Office of Health Equity

Hepatitis C–Advanced Liver Disease Disparities Dashboard

News Release

VA Launches Hepatitis C–Advanced Liver Disease Disparities Dashboard

o Tool will enhance VA efforts to treat all Veterans with Hepatitis C and advanced liver disease…

Link here….2

Hepatitis C-Advanced Liver Disparities Disease Dashboard

The purpose of the HCV-ALD Dashboard is promote equitable diagnosis and treatment of underserved Veterans with hepatitis C and advanced liver disease.

The Hepatitis C-ALD Dashboard utilizes a set of criteria - age, gender, geography, service era, race/ethnicity - to characterize Veteran groups with ALD due to hepatitis C who may require targeted intervention to improve their health.

The dashboard advances the vision for quality care and improved access to care as identified in the VHA Blueprint for Excellence. 3

Office of Health Equity

VA Core Values: Integrity+Commitment+Advocacy+Respect+Excellence =*I CARE*

Program Office ScopeRole of Program – Office of Health Equity (OHE)

– OHE champions the advancement of health equity and reduction of health disparities through 5 key focal areas*:

1.Leadership2.Awareness3.Health Outcomes4.Diversity and Cultural Competency of the Workforce5.Data, Research, and Evaluation

– Strategic Alignments VHA Strategic Plan Objective 1(e)—Quality & Equity: Veterans

will receive timely, high quality, personalized, safe, effective and equitable health care, irrespective of geography, gender, race, age, culture or sexual orientation

Blueprint for Excellence strategies 2.2a, 3.2a and 7.2b

*VHA Health Equity Action Plan

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Vulnerable Populations

Racial or Ethnic Group

Gender Age Geographic

Location Religion Socio-Economic

Status

Sexual Orientation Military Era Disability –

Cognitive, Sensory, Physical

Other characteristics historically linked to discrimination or exclusion

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Applying an Equity LensThe lens through which you view conditions, circumstances, and processes to understand who experiences the benefits and burdens of a program, policy, or practice.

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Hepatitis C–Advanced Liver Disease

Disparities DashboardDashboard Screen

shots National Data

Dashboard Screen - Example

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Hepatitis C-Advanced Liver Disease Dashboard

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Hepatitis C-Advanced Liver Disease Dashboard

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Hepatitis C-Advanced Liver Disease Dashboard

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Hepatitis C-Advanced Liver Disease Dashboard

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Hepatitis C-Advanced Liver Disease Dashboard

Dashboard Data OHE Hepatitis C - Advance Liver Disease Dashboard depicts:

– VISN– Facility– Overall/National– Facilities by VISN tables  

The data is compared to FY14 VHA unique outpatient encounters to provide context as the demographics of the regions vary

No Personal Health Information (PHI) on the Dashboard

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Dashboard –Disparities Exercise The predominance of Veterans at the VA who have Hepatitis C and

Advanced Liver Disease based on this data  - refer Overall data on the Dashboard =

o Born between 1945 and 1965 ( 89.1%) + male ( 97.8%) + white ( 50.4%)  + Urban(73.9%)

BUT when you look at those percentages in comparison with the VA demographics as of FY 2014  (noted as Unique FY14) the top disparities are as follows:

o  Born between 1945 and 1965 (89.1 % Vs 45.6% = 43.5% difference)

= mostly Vietnam Era Veteranso Black ( 33.5% Vs 14.7% =  18.3% difference)

At the VISN and facilities with higher population of racial/ethnic minorities the relative differences and therefore disparities may become more pronounced

  These numbers are not the same for every VISN/Facility which is why

OHE depicts the other sections on the Dashboard.  A similar exercise in each section helps identify the differences and/or disparities. 16

What’s next?The OHE will provide patient specific data

directly to facility POCs for any of the vulnerable Veteran groups represented

The OHE will work directly and collaborate with VA offices, programs , medical centers and other stakeholders to address any identified disparities and refine the current dashboard

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Related Collaboration in Progress The Office of Health Equity-QUERI Partnered

Evaluation Initiative, Principal Investigator Donna L. Washington, MD

o A population health approach to examine the distribution of diagnosed health conditions, mortality, and healthcare quality across the entire VA healthcare system, as defined by Veterans’ membership, or not, in vulnerable population groups

o Evaluate whether characteristics of the healthcare delivery settings (e.g., geography, treatment setting) and of the types of care that individuals use, including new models of care such as Telehealth, influence the quality of care that Veterans receive

The OHE plans to fund FY16 VISN- wide QI Project on Hepatitis C and liver disease led by the BRIDGE QUERI

o Partnership with other VA program offices to explore additional steps in tackling Hepatitis C disparities among vulnerable Veterans

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Collaboration - Outreach

Outreach efforts are underway–to those who work with vulnerable Veteran populations disparately impacted

If your organization works with vulnerable Veterans as defined by age, gender, geography, service era, race/ethnicity and is willing to support this project, please contact the VA Office of Health Equity: VHA 10A6ACTION@VA.GOV

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What can you do?

