244 Community perspectives on hospital accountability to equity

Abstract

Objectives/Goals: Our objective is to examine patient and community perspectives on hospital actions that signify accountability to healthcare equity; part of our overall goal is to identify equity measure concepts representative of community perspectives and priorities for future hospital accountability programs. Methods/Study Population: We conducted a qualitative thematic analysis of secondary data – 32 focus group transcripts from our hospital’s Community Health Needs Assessment (CHNA). A tri-annual CHNA is required of nonprofit hospitals to maintain tax exemption. Diverse participants were recruited from our hospital’s large catchment area. Coding focused on responses to 6 pertinent questions. We adapted the National Committee for Quality Assurance, “Health Equity Measurement Framework for Medicaid Accountability” which consists of 5 domains (access, clinical, experience, structure, and social) to guide the development of our a priori coding tree and subsequent analysis. Two coders double-coded 25% of transcripts. The multidisciplinary research team, including community partners, met iteratively to extract and refine themes. Results/Anticipated Results: We organized our analysis by our conceptual framework’s 5 measurement domains. The “access” and “experience” domains were the most salient for participants. We defined “access” by four sub-domains: financial access, physical access, communication access, and navigability; and “experience” by two subdomains: inclusivity and accomodation. Beyond discussing concepts within these measurement domains, participants debated the “scope” of the hospital’s role with regard to healthcare equity. While some did not think “it was the hospitals” responsibility to give people access to good jobs or fair pay, education…, “other participants felt that healthcare involves not just addressing peoples’ physical health but. their housing… because how can someone take care of their health when they are homeless?” Discussion/Significance of Impact: When asked about hospital accountability to healthcare equity, “access” and “experiences” of care are the most salient measurement domains for patients and communities. The “scope” of the hospital’s role is debated. Policy and health system leaders can apply these perspectives to equity measurement initiatives.