of COVID-19 in patients about to give birth. By testing for antibodies, the team hopes to determine whether exposure to the SARS-CoV2 virus differs by race, ethnicity or other factors.

Researchers with the not-for-profit healthcare system’s Advancing Health Equity program are leading the nine-month study, called the Maternal Covid-19 Antibody Race and Ethnicity (CARE) Study. Among the first of its kind in the U.S.,* Sutter’s Maternal CARE Study aims to increase understanding of whether and how COVID-19 exposure during pregnancy differs by race and ethnicity. The study will look at maternal health indicators including number of weeks of gestation, method of delivery (vaginal or C-section), length of stay and postpartum depression, among others.

“Sutter Health is a recognized national leader in healthcare quality and we consider health equity to be a component of quality. We believe the Maternal CARE Study is a first step in understanding the health equity gap for pregnant patients of color,” says Sutter Health Chief Medical Officer Stephen Lockhart, M.D., Ph.D., and one of the lead investigators for the study. “The more caregivers learn how the spread of COVID-19 affects pregnant women of diverse races and ethnicities, the better we can care for these patients and the more lives we can save through targeted interventions and solutions,” says Lockhart.

According to Alice Pressman, Ph.D., M.S., director of Sutter’s Center for Health Systems Research, and a lead investigator of the study, “Sutter Health is ideally suited to conduct the study because of our diverse patient population and the fact that about 32,000 babies are born across our network each year.”

The Northern California-based health system cares for one of the most diverse patient populations in the country, with 54% of patients self-identifying as non-white. Sutter’s integrated network of 3 million ethnically, economically and geographically diverse patients is a microcosm of the rest of the nation.

Sutter’s Maternal CARE Study began enrolling participants in July 2020 and will continue through March 2021.

“The information we glean from the Maternal CARE Study could potentially give us significant insight into COVID-19 and how exposure impacts diverse groups during pregnancy,” says Pressman. “The hope is through greater understanding of COVID-19, we can get ahead of the disease and save lives.”

Straightforward Process for Gathering Samples

The process is straightforward for pregnant Sutter patients who consent to join the study. When a pregnant woman comes to the hospital to give birth, a small extra blood sample is collected during the required routine blood tests at admission. The blood sample is then tested for antibodies which show whether a person has had COVID-19 in the past.

Precision Medicine and the Sutter Health Biobank Make the Maternal CARE Study Possible

Gregory Tranah, Ph.D., director of Precision Medicine at Sutter and a lead investigator of the study says, “One key to running a relatively large study like the Maternal CARE Study is the ability to properly collect, store and analyze biological samples. Sutter is prepared to handle these requirements thanks to our adoption of the precision medicine medical care model and having our own biobank.”

Says Tranah, “We anticipate the data from the study will lead us to useful insights that improve and provide more equitable care for pregnant women of color across the country.”

*A University of Pennsylvania study of nearly 1,300 women over a three-month period earlier this year found that Black and Latinx pregnant women in Philadelphia are five times as likely as their white counterparts to have been exposed to COVID-19.

Juneteenth: A Day for Celebration, Education and Connection

Posted on Jun 18, 2020 in Health Equity Institute, Scroll Images

Juneteenth is the oldest-known celebration commemorating the end of slavery in the United States. Although the Emancipation Proclamation of 1863 declared all slaves free, it was not until two and a half years later, on June 19,1865 that Union soldiers landed in Galveston, Texas and informed slaves that the Civil War had ended and slavery had been abolished. The news kicked off widespread celebrations across the state.

Sutter Health joins in the celebration of this historic event, but the realities of today are sobering.

One hundred and fifty-five years later, racism still exists in our country and freedom for Black Americans remains elusive. The killing of George Floyd is an example of the systemic racial injustice Black Americans have endured for centuries in the U.S.

“Sutter Health affirms that Black Lives Matter and encourages us all to speak up and raise our voices against racism and to advocate for systemic change,” says Stephen Lockhart, M.D., Ph.D., chief medical officer and executive sponsor for Sutter’s Multicultural Inclusive Resource Group.

