Finding Answers

Disparities Research for Change

FAIR Toolkit: Strategies Levels Modes

Finding Answers is a national program of the Robert Wood Johnson Foundation,

with direction and technical assistance provided by the University of Chicago.

Strategy is the approach or tactic the project employs.

Using a variety of strategies is not uncommon.

Level is the primary target of the project. While all disparities

reduction projects are meant to impact patient outcomes, an

intervention can occur at multiple levels.

Mode is the channel used to deliver the intervention to its

intended target. Some projects rely heavily on technology while

others use more traditional methods.

WH

AT

WH

0H

OW

The solutions that help end health disparities will be as multifaceted as the causes. Health care organizations will need to determine what solutions work for them based on their patient population, equity goals, practice structure and capacity for change.

Brainstorm. Challenge yourself and your team. What approach makes the most sense? Where can you have the largest impact? How can you leverage existing quality improvement efforts, infrastructure and technology?

Use the strategy, level and mode flashcards to explore the possibilities for your organization. Think creatively about how to use these building blocks: combine a strategy (“what” will you do?) with a level (“who” will you target?) and a mode (“how” will you reach them?) to design your equity activity.

Engagingthe Community

Strategy

Engaging the Community

Involving organizations or

individuals outside the

health care delivery setting

• Mediaeducationcampaign

• Church-basedcaredelivery

• School-basedcaredelivery

• Peer-to-peerinformationexchange

• Coalitionbuildingandcommunityadvocacy

• Communityoutreach

DIABETES

DEPRESSION

07

26 30

Delivering Educationand Training

Strategy

Delivering Education and Training

Providinginformation,tools,

and/or teaching skills

• Instructionindiseasescreeningandprevention

• Culturalcompetencytraining

• Diseaseself-managementtraining

• Onlinehealthinformation

• Experience-basedlearning

• ProfessionaldevelopmentorCMEcourses

• Decisionaids

• Waitingroomkiosks

DIABETES

DIABETES AND CARDIOvASCULAR DISEASE RISk FACTORS

HYPERTENSION

DEPRESSION

01 02 03 05 07 08

09 10 11 13 14

17 18 19 21 22

23 24 25 26 27 28 29 30 31 32 33

Restructuring the Care Team

Strategy

Restructuring the Care Team

Shiftingresponsibilitiesamong

membersofthecareteamor

addingmemberstotheexisting

care team

• Nurse-ledinterventions

• Patientconsultationwithapharmacist

• Involvingprimarycarephysiciansinspecialtycare

• Reassigningdutiesandtasksamongexistingpatient-facingstaff

• Addingapatientnavigator

• Employingacommunityhealthworker

• Introducingasocialworker

DIABETES

DIABETES AND CARDIOvASCULAR DISEASE RISk FACTORS

HYPERTENSION

DEPRESSION

02 05 06 07 08

09 10 11 12 14

19 21

25 28 29 30 31 32 33

ProvidingFinancial Incentives

Strategy

Providing Financial Incentives

Offeringmoneyorsubsidizing

the cost of goods or services

toinfluencebehavior

• Vouchers for care

• Gifts or giftcards for treatment adherence

• Bonuses or salary increases for meeting performance

benchmarks

• Financialrewardsorpaymentsforimprovedoutcomes

• Providingbusfareorchildcare

DIABETES

DIABETES AND CARDIOvASCULAR DISEASE RISk FACTORS

HYPERTENSION

03 04

11

19 20

ProvidingRemindersandFeedback

Strategy

Providing Reminders and Feedback

Promptingadherenceto

care guidelines and sharing

informationabout

performance and progress

• Follow-upphonecalls

• Take-homehealthmaintenancecard

• Performanceandfeedbackreports

• Process-of-caretrackingsystem

• Disease registry

DIABETES

DIABETES AND CARDIOvASCULAR DISEASE RISk FACTORS

HYPERTENSION

DEPRESSION

01 03 04 05 05 07

09 11 12 14

15 16 18 19 20

24 25 26 28 30 31 32 33

Enhancing Language and Literacy Services

Strategy

Enhancing Language and Literacy Services

Improving communication

amongproviders,specialists

or patients

