Trinity Health
Novi, Mich.

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Standardized Collection of Patient Demographic Data
Equity of care has been a Trinity Health Unified Enterprise Ministry® (UEM) imperative since 2008. When research revealed gaps in care at one hospital, leadership sought to identify — and eliminate — gaps in care at all Trinity Health Ministry Organizations (MOs). The first step was making all MO Chief Executive Officers accountable for addressing these issues by a specific date. The second step was creating a process for replication across the UEM.

The process linked cultural competency with clinical care delivery, improved clinical and service outcomes for all patients — minority and non-minority — and supported Trinity Health's commitment to providing culturally and linguistically competent patient care.

Implemented at every MO by December 31, 2009, the plan included three process components, at a minimum:

1. Demographic Data Collection: Data collection requirements included that the key demographic data elements be obtained during the registration process. The entered data — race, ethnicity, age, language and gender — are learned by standardized, scripted questions and consistent interactions with patients (not by observation). Changes to Trinity Health's Genesis systems and interface ensured that, when applicable, the detailed data collected was easily and readily sharable electronically.
2. Associate Education: All registration associates were educated and trained on the "why" of the disparities of care and the change in the registration process. They were instructed that visual observations and failure to ask questions would not be an option and this education process enabled them to obtain and consistently collect the key data elements using the data fields in the registration system. Additional training for associates involved in the delivery of patient-centered care — including medical staff — closed an important loop.
3. Communication (internal and external): Because communication is the critical link between data collection and improvements in culturally and linguistically competent patient-centered care, Trinity Health and each of its MOs created communication tools to disseminate information about registration process changes and required education. Used for both the initial and continual communication and education, the tools focused on patients, associates, clinical and medical staff and the communities served. External communication tools were linked to each MO's community outreach activities.

Senior Emergency Rooms
Recognizing that that conventional emergency rooms are not optimized for the care of older people, Trinity Health is transforming health care for people over 65 through its Senior Emergency Room initiative, being implemented by Trinity Health hospitals from Maryland to California.

Trinity Health's Holy Cross Hospital, in Silver Spring, Md., had the system's first Senior ER and the Saint Joseph Mercy Health System in Michigan is the first in Michigan, replicating an ideal model throughout its system. Other regional systems throughout Trinity Health are in the planning stages, preparing to bring this innovative model of patient-centered, evidence-based care to their areas and fill critical gaps for those over the age of 65.

Trinity Health's Senior Emergency Room initiative is a proactive response to the aging of America. It is based on evidence that people over 65 respond more positively and have better patient outcomes when medicine and care are delivered differently. The methodologies are proven to help patients return to wellness faster, stay healthier longer, and spend more time at home than in the hospital.

The setting is physically and clinically distinct, featuring specially trained caregivers, and a calming, quieter environment that protects against falls, pressure sores and more. Additional services include polypharmacy review, depression screenings, provision of free adaptive devices and a follow-up after discharge that is already helping to significantly reduce readmissions.

Community Connections Grid Kiosk
It is often difficult to identify and match volunteer resources to those having the greatest need during a brief hospitalization or office visit. Programs developed to address these gaps have primarily been rooted in community-based organizations and have limited or no connection to health care delivery systems. Trinity Health's Community Connections Grid Kiosk is a project in the works, going live in 12 communities — and in five states from Maryland to California — in June 2011. It is expected to fill some important voids for many underserved individuals.

The Kiosk will be used to:

1. Identify and screen patients for issues with:
   1. Social Conditions: housing, medication, transportation, meals.
   2. Clinical Services: dental, mental health — counseling/psychiatry, exercise, smoking cessation, vision and hearing.
   3. Chronic Health Conditions: depression, hypertension, arthritis, chronic pain, diabetes, lung disease.
   4. Spiritual Conditions: friend or family dependability.
2. Integrate community-based programs with Trinity Health programs.
3. Continuously identify gaps and barriers in services that impact patient health status.
4. Improve adherence to prescribed therapies.

Regional initiatives of Trinity Health organizations are included as separate program entries.