Measuring Equity of Care in Hospital Settings: From Concepts to Indicators

The province of Ontario has identified the need to address inequities in health care. In 2009, the Toronto Central Local Health Integration Network (TC LHIN) required hospitals to begin reporting on equity initiatives. Despite increasing interest, measuring equity in hospitals is a relatively new practice in Canada. Knowledge of indicators best suited for assessing equity in hospitals, including how best to measure and take action relative to these indicators, is only just developing.

CRICH partnered with the Hospital Collaborative on Marginalized Populations in the TC-LHIN to complete a review of scholarly and grey literature concerning existing approaches for measuring equity of care in the hospital setting.

This report frames equity as a crucial component of health care quality in the hospital, with the understanding that inequitable care may lead to “potentially avoidable differences in health … between groups of people who are more and less advantaged socially” and that “these differences systematically place socially disadvantaged groups at further disadvantage in health”.

This report focuses specifically on indicators related to equity of care provided by hospitals. We also looked at hospital equity indicators that are directly relevant to TC-LHIN priority populations (i.e., the elderly, people with mental illness and addictions, and people with diabetes mellitus). Indicator selection was guided by the following criteria: Evidence of previous use, Endorsement, Feasibility, Adaptability, Applicability to equity, and Transferability.

Two hundred fifty one academic and 111 grey publications were reviewed in light of these criteria and priorities. Ten indicators emerged as appropriate for Toronto hospitals to utilize as they begin systematically to measure and monitor equity of care within their walls. Of these ten, seven constitute general indicators for measuring equity of hospital care and three are indicators pertinent to TC-LHIN priority populations. The general indicators are grouped into two broad themes: Cultural Competency and Quality of Care. Importantly, all but one of the indicators (i.e. cultural concordance between patient and staff) require stratification by sociodemographic data to become equity indicators.

Reducing health inequities will require multi-stakeholder commitments extending far beyond hospitals. Nevertheless, by measuring, monitoring, and reporting on their own equity performance, Toronto hospitals can set a precedent in Canada, and play an important leadership role in advancing equitable health care and equitable outcomes for patients.