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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
Mode
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