Community Engagement Program

Using Data To Advance Equitable Outcomes With Community Health Centers And Other Community Health Providers

Community health centers (CHCs) and other healthcare providers typically focus on equity as a critical part of their mission. Because they are committed to delivering high quality service to historically marginalized populations, it may be assumed that equity concerns are inherently being addressed. However, given the mismatch between resources and demands that many CHCs experience, it is important to consider ways to ensure equity in health outcomes for all population groups. One of the best ways of achieving this is for organizations to use their own data to evaluate equity in care delivery and health outcomes.

Data can provide a window into whether equity is being achieved. When data demonstrates differences in health outcomes between groups of people, understanding why these differences exist can help identify ways to provide more effective and equitable care. The following steps are designed to walk a CHC or other health organization through the process of turning data into actions that help deliver more equitable care and address systemic barriers that affect health outcomes.

Step 1: Establish a Multi-Disciplinary Working Group

Form a working group that can help you understand your data. This group will be responsible for moving the project forward and communicating findings. Tips to get you started:

• Invite members from different disciplines and parts of the organization. Include roles such as population health, quality improvement, medical assistants, community health workers, and providers of health and mental health services.
• Assign a project manager to move the work forward.
• Work with community partners and groups of patients to gain an outside perspective.
• Establish a timeline for your work together and regular project meetings.

Step 2: Generate Questions for the Data

A good place to start your analysis is to create questions that can be important for understanding the data and may help to identify causes of differences among and between patient groups. Knowing the populations that you serve will guide you in determining which questions are important and should be explored further.

Step 3: Analyze Existing Quantitative Data

The next step is to look at data that includes additional elements or variables. For example, an initial analysis shows lower rates of colorectal cancer screening among white populations versus all other populations. Within the white population, there are different languages spoken, such as Russian, Portuguese, and English. You could look at whether white patients who speak a language other than English have screening rates that are different than those who speak English. Looking deeper into the data on language can help you figure out if language barriers contribute to lower screening rates.

Data to Consider: There are several sources to consider within and outside of your organization. Population health platforms and electronic medical records could serve as the best sources about patients. Data from research projects or publicly available data from local, state, and federal sources could also be useful. It can be useful to start with a small set of data first and then expand your analysis to a larger dataset.

Example: Data Elements to Consider When Performing a Quantitative Analysis Include:

The above list is not exhaustive, nor will you need to look at all these variables. Your knowledge of those you serve should guide your selections. Resource constraints may limit your ability to do a thorough analysis of the many data elements. Be realistic about your capacity and clear about the completeness and accuracy of the data that you choose. Also, consider whether you might partner with a local researcher or academic institution to support this work. For example, many schools of public health require students to complete practicums. Those students often have analytic skills and could support an equity-focused inquiry.

Resource: The Harvard Catalyst Community Engagement Program offers Community-Engaged Student Practice Placements.

Missing Data: It’s important to understand what data is missing. When you have large quantities of missing data or a large percentage of patients who decline to provide information, your data may not adequately reflect your population, and conclusions from an analysis may not be correct. For example, if you want to examine cervical cancer screening rates by sexual orientation and find 40% of patients have missing data for this variable, it would not be wise to use this data. Instead, a first step could be improving data collection by training staff on the importance of collecting sexual orientation information in a sensitive and professional manner.

Resource: The Institute for Healthcare Improvement offers a guide to building data infrastructure to support health equity.

Step 4: Conduct a Qualitative Analysis of Root Causes

Conducting a qualitative analysis means systematically reviewing words to understand people’s thoughts and experiences, rather than using numbers or statistics. Qualitative data can be collected through interviews, focus groups, or open-ended responses on surveys or medical records. A qualitative analysis can help make clearer the underlying reasons, or root causes, for health behaviors and health outcomes.

Select an Approach: There are many approaches used to gather qualitative data including focus groups, interviews, and existing needs assessment data. Time and resource constraints may be determining factors that inform which methods you choose. It is important to create open-ended questions that help you understand the “why” and “how” underlying the inequities you identify.

Determine Whose Voices to Include: You may choose to work directly with patients, family members of patients, clinic staff, community representatives, or subject matter experts to best understand your quantitative data. You could collect data from one or multiple groups of people in these roles. Different perspectives are important to get at root causes.

Gather the Qualitative Data: Work with your team to execute your data-gathering strategy. Think through how you will invite people and whether you will offer them incentives to participate. If you are conducting interviews or focus groups, make sure they are led by someone with expertise. Look for patterns and themes in what you hear, probing for barriers that limit access and healthy behaviors as well as what might support better health.

Resource: The Institute for Healthcare Improvement offers a guide for improving health equity through community partnership.

Step 5: Share Findings With Internal and External Partners

The next step to promote equity is to take the information you have gathered and begin to share these findings with others to gather additional data and build support.

• Share a report or presentation with those who participated in the interviews or focus groups to make sure you accurately captured their feedback.
• Share findings with others in your CHC to determine whether the data you have captured resonates with those working directly with patients. Sharing data with community health workers, medical assistants, and providers can help to validate, educate, and rally support for responding to inequities.
• Funders may also be interested in the data collected and wish to provide resources for planned activities to address root causes.
• Brainstorm creative ways to reach your intended audience. This could include live social media events, one-pagers, radio shows, and digital media.
• To ensure equity in returning research results, use plain language throughout all content, explain terms, and use culturally relevant graphics. Use subtitles, captions, or alt text to ensure accessibility of audiovisual materials and websites.

Resource: The Harvard Catalyst Community Engagement Program created a guide on best practices for equitably sharing research results with community members [PDF].

Step 6: Develop a Plan for Addressing Underlying Inequities

Your working group can build a plan for addressing the underlying inequities you have identified. This may involve changing current clinical practices, operations, or building new approaches to respond to diverse patient needs. The scope of your plan will depend on the resources available. You may identify both immediate solutions and long-term goals that require more time and money as well as policy advocacy.

Resource: The following resources can help you to create patient education materials.

• Plain language materials development checklist
• Translation guidelines for equity in research

Work with your group, clinic staff, and outside advisors to help you put your plan into action. As you make changes, monitor your data to see if outcomes improve. Continuing to receive feedback from patients and staff will help you adjust as necessary. Working to provide equitable care is an ongoing endeavor.