Data & Infrastructure

Addressing Social Determinants of Health

In 2021, the Dalio Center launched “We Ask Because We Care,” a system-wide, coordinated campaign to improve the collection of demographic information from our patients. In our first year, we focused on race, ethnicity, and language data. Then, in 2022, we expanded the program to include sexual orientation and gender identity and social determinants of heath (SDoH).

Addressing SDoH—including housing insecurity, food insecurity, transportation challenges—is an essential part of NewYork-Presbyterian’s strategy to achieve greater equity within our communities.

Ongoing Emergency Department SDoH Screenings and Launching Inpatient SDoH Screenings

In 2022, in collaboration with the Center for Community Health Navigation, we successfully launched screening in seven emergency departments and several outpatient clinics, screening more than 3,000 patients per month in our emergency departments and over 5,000 per month in outpatient settings. In 2023, we expanded and continued to enhance the EMR to improve screening and referral workflows.

Recognizing the importance of SDoH screening to patient care, the Dalio Center collaborated with NewYork-Presbyterian’s Social Work and Case Management teams to support a system-wide implementation of standardized inpatient screening during 2023 involving all NewYork-Presbyterian campuses. To support this work, SDoH screening was established as one of the ten Quality and Patient Safety goals for 2023. The implementation began in January 2023 and continued through October, with ongoing data tracking still taking place. Key accomplishments include:

Revised assessment questions for Social Work and Case Management teams in the three domains of food, housing, and transportation, standardizing the questions throughout the system
Integrated food, housing, and transportation domains into Social Work and Case Management workflows
Added a utilities domain (e.g., electricity, heat, and hot water) to SDoH screening
Established a dashboard to track progress and compliance with the new standardized domains
Developed staff training tools to support SDoH screening, including screening scripts, motivational interviewing tips, and modules on health justice and health literacy

An interdisciplinary group of hospital leaders and process owners monitored dashboards for improvement of inpatient screening. In January 2023, 67% of adult patients discharged had all three domains completed. By September 2023, 91% of adult inpatients had all three domains completed, showing an overall improvement of 36%. In addition, the newly added domain about utilities is now being tracked for completion.

91%

of adult inpatients had all three SDoH domains completed by September 2023

50+

quality, access, and experience measures disaggregated for equity

10+

system-wide dashboards

Measuring Equity

A key pillar of our work to address health inequity includes equity measurement and monitoring. This measurement strategy begins with identifying quality, access, and patient experience measures that reflect our organizational priorities and disaggregating them by key demographic and/or descriptive variables (i.e., race, ethnicity, language, sexual orientation, gender identity, payor, and social determinant of health survey data). Our goal is to review and monitor these measures to make sure that everyone gets the highest quality of care, taking action when goals are not met.

We acknowledge that race is a social construct and not a valid way to understand human difference. But, because race continues to differentially shape the lives, opportunities, and health of many, NewYork-Presbyterian and our school partners, Columbia and Weill Cornell, continue to collect and analyze race and ethnicity data.

In 2023, the Dalio Center continued to advance this work, using the principles established in 2022 and lessons learned from the disaggregation of hospital-acquired infection measures last year.

Key Accomplishments in 2023

Health Equity Analysis of NewYork-Presbyterian’s Core Inpatient Quality Measures
Health Equity Analysis of NewYork-Presbyterian’s Patient Experience Scores
Development of a Service Line Dashboard to Understand Access and Service Utilization
Development of an Emergency Department Length of Stay Dashboard
Continued Maintenance and Development of the Ambulatory Care Equity Dashboard
Continued Participation on NewYork-Presbyterian’s Predictive Models Working Group to Identify and Address Algorithmic Bias

Health Equity Report

The Dalio Center led the drafting, collation, and publication of the 2023 NewYork-Presbyterian Health Equity Report, which assessed the demographic profile of inpatient discharges, emergency department visits, and outpatient visits at NewYork-Presbyterian, as well as highlighted health equity work in pediatrics. We also added a new section focusing on patient experience that evaluates the patient experience survey data by patient preferred language.

The demographic section of the report contains measures of patient access, comparing the demographics of our patients to the demographics of the residents who live in our service areas across New York City and Westchester. It also includes an additional section on the language demographic profile of our patients.

The patient experience section of this report contains an analysis of our Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data, as well as the Dalio Center’s plans to address identified gaps.

Last, the pediatric programs section discusses pediatric health equity initiatives at NewYork-Presbyterian, including sickle cell disease programs and lactation support programs.

View NewYork-Presbyterian’s 2023 Health Equity Report

Data & Infrastructure

Addressing Social Determinants of Health

Measuring Equity

Key Accomplishments in 2023

Health Equity Report

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