Sutter Health President and CEO Sarah Krevans says, “Our Sutter values compel us to speak out against inequity in healthcare and injustice and racism in our society. Within Sutter, our organization has an unyielding commitment to equity, diversity and inclusion, and we work to embed it into our culture. We know there is more to be done and are committed to it.”

Sutter takes pride in caring for one of the most diverse patient populations in our nation. Dr. Lockhart is leading a national effort to advance health equity and address health disparities that exist for patients in healthcare across the country. “We know that inequities exist in healthcare and we’re focused on being a national leader to address those disparities and improve healthcare for all. To the extent we are able to make a difference, we have a moral obligation to do so.”

Art Out of Turmoil: Mission Care Center Converts Plywood into Community Murals

Posted on Jun 17, 2020 in Health Equity Institute, Scroll Images

SAN FRANCISCO – Sutter Pacific Medical Foundation (SPMF) invited a dozen local artists along with employees and their family and friends to craft murals on its temporarily boarded-up windows at 899 Valencia Street Care Center, a group of family and internal medicine clinicians who see children and adults.

In response to recent racial justice protests in the Mission District, the primary care clinic, which sits at the corner of Valencia Street and 20th Street in the heart of the Mission, erected plywood boards to protect the facility and ensure it would remain open and able to provide healthcare for patients.

The clinic provides routine health care services, including preventive care, women’s health, chronic condition management, and treatment for acute illnesses for this diverse community, and has remained open during the COVID-19 pandemic.

“The project’s goal has been to create a safe space for artists to express themselves in support of recent urgent civil issues, which directly impact this community,” said SPMF Care Center Manager Andrea Contreras.

Local artists painted colorful murals on 16 large floor-to-ceiling wooden panels. Themes focused on essential workers, Black Lives Matter and health in the community. Mediums ranged from graffiti to paint to vinyl wall wraps with messages like “Essential Workers for President!” and “We are with you 899.”

“Our center understands there are many challenges in the struggle for equality and firmly believes that well-being, safety and quality-of-life must include quality health care,” said Robert Nordgren, M.D., CEO of the Sutter Bay Medical Foundation, who attended the painting.

The Mission District has a proud tradition of creating murals to reflect the current culture and changing times. As onlookers passed by the artworks in progress, many stopped to praise the bold emerging themes and to share their happiness over the new colorful—and powerful—displays.

“While these boards are temporary, we hope this gesture will be a long-lasting force for bringing the community together to heal,” said Dr. Nordgren.

Standing by our Values in Difficult Times: A Message from Sarah Krevans to the Employees of the Sutter Health Network

Posted on Jun 3, 2020 in Health Equity Institute, Scroll Images

Last week our Advancing Health Equity Team published a study looking at disparities in treatments and outcomes in African American patients with COVID-19. The unequal burden of disease and disparate treatment is still a significant problem in our country, and Sutter Health is committed to being part of the solution. We have seen across the country, and in our own neighborhoods, the tragic impact to communities of color from the coronavirus, and then on May 25, we watched with horror and sadness the unjust death of George Floyd in Minneapolis.

Over the last several days, many peaceful protesters raised their voices to advocate for justice and equality, and we stand with them as they peacefully advocate for a just society where no one’s life is at increased risk because of racism or discrimination. We must also condemn the violence that has led to injuries and to the senseless death of a federal security officer in Oakland.

To our patients and communities, I want to affirm Sutter’s unwavering commitment to our values and our not-for-profit mission. Our integrated network strives every day to provide a safe, caring and compassionate place to work and receive exceptional care, regardless of gender, age, race, disability, ethnicity, sexual orientation or religious belief. We are committed to advancing diversity and inclusion throughout our organization and providing equitable health outcomes for all.