• Health literacy screening

• Interpreter services

• Collection of patients’ language preferences

• Improving language skills of staff

DIABETES AND CARDIOvASCULAR DISEASE RISk FACTORS

HYPERTENSION

13

17

Increasing Access toTesting andScreening

Strategy

Increasing Access to Testing and Screening

Addressing financial and

logisticalbarrierstotesting

and screening

• Free screening opportunities

• Incorporatingscreeningsintoexistingappointments

• Screenandtreatinthesamevisit

• Rapid test results

• At-homesymptommonitoring

• Self-administeredandtake-hometestkits

DIABETES

HYPERTENSION

DEPRESSION

06

15

24 25 27 29 32

ProvidingPsychologicalSupport

Strategy

Providing Psychological Support

Delivering therapy or counseling

to promotehealthybehavior

orpsychologicalwell-being

ofpatients,theirpartners,or

their families

• Psychologicalsupportandencouragement

• Usingmotivationalinterviewingtechniques

• Employing harm and risk reduction strategies

DIABETES AND CARDIOvASCULAR DISEASE RISk FACTORS

HYPERTENSION

DEPRESSION

10

18

23 24 25 29 30 31 33

Patient

Level

Patient

Impacttheknowledge

orbehaviorsofpatientsor

their families

• Culturally-targetededucationandoutreach

• At-homesymptommonitoring

• Financialincentivestoimprovetreatmentadherence

• Self-managementandgoalsettingprograms

• Literacyscreeningforallpatients

DIABETES

DIABETES AND CARDIOvASCULAR DISEASE RISk FACTORS

HYPERTENSION

DEPRESSION

02 03 04 05 06 07 08

09 10 11 13 14

15 17 18 19 21 22

23 24 25 26 27 28 29 30 31 32 33

Provider

Level

Provider

Impacttheknowledge

orbehaviorsofproviders

• Culturalcompetencytraining

• Disparityreportcards

• Pay-for-performanceincentives

• Trainingtoimprovecommunicationandlisteningskills

• Process-of-carereminders

DIABETES

DIABETES AND CARDIOvASCULAR DISEASE RISk FACTORS

HYPERTENSION

DEPRESSION

01 02 04 05 06 08

10 13 14

15 16 17 19 19 20

24 25 26 28 29 30 31 32

Microsystem

Level

Microsystem

Addnewmemberstoor

shiftresponsibilitiesamong

the immediate care team

• Employingcommunityhealthworkersorpeereducators

• Providingpatientsupportoutsidetheclinicvisit

• Improveaccesstospecialtycare

• In-housementalhealthprofessionals

• Assigningpatientstocaremanagers

DIABETES

DIABETES AND CARDIOvASCULAR DISEASE RISk FACTORS

HYPERTENSION

DEPRESSION

02 05 06 07 08

09 10 11 14

19

25 28 29 30 31 32 33

Organization

Level

Organization

Impact organization operations

thatmayrequirecoordination

amongmanagement,providers,

informationtechnology,and/or

human resources

• Redesigningthesystemofoperations

• InstitutinganElectronicHealthRecord(EHR)system

• Improvingtheclinicalencounter

• Diversityhiringinitiatives

• Coordinatingcareacrossdepartments

DIABETES

DIABETES AND CARDIOvASCULAR DISEASE RISk FACTORS

HYPERTENSION

DEPRESSION

03 05 07

12 13

19

28 31 32

Community

Level

Community

Workwithpeopleor

organizations outside

traditional health settings

• Church-basedhealtheducation

• School-basedscreening

• Socialserviceagencypartnerships

• Outreachtocommunityleaders

• Partnerincapacitybuildingefforts

• Conveneacommunityadvisoryboard

DIABETES

DEPRESSION

07

26 28 30

Policy

Level

Policy

Influencelaws,regulations,

or resource allocation on a

regionalornationalbasis

• Legislative advocacy

• Foundationgrantsprograms

• Providingexpertinputtoregulatoryagencies

• Meetwithlocalrepresentatives

In-person

Mode

In-person

Interactionbetweenone

or more people in the same

space/location

• Improvingpatient-providercommunicationduringthe

office visit

• Providingprimarycareproviderswithcultural

competency training

• One-on-onepatientcounseling,coachingoreducation

• Trainingagroupofcommunityhealthworkers

• On-sitelanguageservices

DIABETES

DIABETES AND CARDIOvASCULAR DISEASE RISk FACTORS

HYPERTENSION

DEPRESSION

01 02 04 05 06 07 08

11 14

17 21

24 25 26 27 28 30 31 32

Telecommunication

Mode

Telecommunication

Transmission of information

vialandlines,cellphonesor

mobiledevices

