(CHICAGO and BOSTON)--Health care disparities are widely established in the United States, but until now there has not been agreement between surgeon-scientists, health disparities researchers, federal funding organizations, and policymakers on which specific research areas are the most pressing ones to address from both a research and funding perspective.
Identifying research and funding priorities for addressing health care disparities -- which encompass differential access, care, and outcomes due to factors such as race/ethnicity -- is the topic of a new scholarly article co-authored by researchers from several institutions. In the article, published in the March 16, 2016 issue of JAMA Surgery, the authors summarize specific priorities that were identified during the Inaugural National Institutes of Health (NIH)-American College of Surgeons (ACS) Symposium on Surgical Disparities Research, held in May 2015, at the National Institutes of Health.
"The goal of the symposium was to create a national research agenda that could be used to prioritize funding for research. We conducted an extensive literature review of existing research, organized the results by theme, and asked attendees to identify what they saw as the top priorities for each theme," explained lead author Adil Haider, MD, MPH, Kessler Director of Center for Surgery and Public Health, a joint initiative of Brigham and Women's Hospital, Harvard Medical School and Harvard T.H Chan School of Public Health.
An extensive medical literature review on surgical disparities was developed in advance of the symposium for attendees to access through a searchable database prepared by researchers and staff at the Center for Surgery and Public Health at Brigham and Women's Hospital. In collaboration with colleagues from the National Institute of Minority Health and Disparities (NIMHD), researchers from the Center for Surgery and Public Health categorized this literature review into five themes: patient and host factors; systemic factors and access issues; clinical care and quality; provider factors; and postoperative care and rehabilitation. Over the course of the two-day state of the science symposium, more than 60 top-level researchers, surgeon-scientists and federal leaders used these themes to guide interactive consensus-building exercises. Breakout sessions throughout the symposium yielded three to five top research priorities by theme. Overall priorities, irrespective of theme, included "leveraging electronic health records and health technologies to improve care, prioritizing shared decision-making in palliative and end-of-life care, and evaluating provider cultural dexterity in patient rapport-building."
After presentations by leaders in the field and several rounds of discussion, the top five overall research and funding priorities identified by symposium attendees, and articulated in the JAMA Surgery article are:
- Improving patient-provider communication by teaching providers to deliver culturally dexterous care, and measuring its impact on elimination of surgical disparities.
- Fostering engagement and community outreach and using technology to optimize patient education, health literacy and shared decision-making in a culturally-relevant way. Further, disseminating these techniques and evaluating their impact on reducing surgical disparities.
- Evaluating regionalization of care versus strengthening safety net hospitals, within the context of differential access and surgical disparities.
- Evaluating the long-term impact of intervention and rehabilitation support within the critical period on functional outcomes, and patient-defined perceptions of quality of life.
- Improving patient engagement and identifying their expectations for postoperative and post-injury recovery, their values regarding advanced health care planning, and palliative care needs.
The symposium originated with the ACS Committee on Optimal Access (now called Committee on Health Care Disparities), and was jointly hosted by the ACS and the NIH (in particular, the National Institute of Minority Health and Disparities, or NIMHD). Between the ACS's history and success with surgical quality improvement programs and the NIMHD's considerable research and scientific resources, symposium organizers recognized a dynamic partnership that could significantly expand access to surgical care. Both the ACS and the NIH prioritize research initiatives to mitigate surgical disparities.
"We are confident that this is just the beginning of a much larger effort, and hopeful that the National Institutes of Health and the NIMHD will continue to work with the ACS to build upon the foundation that was set during the symposium by establishing a funding stream to support this important research. Together, we can foster systemic change, effectively eliminating surgical and other health care disparities," said L.D. Britt, MD, MPH, FACS, professor at Eastern Virginia Medical School and chair of the ACS Committee on Health Care Disparities. Dr. Britt played a critical role in the creation of the committee and defined the committee's deliverables, which included a national symposium.
The authors concluded that "The NIH-ACS Summit on Surgical Disparities Research succeeded in identifying a comprehensive research agenda." In particular, they noted that future research is needed, especially in the areas of patients' care perspectives, workforce diversification and training, and systematic evaluation of health technologies to reduce surgical disparities. Within the context of the larger literature focused on disparity-related research, results also call for ongoing evaluation of evidence-based practice, rigorous research methodologies, incentives for standardization of care and building on existing infrastructure to support these advances.
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In addition to Dr. Haider and Dr. Britt, other authors of the Symposium summary article are: Allysha C. Maragh-Bass, PhD, MPH; Maya Torain, BS; Cheryl K. Zogg, MSPH, MHS; Elizabeth J. Lilley, MD, MPH; Navin R. Changoor, MD; Peter Najjar, MD, MBA; John A. Rose, Jr., MD, MPH; Ali Salim, MD, FACS, all based in Boston from the Center for Surgery and Public Health, Harvard Medical School and Harvard T.H. Chan School of Public Health, and/or the Department of Surgery, Brigham & Women's Hospital; Irene Dankwa-Mullan, MD, MPH, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda; Yvonne T. Maddox, PhD, National Institutes of Health, Bethesda; Lisa M. Kodadek, MD, Johns Hopkins University School of Medicine, Baltimore; Henri R. Ford, MD, MHA, FACS, Children's Hospital Los Angeles, University of Southern California, Los Angeles; Steven Stain, MD, FACS, Albany (NY) Medical College; Shahid Shafi, MD, MPH, FACS, Baylor Scott & White Health System, Dallas; Beth Sutton, MD, FACS, United Regional Hospital, Kell West Regional Hospital, Wichita Falls, TX; and David B. Hoyt, MD, FACS, American College of Surgeons, Chicago.
Support for the Symposium was provided by the American College of Surgeons and National Institutes of Health.
Citation: Setting a National Agenda for Surgical Disparities Research: Recommendations from the National Institutes of Health and American College of Surgeons Summit. JAMA Surgery.
About the Center for Surgery and Public Health at Brigham and Women's Hospital
The Center for Surgery and Public Health (CSPH) at Brigham and Women's Hospital was established in 2005 as a joint program of Harvard Medical School and the Harvard T. H. Chan School of Public Health. Its mission is to advance the science of surgical care delivery by studying effectiveness, quality, equity, and value at the population level, and developing surgeon-scientists committed to excellence in these areas. CSPH works with a diverse set of collaborators, including academic institutions, non-profit and for-profit organizations nationally and internationally, in order to eliminate disparities and foster patient-centered care through policy and practice.
Brigham and Women's Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare. BWH has more than 4.2 million annual patient visits and nearly 46,000 inpatient stays, is the largest birthing center in Massachusetts and employs nearly 16,000 people. The Brigham's medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in patient care, quality improvement and patient safety initiatives, and its dedication to research, innovation, community engagement and educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Brigham Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, more than 1,000 physician-investigators and renowned biomedical scientists and faculty supported by nearly $600 million in funding. For the last 25 years, BWH ranked second in research funding from the National Institutes of Health (NIH) among independent hospitals. BWH continually pushes the boundaries of medicine, including building on its legacy in transplantation by performing a partial face transplant in 2009 and the nation's first full face transplant in 2011. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative as well as the TIMI Study Group, one of the premier cardiovascular clinical trials groups. For more information, resources and to follow us on social media, please visit BWH's online newsroom.
About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 80,000 members and is the largest organization of surgeons in the world. For more information, visit http://www.facs.org.
Journal
JAMA Surgery