Yale Medicine is undertaking a comprehensive effort to standardize healthcare practices and aims to close disparity gaps across its patient population.
Through its "care path" initiative, the New Haven, Connecticut-based academic health system tracks each step of the treatment continuum to eliminate disparities, present providers with the latest clinical guidelines within minutes and ensure compliance, said Dr. Deborah Rhodes, enterprise chief quality officer for Yale Medicine, Northeast Medical Group and the Yale New Haven Health System.
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Health systems are intensifying their analyses of disparities and determining how to change course. The Centers for Medicare and Medicaid Services and accrediting agencies such as the Joint Commission have mandated that hospitals stratify quality and safety data by race and ethnicity to investigate persistent inequities and devise plans for closing gaps. Many health systems have identified key priority areas, such as maternal and heart health.
Rhodes described the overall challenge as twofold: Persistent health disparities arise from unequal care distribution and are compounded by slow adoption of new medical evidence and standards, which can take up to 17 years to integrate into practice.
Yale Medicine is implementing a systemwide approach. Since 2020, the health system has developed more than 650 care paths, spanning conditions presented in inpatient, outpatient and emergency settings.
The initiative has a particular focus on documented disparities such as hypertension during pregnancy, COVID-19, diabetes, heart failure and alcohol use disorder. The care paths serve as integrated guides that incorporate personalized information and evidence-based protocols and are designed to ensure consistent care delivery to all patients.
"We have gone condition by condition across the inpatient and ambulatory and emergency department environments to build very detailed clinical pathways and algorithms that define what our best practice standards are," Rhodes said.
By integrating these pathways with electronic health records, the health system can identify existing disparities and streamline care processes to address them. For example, the maternal mortality crisis is partly fueled by inadequate management of hypertension during pregnancy because Black patients are less likely to receive recommended treatments than their white counterparts.
Yale Medicine developed a step-by-step program integrated into its Epic Systems EHR to promote structured and evidence-based administration of medications for hypertensive emergencies in pregnant patients. The health system convened a multidisciplinary team of hypertension and pregnancy experts, nurses and emergency physicians to develop the tool and incorporated guidance from the American College of Obstetrics and Gynecology, also known as ACOG.
"We have driven adherence rates to guideline best practices through the roof with this pathway," Rhodes said. "We looked at whether our compliance rates with ACOG best practices differed by race, and they did not in our health systems. We are certain it's because of this pathway."
The care pathways are regularly updated to reflect evolving clinical guidance and research findings. The health system has also integrated resources to address social determinants of health and patient support services.
Each care path is attached to dashboards that track steps in real time to direct the same level of care to every patient. Yale Medicine breaks down the data by race and ethnicity to ensure there are no disparities.
"With traditional clinical support tools, you're trying to fit everything that you're trying to remind that clinician of into a little box on Epic," Rhodes said. "A pathway can allow you to make longitudinal dependent decisions in a way that carries the patient through the entire episode of care."
Yale Medicine launched its first-ever care path in 2020 when uncertainty persisted about treatments for hospitalized COVID-19 patients. This allowed the health system to respond to emerging evidence, Rhodes said. These extreme circumstances also engendered buy-in from clinicians who may otherwise have been skeptical of standardized care protocols, she said.