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Griffith DM. Antiracism and Health Equity Science: Overcoming Scientific Obstacles to Health Equity. Public Health Rep 2024; 139:288-293. [PMID: 38504480 PMCID: PMC11037222 DOI: 10.1177/00333549241236089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Affiliation(s)
- Derek M. Griffith
- Center for Men’s Health Equity, Georgetown University, Washington, DC, USA
- Racial Justice Institute, Georgetown University, Washington, DC, USA
- Department of Health Management and Policy, School of Health, Georgetown University, Washington, DC, USA
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Mathias P, Mahali LP, Agarwal S. Targeting Technology in Underserved Adults With Type 1 Diabetes: Effect of Diabetes Practice Transformations on Improving Equity in CGM Prescribing Behaviors. Diabetes Care 2022; 45:2231-2237. [PMID: 36054022 PMCID: PMC9649356 DOI: 10.2337/dc22-0555] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/10/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Continuous glucose monitoring (CGM) is associated with improved outcomes in type 1 diabetes, but racial-ethnic disparities exist in use. We were interested in examining whether addressing structural health care barriers would change provider prescribing behaviors to make CGM access more equitable. RESEARCH DESIGN AND METHODS From January 2019 to December 2021, we used multilevel stakeholder input to develop and implement several non-grant-funded practice transformations targeted toward equity, which included 1) developing a type 1 diabetes clinic, 2) conducting social needs assessments and management, 3) training support staff to place trial CGMs at the point of care, 4) optimizing prescription workflows, and 5) educating providers on CGM. Transformations were prioritized based on feasibility, acceptability, and sustainability. To examine effect on prescribing behaviors, we collected monthly aggregate data from the electronic medical record and performed multiple linear regression to examine and compare change in CGM prescriptions over the 3 years of transformation. RESULTS In total, we included 1,357 adults with type 1 diabetes in the analysis (mean ± SD age 38 ± 18 years; 30% Black [n = 406], 45% Hispanic [n = 612], 12% White [n = 164]; and 74% publicly insured [n = 1,004]). During the period of transformation, CGM prescription rates increased overall from 15% to 69% (P < 0.001). Improvements were seen equally among Black (12% to 72%), Hispanic (15% to 74%), and White adults (20% to 48%) (between-group P = 0.053). CONCLUSIONS Diabetes practice transformations that target equity, offload provider burdens, and focus on feasible sustainable stakeholder-driven solutions can have powerful effects on provider prescribing behaviors to reduce root causes of inequity in CGM among underserved adults with type 1 diabetes. Continued focus is needed on upstream determinants of downstream CGM use.
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Affiliation(s)
- Priyanka Mathias
- Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, NY
| | - Lakshmi Priyanka Mahali
- Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, NY
| | - Shivani Agarwal
- Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, NY
- NY Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, NY
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Ebekozien O, Mungmode A, Buckingham D, Greenfield M, Talib R, Steenkamp D, Haw JS, Odugbesan O, Harris M, Mathias P, Dickinson JK, Agarwal S. Achieving Equity in Diabetes Research: Borrowing From the Field of Quality Improvement Using a Practical Framework and Improvement Tools. Diabetes Spectr 2022; 35:304-312. [PMID: 36072814 PMCID: PMC9396719 DOI: 10.2337/dsi22-0002] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
There are limited tools to address equity in diabetes research and clinical trials. The T1D Exchange has established a 10-step equity framework to advance equity in diabetes research. Herein, the authors outline this approach and expand on its practical application.
