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Setting a national agenda for surgical disparities research

The JAMA Network Journals

Leading researchers and clinicians have identified priorities for surgical disparities research for use by clinicians, researchers, funding organizations, policymakers, and other key stakeholders, according to an article published online by JAMA Surgery.

Healthcare disparities, i.e., differences in the burden of disease, injury, violence, or opportunities to achieve optimal health experienced by socially disadvantaged populations, have been well documented. Compared with other groups, African American individuals have an increased mortality risk across multiple surgical procedures. Gender, sexual orientation, age, and geographic disparities are also well documented. Further research and interdisciplinary collaboration are needed to understand the interrelated factors that affect patient experiences in the surgical setting.

In acknowledgment of these issues, the American College of Surgeons (ACS) and the National Institutes of Health-National Institute of Minority Health and Disparities convened a research summit to develop a national surgical disparities research agenda and funding priorities. Sixty leading researchers and clinicians gathered in May 2015 for a 2-day summit.

In summary, five overarching priorities were identified for surgical disparities research. Research should be directed toward:

  • Improving patient-clinician communication by helping clinicians deliver culturally dexterous, competent care and measuring its effect on the elimination of disparities.
  • Fostering engagement and community outreach by using technology to optimize patient education, health literacy, and shared decision making in a culturally relevant way; disseminating these technologies; and evaluating their effect on reducing surgical disparities.
  • Improving care at facilities with a higher proportion of minority surgical and trauma patients. This includes evaluation of regionalization of care vs strengthening of safety-net hospitals within the context of differential access and surgical disparities.
  • Evaluating the longer-term effect of acute interventions and rehabilitation support within the critical period of injury or illness on functional outcomes and patient-defined perceptions of quality of care.
  • Improving patient centeredness by identifying expectations for postoperative and postinjury recovery. This includes adhering to patient values regarding advanced health care planning and palliative care needs.

"We challenge researchers and funding entities to take these priorities to heart and begin moving research in the field of surgical disparities 'from knowing to doing.' Within the context of the larger literature, summit results also call for ongoing evaluation of evidence-based practice, rigorous research methods, incentives for standardization of care, and building on existing infrastructure to support these advances. With ongoing support and collaboration from the NIH, ACS, and affiliates, best practices for implementation of identified research priorities can be achieved and be used to create more optimal access to equitable quality care for all patients," the authors write.

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(JAMA Surgery. Published online March 16, 2016. doi:10.1001/jamasurg.2016.0014. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Media Advisory: To contact corresponding author Adil H. Haider, M.D., M.P.H., call Lori Schroth at 617-525-6374 or email ljschroth@partners.org.

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