London Health Sciences Centre offers many programs that apply an equity lens. Each of these programs use sociodemographic data differently, depending on data availability and program goals, to improve care for the populations they serve.
We spoke with Chris Harris, Director of Patient Safety and Patient Relations, and Tammy Quigley, Director of Quality and Performance, to find out more.
Could you talk a little about some of your programs that are incorporating an equity lens, and how you were able to use sociodemographic data for each?
We have examples from three projects in which we used various data sources: the Prenatal Immigrant Program, the South West Regional Cancer Program, and the Renal Program.
The Prenatal Immigrant Program: Developing a program that is responsive to patient demographics
The Prenatal Immigrant Program was borne out of a review of our interpreter services data. We noted a spike in our use of Arabic interpreter services, which prompted us to talk to our staff to understand what had changed. We found that this was due to a growing population of Syrian refugees in London and the surrounding area. We reached out to our community partners to understand how we could better support their needs, and decided to hold group prenatal classes for Arabic-speaking immigrants. This is a small program, but has been incredibly beneficial as these classes have brought this group together as a community in addition to providing them care.
The South West Regional Cancer Program: Using population-level data to better serve cancer patients in the region
The South West Regional Cancer Program is housed at London Health Sciences Centre and is charged with implementation of the Ontario Cancer Plan throughout the South West Region. One of its goals is to ensure services are equitable, accessible, and supportive of all adults, taking into account factors such as geography, religion, and culture.
Some of the data we have used to learn about the demographics of cancer patient populations include Cancer Care Ontario reports and databases; Statistics Canada information, including regional census and sociodemographic data; South West LHIN compiled statistics; and we’ve also learned from anecdotal information. The Cancer System Quality Index (www.csqi.cancercare.on.ca) is an extremely valuable tool that is used to drive and measure many of our improvement efforts.
Using heat maps that show cancer screening rates across our region, we have been able to drill down to identify specific communities with lower rates, and then work with local service agencies (e.g., the London Intercommunity Health Centre) to target the community members in those areas if there are specific cultural considerations.
Low cancer screening rates in urban settings were also examined, and we found that some of these lower rates could be attributed to isolation and gaps in language, knowledge, and cultural expectations in recently immigrated ethno-racial populations.
We conducted focus groups with key community service providers throughout the City of London, and one project in particular was launched to mobilize newcomers and immigrants to cancer screening programs, targeted specifically at identified ethno-cultural groups.
Regional Renal Program: Forming partnerships to better understand populations
In general, we knew that Indigenous populations have high incidences of kidney disease resulting from unmanaged diabetes, and this had been identified as a priority by the Ontario Renal Network. However, three to five years ago we did not have reliable data within London Health Sciences Centre regarding how many of our patients were Indigenous.
Although we did not have this data, we understood population health trends and knew generally what our patient population looked like, and we struck up a partnership with the Southwest Ontario Aboriginal Health Access Centre to improve care for Indigenous communities. Our focus has been around shared education and building capacity in their community, and learning from them.
We now have better data around people who self-identify as Indigenous through the Ontario Renal Network Data System, and can also identify other communities using data from this system (such as interpreter services usage).
Can you tell us more about how you’ve partnered with communities?
One challenge is that we need to be sure that we’re not doing anything for people, but rather are truly partnering with them. We need to step back and remove ourselves from the traditional paternalistic model, and instead listen and be willing to learn and use solutions proposed by the people we’re working with, not impose our own.
As we engage and work with our local First Nations communities, the lack of data at the local community level is a real barrier. Much of the work we do at the sub-regional and geographic level is based on postal code analysis. This does not create an accurate picture for our First Nations communities that often share postal codes with neighbouring municipalities as they are in sparsely populated rural settings.
Census and other government datasets are not representative in many instances due to known underreporting and a history of fear and mistrust and the effects of colonialism. We partner directly with the community health centres, band representatives and community leaders to ensure we have more robust community driven datasets and information to inform joint planning efforts.
What advice would you give to others who are starting to use data to address health equity?
First and foremost, partnerships are key. It’s also important to reach out and visit your partners in the community, rather than have them come to the hospital.
Second, you have to get creative in finding proxy data if you don’t have a great source of sociodemographic data. There could be weaknesses or gaps in the data you do have, so you may need to go beyond data from within your organization and seek out other sources as necessary. This also speaks to the importance of partnerships, as partner organizations can help provide some of these data.
Where would you like to go from here?
We are focusing on improving care for Indigenous communities – we recognize that we have not always provided the best care for these populations, and we want to address it in partnership with these communities. There are also other areas, such as the mental health and homeless populations, where we need strong data to figure out what to do and why. Cancer Care Ontario have been a leader in helping us with this work.
We are also making sure our staff are trained through the Ontario Indigenous Cultural Safety Program administered by the Southwest Ontario Aboriginal Health Access Centre as well as Cancer Care Ontario’s training. The first step is for leadership to complete this training to set an example for all 14,000 staff to follow.
You may also be interested in:
Quorum’s Indicators & Change Ideas page for more information on QIP indicators and related change ideas.