• Interactivevoiceresponsetelephonesystems

• Hotlinesorcall-inphonesupport

• Telephonebasedcaremanagement

• Textorvoicemailreminders

• Follow-upphonecalls

DIABETES

DIABETES AND CARDIOvASCULAR DISEASE RISk FACTORS

HYPERTENSION

DEPRESSION

05 06 08

10

15 18 21

29 31 33

Internet

Mode

Internet

Usingcomputernetworks

toexchangeinformationor

ideas

• Websiteswithhealthinformation

• Patient-providercorrespondenceviaemail

• Remotetelemedicineservices

• Onlinesupportviaprivatechatfunction

• VideoconferencingorSkype

• Usingsocialmediaplatformsanddiscussiongroups

• On-demandtestresults

DIABETES

DIABETES AND CARDIOvASCULAR DISEASE RISk FACTORS

HYPERTENSION

DEPRESSION

03 06

13

20

23 24 30

InformationTechnology

Mode

Information Technology

Acquisition,processing,

storage and dissemination

of information

• ElectronicHealthRecord(EHR)system

• Diseaseregistries

• Customizedinformationforpatients

• Individualreportcardsforproviders

• Sharinghealthinformationamongplatforms

• Computerizeddecisionaids

• Automatedprocess-of-carereminders

DIABETES

DIABETES AND CARDIOvASCULAR DISEASE RISk FACTORS

HYPERTENSION

DEPRESSION

07

09 12 13 14

15 16

29 31 32

Print

Mode

Print

Sharinginformationviaa

hard-copy

• Postersinthewaitingroom

• Postcardreminderstoscheduleanappointment

• Disease information or medication handouts

• Annualmailingaboutflushot

• Performancereports

• Care instructions

• Magazinesorbrochures

• Writtenreferrals

DIABETES

DIABETES AND CARDIOvASCULAR DISEASE RISk FACTORS

HYPERTENSION

DEPRESSION

01 03 04 06

09 11 12 14

15 17 19 21

24 25 27 30 31 32 33

Multimedia

Mode

Information Technology

Usingacombinationof

text,audio,video,images,

or interactive media

• Videodocumentaries

• MP3,podcastormusicdownloads

• Informationalkiosks

• Interactivecomputerprograms

• Smartphoneapps

• Videogames

• Self-guidedtrainingmaterials

DIABETES

DIABETES AND CARDIOvASCULAR DISEASE RISk FACTORS

HYPERTENSION

03

09 13

17 22

DIABETES

.................................

01 Cultural Competency Training and Disparities Report Cards

02Customizing Health Messages Based On Cultural Understanding of Disease

03Patient Financial Incentives and Culturally Tailored Outreach

04Pay-for-Performance Programs to Improve Care

05Personalized Diabetes Education and Coaching

06Real-Time Tele-Monitoring of Glucose Levels

07Redesigning Care Delivery in Fee-for-Service Practices 08Using Community Health Workers to Reduce Disparities

DIABETES AND CARDIOvASCULAR DISEASE RISk FACTORS

.................................

09Communicating Risk Information Using Technology 10Nurse Telephone-Based Cardiovascular Disease Risk Management System

11Patient Care Management and Rewards Program

12Point of Care Automated Medication Delivery System

13Remote Video Interpreting Services

14Peer Review Office Visits

HYPERTENSION

.................................

15At-Home Blood Pressure Monitoring

16Automatic Reminders to Intensify Therapy

17Clinical Screening of Patients’ Health Literacy

18Culturally Adapted, Telephone-Based System to Promote Physical Activity

19Patient-Directed Financial Incentives

20Incentives to Improve Quality

21Peer and Health Educator Support to Improve Health

22 Peer-Based Storytelling

DEPRESSION

.................................

23 Culturally Concordant Telemedicine

24Culturally-Focused Depression Screening, Diagnosis and Consultation

25Depression Screening and Treatment for Patients Seeking Care at a Public Emergency Department

26Engaging the Community to Improve Outcomes

27Identifying and Treating Maternal Depression

28Incorporating Care Managers to Improve Care

29Interactive Telephone System to Identify and Treat Depression

30 Internet-Based Depression Education for Minority Youth

31Over the Phone Depression Counseling

32Redesigning Clinic Operations to Improve Depression Care

33Telephone-Based Depression Care Management

Learnmoreaboutall33

FindingAnswersprojectsat

www.solvingdisparities.org/

grantsportfolio