Study Shines Light on COVID-19 Racial Disparities

Posted on May 21, 2020 in Health Equity Institute, Scroll Images

Differences in How People Access Care Contribute to Inequalities

SACRAMENTO, CALIF. – As the COVID-19 pandemic spreads throughout the U.S., evidence is mounting that racial and ethnic minorities and socioeconomically disadvantaged groups are bearing a disproportionate burden of illness and death. Here in California, African Americans are about 6% of the California population, but make up 10.3% of COVID-19 deaths where race/ethnicity is documented.

To better understand how this issue impacts patients in Sutter Health’s network, and to help develop solutions, Sutter’s Advancing Health Equity team undertook a thorough data analysis of the not-for-profit system’s COVID-19 patients. The resulting study, published today by the journal Health Affairs, revealed that African American COVID-19 patients are 2.7 times more likely to be hospitalized than their Non-Hispanic White counterparts, and they tend to arrive at Sutter healthcare facilities sicker and with more severe symptoms.

The findings underscore the fact that race and ethnicity still play a pivotal role in determining how and when care is accessed. Despite having health coverage, African American COVID-19 patients may not seek testing and care until it is an emergency requiring hospitalization.

Stephen Lockhart, M.D., Ph.D.

“The COVID-19 pandemic has ripped a Band-Aid off of the structural inequities that exist within our society – we must address these disparities right away because the cost of not addressing them is measured in human life,” said Stephen Lockhart, M.D., Ph.D., chief medical officer at Sutter Health. “With lives on the line, we as a state can and should do better in connecting minority patients to culturally competent care – that is why Sutter Health has committed to advancing health equity and this study is just one part of our mission and work. We have a moral obligation to do so and must work together to meet this moment and lean into the opportunity to advance health equity for generations to come.”

The study, “Disparities In Outcomes Among COVID-19 Patients In A Large Health Care System In California,” was conducted using Sutter’s electronic health record (EHR) data to characterize COVID-19 tested and confirmed cases by key sociodemographic and clinical characteristics, including self-reported race and ethnicity, across the 22 Northern California counties served by Sutter’s network.

A number of factors uniquely position Sutter to offer early insights into the reasons for the disparities in health outcomes that have been noted nationally. As an integrated healthcare delivery network serving more than 3.5 million patients a year, Sutter had been studying healthcare disparities for close to three years when it became one of the first in the nation to treat patients with COVID-19. And Sutter’s integrated system-wide electronic EHR includes race/ethnicity data throughout its service area, which is one of the most diverse regions of the country.

Sutter Health also operates in an environment that is one of the closest to universal healthcare coverage of any state in the U.S., mitigating one of the known causes of healthcare disparities – unequal rates of medical coverage – and making other factors driving disparities more visible. But coverage is not the same as access, and the higher hospital admissions and mortality rates for African American COVID-19 patients in California revealed by the study illustrate that expanded healthcare coverage is not enough to resolve health disparities.

Kristen M.J. Azar

“The real value of the study lies not in the disparities it reveals but in its utility to inform our work to develop solutions that will address the equity gaps we are seeing with programs such as community outreach and engagement in at-risk neighborhoods,” said Kristen M.J. Azar, R.N., MSN/MPH, Sutter Health’s lead author for the study and research scientist within the Sutter Health Center for Health Systems Research. “This pandemic underscores the need to develop innovative solutions that are specifically tailored to address the unmet needs of those at highest risk.”

Sutter has extensive experience looking for and analyzing disparities within its own network and beyond.

The results of the COVID-19 study mirror the patterns Sutter observed in a 2017 study about African American patients with asthma and how they access care. The asthma study found 72% of patients drove up to eight miles to a hospital emergency department to access care, even though they lived within one mile of a primary care clinic. We observed they were doing so because of a lack of culturally competent care.

After reviewing the findings of the 2017 study, Sutter developed its Advancing Health Equity Adult Asthma Program. Since the program began in April 2017, nearly 600 African American patients suffering from asthma attacks have been connected to a respiratory therapist to participate in the asthma program. As a result, very few have returned to the emergency room. The asthma program serves as a model for trusted outreach, education and treatment in a public health crisis – and how they can reduce health disparities.

