2006 Model Practice Application (Public)

Boston Disparities Project

Boston Public Health Commission

The Boston Disparities Project addresses the severity of disparities that exists between residents of color and White residents in Boston. The goal is to narrow and eventually eliminate racial and ethnic health disparities. Current funding partners for grantees include: Blue Cross Blue Shield of Massachusetts, Boston Foundation, Brigham and Women’s Hospital, Harvard Pilgrim Health Care Foundation, Massachusetts General Hospital, and the Boston Public Health Commission. The outcomes of the practice include: three publications, fundraising and $1 million RFP release, movement from recommendations on paper to actions in the community, a 12-month evaluation and training period, and the ability to sustain current projects and leverage resources to fund new programs.

The BPHC’s Disparities Project aims to address the severity of disparities that exist among residents of color. The need to address this issue was determined through continuous dialogue with the community stakeholders and by reviewing the health data routinely collected (morbidity, mortality, hospitalizations, access to care, BRFSS, etc.). Following the success of programs like REACH and BHSI, the BPHC and Mayor Menino took a coordinated public health and environmental approach to eliminate health disparities by convening community residents and other key stakeholders from different sectors to develop two reports with strategies to close the health gap between White residents and residents of color in Boston. Each of the recommendations are linked to short term and intermediate action steps, ones that can be reached in the next few years with the dedication of available resources and the prioritization of activities. To highlight how each of these action steps can result in meaningful changes, the Disparities Project earmarked $1 million in funding to support pilot programs that will move these recommendations from paper to actions in the community. The project now oversees the implementation of 33 hospital and community based projects in all 17 neighborhoods of Boston.

Informed by background research findings, the BPHC and Mayor Menino developed the Disparities Project as a citywide initiative. Under this model, stakeholders in the government, business, community and human services sector, became actively engaged in implementing strategies to close the health gap between White residents and residents of color in Boston. To catalyze activities, the health department has funded programs that implement health care and social factor priorities like investment in high-risk neighborhoods. Moreover, to sustain this initiative, the BPHC has linked the elimination of health disparities to its core and ongoing public health functions and is developing regulations on issues like standardizing hospital data collection efforts to better measure health disparities. Together, the Mayor of Boston and the BPHC have marshaled its resources to guarantee that race and ethnic based health disparities are a thing of the past for Boston.

The mission of the BPHC is to protect, promote and preserve the health and well-being of Boston residents, particularly those most vulnerable. The project reflects this mission. During the planning phase, the BPHC worked closely with the Mayor to convene stakeholders across the city to serve as members of his Task Force and Hospital Working Group. The BPHC staffed these meetings and provided technical assistance, research, and operational/logistical support for both work groups. Furthermore, BPHC worked with the Mayor to raise funding to implement recommendations from the groups. As a sign that health disparities are a concern not only for Boston, BPHC also worked with elected officials to create a State Disparities Commission, the only statewide legislative model in the nation, focused on eliminating racial and ethnic disparities. Now in the implementation and evaluation phases of the initiative, BPHC is working with hospital and community based partners to implement 33 programs in all Boston neighborhoods. BPHC is also working with a multi-disciplinary team of trainers to provide educational opportunities for current grantees and the general public. In addition, BPHC is working with a team of inter-disciplinary team of evaluators from Northeastern University to evaluate all 33 programs and identify those that can be replicable and have the potential to improve conditions for local residents in the near future.

The project enlisted the help of community stakeholders and neighborhood coalition members from development of the recommendations to the implementation and evaluation of the pilot projects. Finally, the BPHC hosted a series of roundtables to engage the public in a discussion of the blueprint recommendations to determine whether they would ultimately improve the health of residents of color.

Over the last several years, there has been a growing recognition of the severity of the health disparities that exist between people of color and white residents in Boston. There are patterns of greater disease incidence and poorer outcomes seen in the health data that is monitored by the BPHC. Racial and ethnic residents are more likely to have high blood pressure, diabetes, HIV, prostate cancer, asthma, lead poisoning, and on and on. As a result of his concern with this lingering problem, Mayor Thomas M. Menino began a major initiative which has developed into the Boston Public Health Commission's "Disparities Project". Below is a timeline of key activities of the project:

Summer 2003 - January 2005:

• Mayor and BPHC convened CEOs from the city’s major teaching hospitals and asked for their help in ensuring all Bostonians have equitable access to quality health care. This hospital working group met monthly to develop hospital-specific strategies for reducing disparities.