Learn the facts –Fact sheet & VHA sites

http://vaww.hepatitis.va.gov/Share the factsOutreach to increase engagement-

oScreeningo Treatment linkage oSupport to achieve treatment

completionoEmpower to take action

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More Information… Interactive Dashboard Available via VA intranethttps://vaww.vha.vaco.portal.va.gov/sites/OHE/Pages/ALD-VISN%20Dashboard.aspx

Office of Health Equity (OHE)– Intranet ->

http://vaww.pdush.med.va.gov/programs/ohe/oheDefault.aspx

– SharePoint -> https://vaww.vha.vaco.portal.va.gov/sites/OHE/Pages/Default.aspx

– Internet –> Coming Soon

To learn more about VA Health Equity Efforts - Visit the Links on the Appendix Slides ->>NEXT

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Appendix 1• Health Equity Action Plan (HEAP)

– https://vaww.vha.vaco.portal.va.gov/sites/OHE/Pages/HEAP.aspx– http://www.hsrd.research.va.gov/news/video/heap.cfm

( Video)

• Healthcare Equality Index (HEI) – https://

vaww.vha.vaco.portal.va.gov/sites/OHE/CCC/SitePages/HEI.aspx

• Hepatitis C – Advanced Liver Disparities Dashboard 2015– https://

vaww.vha.vaco.portal.va.gov/sites/OHE/Pages/ALD-VISN%20Dashboard.aspx

• Health Equity Environmental Scan 2015– https://vaww.vha.vaco.portal.va.gov/sites/OHE/Pages/HEScan.aspx– VAntage Blog http://www.blogs.va.gov/VAntage/23168/23168/

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Appendix 2

• American Journal of Public Health (AJPH) Supplemental Issue 2014– http://ajph.aphapublications.org/toc/ajph/104/S4https://vaww.vha.vaco.portal.va.gov/sites/OHE/Pages/VA_AJPH.aspx

• AJPH Veterans Health Equity Collection Page 2015– http://ajph.aphapublications.org/topic/vaheathequity

• Health Equity Coalition– http://vaww.pdush.med.va.gov/programs/ohe/oheCoalition.aspx

• Clinical Look at Unconscious Biases (CLUB) – https://vaww.vha.vaco.portal.va.gov/sites/OHE/Pages/UB.aspx

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Appendix 3

• Health Disparities Evidence-based Synthesis Reviews– Evidence Brief: Update on Prevalence of and Interventions to Reduce

Racial and Ethnic Disparities within the VAhttp://www.hsrd.research.va.gov/publications/esp/HealthDisparities.cfmhttp://vaww.hsrd.research.va.gov/publications/esp/HealthDisparities.cfm

– Health Disparities in Quality Indicators of Healthcare Among Adults with Mental Illness

http://www.hsrd.research.va.gov/publications/esp/health_disparities.cfmhttp://www.ncbi.nlm.nih.gov/books/NBK299084/

 • Health Equity Presentation – Special Feature - National

Rural Health Association Reilly Address 2015– http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1748-0361

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Appendix 4Health Equity Cyberseminars – Internet & Intranet:

– Disparities in Healthcare Quality Indicators among Adults with Mental Illness: A systematic review: http://www.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/video_archive.cfm?SessionID=965http://vaww.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/video_archive.cfm?SessionID=965

– Partnership in Pursuit of Health Equity: Focus on Minority Veteranshttp://www.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/video_archive.cfm?SessionID=889http://vaww.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/video_archive.cfm?SessionID=889

– ACA-Health Equity/Disparities Connectionhttp://www.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/video_archive.cfm?SessionID=807http://vaww.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/video_archive.cfm?SessionID=807

– VHA Office of Health Equity- What is it all about?http://www.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/video_archive.cfm?SessionID=769http://vaww.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/video_archive.cfm?SessionID=769

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GET INVOLVED!

The pursuit of Health Equity should be everyone’s business.

It is a journey that takes time and sustained effort.

What can you do today in your area of influence to improve health equity?

At a minimum - in all your actions - do not increase the disparity.

Thank you!

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