Provider organizations like Sutter Health are on the front lines and, while not able to address all of the complex societal factors at issue, can play a unique role in developing solutions. For example, as part of its commitment to advancing health equity, Sutter developed a novel metric, the Health Equity Index (HEI), to identify and quantify disparities in outcomes across patient groups and develop targeted interventions to enhance equity. Through the HEI, our Advancing Health Equity team is taking major steps, like those detailed here, to build on the benefits of our integrated network of care to further health equity within the Sutter system and across the country.

Our health equity work and the findings of the study released today highlight the importance of community-based outreach and access to culturally competent care within the African American community, which hold the promise of reducing disparities. Additional research is needed to understand where healthcare disparities exist, what drives them, and what targeted interventions work best to address them. Sutter remains committed to continued advancement and leadership in this field.

Building a Path Toward Health Equity

Posted on Apr 16, 2020 in Health Equity Institute, Scroll Images

Across the nation, new data is illustrating a startling trend in the spread and impact of COVID-19: inequity. Between Illinois, North Carolina, South Carolina and New York alone, statistics are showing that African Americans are 74% more likely to contract the virus as compared with their total percentage of the state’s population.

While this new data is grabbing headlines and startling communities across the nation, inequities in healthcare outcomes are unfortunately not new news. As we observe Black Maternal Health Week (April 11-17), it is important to highlight that this is especially true for Black mothers, who are still roughly three times more likely to die due to pregnancy related causes.

The United States is facing serious challenges in how we care for expectant mothers and infants. A report in December of 2018 by the Commonwealth Fund found that American women have the greatest risk of dying from pregnancy complications among developed countries. (Munira Z. Gunja, n.d.)

Yet, California appears to be an outlier. California continues to perform better than the national average on maternal mortality with 11.7 deaths per 100,000 live births versus the national average of 17.4 deaths.

This was not always the case. Prior to 2006, the state’s maternal mortality rate had doubled in seven years – and black women were approximately four times more likely to die in childbirth than other ethnic groups.

In response, in 2006, Sutter Health leaders helped spearhead the creation of a multi-stakeholder organization, the California Maternal Quality Care Collaborative (CMQCC), to address maternal mortality and maternal health. The work done through CMQCC helped reduce California’s maternal mortality rate by 55% between 2006 and 2013.

Sutter’s partnership with the CMQCC and our work with their California Birth Equity Collaborative – a quality improvement initiative to improve birth care, experiences and outcomes for Black mothers – is helping to lower preventable maternal deaths or unexpected outcomes that have significant short, or long-term health effects on new mothers.

Sutter’s collaborative efforts have fostered real and much-needed progress, but there is still much more to do. We are committed to using robust data and collaborating with other providers and patients to make meaningful improvements to address equity gaps and improve patient-centered outcomes.

Building on this effort, two years ago Sutter created an ‘Advancing Health Equity’ team – led by Sutter’s Chief Medical Officer Stephen Lockhart, M.D., PhD – dedicated to identifying and addressing the issue through targeted, community-based programs. We are using innovative tools like the groundbreaking Health Equity Index that include analytic methods and dynamic applications of clinical and population data to measure outcomes of care among different patient populations. By reporting on these quality measures by race and ethnicity, we can identify previously unknown differences within populations, share best practices, and identify the need for targeted interventions and solutions.

Within Sutter’s own network, there is currently no inequity in race or ethnicity when it comes to maternal mortality. However, we know that 80% of what drives health outcomes happens outside the walls of our facilities. That is why it is so important that Sutter Health live up to our responsibilities as a national healthcare leader, and continue to research, innovate, and quantify the value of our integrated system of care for the benefit of other healthcare leaders throughout the state and the nation.

“I am so proud of Sutter Health’s long-standing commitment to improving health outcomes for our Black mothers, ” said Dr. Lockhart “COVID-19 reminds us more must be done to address health disparities and advance equity across the U.S. Everyone deserves the chance to live a healthy life.”

As long as inequities exist, the work will continue, but the successes we have seen and the initiatives that we are currently working on help to provide a clearer look at how we can do our part to advance health equity for all.