Referrals to a Novel Health Care Equity Consult Service

The US Centers for Disease Control and Prevention (CDC) define health equity as "the state in which everyone has a fair and just opportunity to attain their highest level of health." Achieving this, according to the CDC, requires sustained efforts to address longstanding and contemporary inequities, reduce social and economic obstacles to care, and eliminate preventable differences in health and health care outcomes. Few operational models currently exist to support clinical teams in navigating health equity factors in clinical settings. The Healthcare Equity Consult Service (HECS) was established to assess concerns that contextual or interpersonal factors, including potential bias, may be shaping patient care and to provide structured support to patients, families, and clinical teams.

This report describes HECS consults conducted from August 2022 to March 2024 across 3 hospitals within an academic medical center in the US. Consults were referred by clinicians, patients, or families to assess equity-related or contextual interpersonal factors during hospitalization. HECS assessments followed a structured, real-time process that included medical record review, patient interviews, conversations with family members, and care team briefings and facilitated interventions to mitigate any potential systemic barriers, communication breakdowns, or perceived bias. Illustrative cases reflected themes in which patients, families, or clinical teams perceived that contextual factors might be shaping care processes, caregiver participation, or trust during clinical encounters. HECS interventions included direct engagement with patients, families, and health care teams to support equitable care. HECS provided real-time recommendations and coaching to clinical care team members regarding perceived biases and contextual factors relevant to patient care. In some instances, these recommendations informed subsequent review or refinement of institutional policies and care processes.

The HECS model offered a promising strategy for embedding equity-centered interventions into acute care delivery. HECS recommendations leveraged multidisciplinary expertise in response to patient experiences and an acknowledgment of societal barriers with a focus on equitable solutions. These recommendations were incorporated into treatment plans and informed institutional efforts to review and refine clinical practice and policies.