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Affiliation(s)
- Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
| | | | | | | | | | | | - J. Sonya Haw
- Grady Memorial Hospital, Emory University, Atlanta, GA
| | | | | | - Priyanka Mathias
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | | | - Shivani Agarwal
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
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Griffith DM, Umeukeje EM. Navigating to Kidney Health Equity. J Am Soc Nephrol 2022; 33:1242-1244. [PMID: 35728885 PMCID: PMC9257807 DOI: 10.1681/asn.2022040421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Derek M Griffith
- Racial Justice Institute and Departments of Health Systems Administration and Oncology, Georgetown University, Washington, DC
| | - Ebele M Umeukeje
- Vanderbilt Center for Kidney Disease and Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee
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Agarwal S, Crespo-Ramos G, Leung SL, Finnan M, Park T, McCurdy K, Gonzalez JS, Long JA. Solutions to Address Inequity in Diabetes Technology Use in Type 1 Diabetes: Results from Multidisciplinary Stakeholder Co-creation Workshops. Diabetes Technol Ther 2022; 24:381-389. [PMID: 35138944 PMCID: PMC9208861 DOI: 10.1089/dia.2021.0496] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: Racial-ethnic inequity in type 1 diabetes technology use is well documented and contributes to disparities in glycemic and long-term outcomes. However, solutions to address technology inequity remain sparse and lack stakeholder input. Methods: We employed user-centered design principles to conduct workshop sessions with multidisciplinary panels of stakeholders, building off of our prior study highlighting patient-identified barriers and proposed solutions. Stakeholders were convened to review our prior findings and co-create interventions to increase technology use among underserved populations with type 1 diabetes. Stakeholders included type 1 diabetes patients who had recently onboarded to technology; endocrinology and primary care physicians; nurses; diabetes educators; psychologists; and community health workers. Sessions were recorded and analyzed iteratively by multiple coders for common themes. Results: We convened 7 virtual 2-h workshops for 32 stakeholders from 11 states in the United States. Patients and providers confirmed prior published studies highlighting patient barriers and generated new ideas by co-creating solutions. Common themes of proposed interventions included (1) prioritizing more equitable systems of offering technology, (2) using visual and hands-on approaches to increase accessibility of technology and education, (3) including peer and family support systems more, and (4) assisting with insurance navigation and social needs. Discussion: Our study furthers the field by providing stakeholder-endorsed intervention ideas that propose feasible changes at the patient, provider, and system levels to reduce inequity in diabetes technology use in type 1 diabetes. Multidisciplinary stakeholder engagement in disparities research offers unique insight that is impactful and acceptable to the target population.
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Affiliation(s)
- Shivani Agarwal
- Division of Endocrinology, Diabetes, and Metabolism, Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, New York, USA
- NY-Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, New York, USA
- Address correspondence to: Shivani Agarwal, MD, MPH, Department of Endocrinology, Diabetes, and Metabolism, Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine-Montefiore Medical Center, 1180 Morris Park Avenue, Bronx, NY 10461, USA
| | - Gladys Crespo-Ramos
- Division of Endocrinology, Diabetes, and Metabolism, Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, New York, USA
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
| | - Stephanie L. Leung
- Division of Endocrinology, Diabetes, and Metabolism, Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, New York, USA
| | - Molly Finnan
- Division of Endocrinology, Diabetes, and Metabolism, Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, New York, USA
| | - Tina Park
- Diagram LLC, New York, New York, USA
| | | | - Jeffrey S. Gonzalez
- Division of Endocrinology, Diabetes, and Metabolism, Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, New York, USA
- NY-Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, New York, USA
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
| | - Judith A. Long
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
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Singh ME, James SP, Germino GG, Rodgers GP. Achieving Health Equity Through Digestive Diseases Research and Scientific Workforce Diversity. Gastroenterology 2022; 162:1597-1601.e1. [PMID: 35007515 PMCID: PMC9038710 DOI: 10.1053/j.gastro.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 12/02/2022]