Fall 2004:

• Mayor and BPHC brought together a cross-sector task force with leaders from academic institutions, community coalitions, health care, and insurance to develop a blueprint with recommendations that addressed social factors along with health factors that contribute to health disparities.
  
  
• BPHC began developing the first data report that took a comprehensive look at health disparities and data including socio-economic factors that were most likely to contribute to differences in health outcomes – such as racism, poverty, and declining access to affordable health insurance.

June 2005:

• Mayor and BPHC released three reports, Mayor’s Task Force Blueprint, Hospital Working Group Report, and Disparities Data report at a high profile press event attended by 300 individuals.
  
  
• BPHC released RFP and held a bidders conference for over 75 representatives from multi-sector organizations in Boston.
  
  

October 2005 - present:

• BPHC began providing technical assistance to all grantees funded to implement pilot projects in all 17 neighborhoods of Boston.
  
  
• BPHC began collaborating with evaluation team from Northeastern University to assess specific indicators among various grantees such as the workforce diversity and patient education categories to begin evaluating critical components necessary for success.
  
  
• BPHC coordinated training opportunities for grantees and public with the Disparities Solutions Center (Data Collection/Quality Improvement Grantees), Harvard Pilgrim Health Care Foundation (all grantees and public), and Visions, Inc. (all grantees and public).
  
  
• BPHC sought resources for year 2 funding.

To help ensure commitment to this issue remains high, BPHC worked with funders and the Mayor to make $1 million available in grants to support community wide efforts to eliminate disparities. This commitment has sparked other foundations to focus and distribute funds to supplement the work that has begun in Boston. Furthermore, the Mayor has designated health disparities as one of eight core priorities in his next four year term.

BPHC with the leadership of the Mayor has been committed to sustaining and leverage resources to eliminate health disparities. Currently, the focus is to actively identify foundation and national support to sustain the project beyond the initial release of $1 million. Agreements have been acquired from three current funders to support current and new programs aimed at addressing disparities in Boston.

Goal: To reduce and ultimately eliminate disparities in health based on race and ethnicity.

Objective: To standardize data collection on the race, ethnicity, language and education of patients seen in Boston’s acute hospitals:

• Performance measures: Implement use of consistent framework for collecting patient information at all acute hospitals and release regulation requiring collection of this information using consistent framework.
  
  
• Data collection: 1) demographic data; 2) patient registrars at hospitals; and 3) by telephone and via in-person registration.
  
  
• Outcomes: 1) consistent data collection on patient’s race, ethnicity, language and education (short-term); 2) information is used for quality improvement efforts (intermediate); and 3) using specific quality measures against race/ethnicity fields will help to identify and develop strategies for addressing disparities in treatment (long-term).

Objective: Increase racial and ethnic diversity of health professionals:

• Performance measures: Increase number of Boston Public High School students that enter the nursing profession; and increase recruitment and retention of students of colors enrolled in various health professions schools.
  
  
• Data collection: student demographic information, number of students who successfully complete programs, number of mentors connected with students, grantees, and quarterly reports submitted to BPHC.
  
  
• Outcomes: 1) health professions/training programs recruit, retain and graduate a larger number of students of color (intermediate); 2) job development programs are replicated to expand opportunities for residents of color to enter the health field (intermediate); and 3) an increased number of residents of color are employed in health careers (long-term).

Objective: Develop model programs to help patients and community members effectively navigate complex health care systems:

• Performance measures: Identify critical components of effective patient navigator programs that can be replicated across settings, e.g., patient education materials, health literacy programs, culturally competent navigators.
  
  
• Data collection: 1) client pre/post tests, number of trainings for patients and navigators, educational materials; 3) grantees; and 3) quarterly reports to BPHC.
  
  
• Outcomes: 1) using new skills, individuals receive more effective and appropriate health care (intermediate); 2) individuals’ health status is improved because of strengthened ability to navigate complex systems of care (long-term).