In the second part of a conversation with Chief Healthcare Executive, Allen talks about closing gaps in healthcare in cities and some very remote areas.
To improve health equity, it's important to understand the gaps and the cause of the disparities, says Rob Allen, president and CEO of Intermountain Health.
Intermountain serves patients in seven western states, operating hospitals in cities such as Salt Lake City and Denver, while offering healthcare services in some very rural areas, where it’s not unusual for people to live an hour or more from a hospital.
In an interview with Chief Healthcare Executive, Allen discusses the efforts and challenges to improve health equity in urban and rural areas. He also talks about the increasing use of telehealth to provide care for those who don’t have easy access to a healthcare provider.
“In any health equity, the very first thing is understanding,” Allen says. “Do you have data? Do you know where the gaps are? And I think the last few years have brought awareness to all of us of gaps that we may not have been aware of before. And that, to me, is the very first step to our ability to actually do something about it.”
(See part of our conversation with Rob Allen in this interview. The story continues below.)
Addressing gaps in stroke care
Intermountain teams have been studying different areas of care to get a better grasp on where gaps are occurring.
They found disparities in stroke care among Spanish residents in Utah, particularly in the Salt Lake City area. For residents who spoke primarily Spanish, the time from onset to treatment was twice as long as for those patients who spoke English primarily. When he heard about that gap, Allen says he fired off plenty of questions.
“I was shocked at that number and immediately I started asking the team, what's wrong? Where are we missing it? What happens in the hospital? You know, are we not getting translators there quick enough? Are we not understanding what they're there for because of the language barrier? I mean, I started asking lots of questions,” Allen says.
From the time patients arrive in the hospital, the treatment time is the same for residents who speak Spanish or English, so it was reassuring to find that patients were getting treated equally, Allen says. But it still didn’t immediately explain the gap.
Part of it was a disparity in stroke education, he says. Intermountain had printed stroke education materials explaining the need to get treatment quickly, but they were only printed in English. “It wasn’t being distributed in Spanish,” he says. One in five residents in Salt Lake City is identified as Hispanic, according to the U.S. Census Bureau.
In addition to the gap in education, Intermountain also found that some Spanish residents had issues with transportation.
“Those that are primary Spanish speaking don't have the same transportation options as others, and therefore rely on different transportation modes that take longer,” he says.
So Intermountain is working on two social determinants of health - education and transportation - to offer better care, including public education campaigns in Spanish media.
“The awareness really is important,” he says. “And even my first assumption of the awareness was totally wrong, of what the problems were.”
Reaching rural areas
In discussions on health equity, rural healthcare sometimes doesn’t get as much attention. Intermountain serves an area covering more than 600,000 square miles, and residents live in wide, remote expanses where they are 60 miles, or more, from a hospital.
“You just don't have access to certain things,” Allen says. “So there's just simply a geographical gap that exists there that is a health equity challenge for us.”
Allen shared a story about a young mother living on the Nevada-Utah border who was experiencing stroke symptoms. Her family knew she needed medical attention right away, but they live a long distance from their nearest hospital, a critical access hospital in Utah.
They spoke with the hospital and began driving toward the hospital, and an ambulance sped to meet them on the road. They met halfway, and the patient was taken by ambulance to the hospital. Neurology specialists communicated via telehealth to physicians in the rural hospital’s emergency department, and the woman has made a full recovery and is home with her family.
“It's a fabulous story of success, where you have this huge inequity gap, just by the situation of what's going on with where they live,” Allen says. “And the system was able to bridge that gap. Those are the things we need to think a lot about as well. And then there's a lot of other gaps in rural (healthcare) that we'll continue to seek understanding in.”
Residents in some rural areas lack access to even primary health care, Allen says. And Intermountain is striving to enhance education and outreach efforts in rural areas.
Telehealth is a key component in Intermountain’s plans to improve equity in rural areas, Allen says.
“We're extending our expansive telehealth services across the wider geography that we now serve,” Allen says.
“Telehealth, etc., allows us to bring specialty care closer to where people are, in some cases even primary care to where they are, because in remote areas, they may not even have access to that,” Allen says. “We will continue to expand that, we’ll continue to expand our reach, and we’ll continue to expand our offerings.”
Allen says it’s important to offer such services in areas where a one-hour drive to a doctor’s office isn’t uncommon.
“When you think of telehealth, there's a lot of remote areas, rural areas, that's how they get extended care,” Allen says. “And they can do a lot through that type of technology and not have to travel, and that's important to them.”
Allen also says Intermountain will be offering more outpatient services, and more hospital services at home.
“In coming years, we're going to see all types of things moving further upstream or closer to home,” Allen says. “And that's going to open more and more opportunities for care right in the home. And we're excited to use technology as well as our great caregivers to expand that kind of work.”