Affiliation(s)
| | | | | | - Griffin P Rodgers
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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Waterman AD, Nair D, Purnajo I, Cavanaugh KL, Mittman BS, Peipert JD. The Knowledge Assessment of Renal Transplantation (KART) 2.0: Development and Validation of CKD and Transplant Knowledge Scales. Clin J Am Soc Nephrol 2022; 17:555-564. [PMID: 35332061 PMCID: PMC8993477 DOI: 10.2215/cjn.11490821] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/18/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Many individuals with kidney disease, particularly those belonging to racial and ethnic minority groups and whose primary language is not English, lack knowledge related to kidney disease symptoms, physiologic functions of the kidney, and benefits and risks of kidney transplantation. Valid instruments to assess patients' knowledge of CKD and kidney transplantation are needed. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Using a sample of 977 patients with stages 3-5 CKD in the Kaiser Permanente health system, we developed the Knowledge Assessment of Renal Transplantation (KART) 2.0 instrument. We conducted cognitive interviews followed by item response theory (IRT) to reduce 48 candidate items. Construct validity was tested by examining differences in scores between patients who spent <1 and ≥1 hour receiving CKD and transplant education. RESULTS Cognitive interviews modified four items and omitted 11. IRT analyses resulted in two scales: the KART 2.0-Transplant Knowledge Scale (16 items; Cronbach's α=0.8) and the KART 2.0-CKD Knowledge Scale (nine items; Cronbach's α=0.79). Differential item functioning showed that the scales were unbiased to capture knowledge across self-identified race, primary language, CKD stage, and sex. Both scales distinguished patients who had spent <1 and ≥1 hour speaking with health professionals (effect size [ES]=0.33 [transplant], 0.54 [CKD]; P<0.001 for both), reading about kidney disease (ES=0.45 [transplant], 0.62 [CKD]; P<0.001), reading about kidney transplantation (ES=0.67 [transplant], 0.69 [CKD]; P<0.001), and reading about living donor kidney transplant (ES=0.76 [transplant], 0.62 [CKD]; P<0.001). CONCLUSIONS The KART 2.0 is a valid tool to assess patients' knowledge of CKD and kidney transplantation.
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Affiliation(s)
- Amy D Waterman
- Department of Surgery and J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, Texas
| | - Devika Nair
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt O'Brien Center for Kidney Disease, Nashville, Tennessee
| | | | - Kerri L Cavanaugh
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt O'Brien Center for Kidney Disease, Nashville, Tennessee
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brian S Mittman
- Health Services Research and Implementation Science, Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - John Devin Peipert
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, Illinois
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Cefalu WT, Rodgers GP. COVID-19 and metabolic diseases: a heightened awareness of health inequities and a renewed focus for research priorities. Cell Metab 2021; 33:473-478. [PMID: 33581046 PMCID: PMC7869609 DOI: 10.1016/j.cmet.2021.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/31/2021] [Accepted: 02/04/2021] [Indexed: 12/16/2022]
Abstract
Chronic metabolic disorders such as diabetes and obesity are major public health issues in the United States. However, significant disparities in their prevalence and incidence place a greater burden on US racial and ethnic minority groups, contributing to worse COVID-19 outcomes in many. Improving treatment and prevention of diabetes and obesity is critical to the NIDDK. In this Perspective, we will review the burden of metabolic diseases in the United States, the observed disparities for metabolic diseases in relation to COVID-19, and research opportunities to address underlying causes of metabolic diseases, their associated health disparities, and COVID-19.
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Affiliation(s)
- William T Cefalu
- Director, Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA.
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Ware LB, Collins KL, Hawley JB, Ahima RS. A deliberate path toward diversity, equity, and inclusion within the ASCI. J Clin Invest 2021; 130:5031-5032. [PMID: 32831295 DOI: 10.1172/jci142423] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Lorraine B Ware
- President, American Society for Clinical Investigation (ASCI), 2020-2021; Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kathleen L Collins
- Editor, JCI Insight, , 2019-2024; University of Michigan, Ann Arbor, Michigan, USA
| | | | - Rexford S Ahima
- Editor, Journal of Clinical Investigation, , 2018-2022; Johns Hopkins University, Baltimore, Maryland, USA
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