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Delgado JL, Warren RC. To advance science we need to address 'otherness'. Nat Hum Behav 2024; 8:622-624. [PMID: 38308090 DOI: 10.1038/s41562-024-01821-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Affiliation(s)
- Jane L Delgado
- National Alliance for Hispanic Health, Washington, DC, USA.
- Healthy Americas Foundation, Washington, DC, USA.
| | - Rueben C Warren
- National Center for Bioethics in Research and Health Care, Tuskegee University, Tuskegee, AL, USA
- School of Dentistry, Meharry Medical College, Nashville, TN, USA
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2
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Figueroa J, McPherson ME, Henriks G, Mountford J, Barker P. Method to share learning in real time at scientific meetings: lessons from the IHI-BMJ International Conference on Quality and Safety. BMJ LEADER 2024; 8:74-78. [PMID: 37407066 DOI: 10.1136/leader-2023-000788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/08/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Capturing and disseminating key learnings on emerging themes for conference participants is challenging, yet also presents a significant opportunity to distill, share and discuss learning in real time with conference organisers and attendees. The Institute for Healthcare Improvement (IHI) and British Medical Journal (BMJ) collaborate annually to convene a Health Quality and Safety conference attracting 1000 to 3000 attendees each year. AIM To test a learning system that harvested and synthesised the key lessons shared by conference participants at the 2022 IHI-BMJ Gothenburg Forum, and to disseminate this content. METHODS Twelve invited Forum attendees collected and shared their 'breakthrough learnings' via electronic survey. Three IHI team members synthesised the participants' responses into themes that were shared and refined in real time at an in-person Forum session including 35 additional participants. RESULTS Participants shared four learning themes: collaboration and co-production, trust, meaningful communication about data, and broadening the scope of the Science of Improvement field to multi-disciplinary and multi-system approaches. CONCLUSIONS Collection of key learning on emerging topics of interest to the health system improvement community is feasible and yielded information both for dissemination and real-time learning. While not representing the full scope of the conference learnings, the content resonated with an additional group of reviewers at the conclusion of the conference and has guided planning for the next annual meeting. This approach may be helpful in capturing key themes for discussion and planning by similar improvement communities.
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Affiliation(s)
- Johanna Figueroa
- Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
| | | | | | - James Mountford
- Galileo Global Foundation, Paris, Paris, France
- Regent's University, London, UK
| | - Pierre Barker
- Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
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3
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Fitzgerald B, Terndrup C, Streed CG, Lee RS, Patel VV, Nall R. The Society of General Internal Medicine's Recommendations to Improve LGBTQ + Health. J Gen Intern Med 2024; 39:323-330. [PMID: 37803097 PMCID: PMC10853142 DOI: 10.1007/s11606-023-08400-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/24/2023] [Indexed: 10/08/2023]
Abstract
Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ +) individuals experience bias in healthcare with 1 in 6 LGBTQ + adults avoiding healthcare due to anticipated discrimination and overall report poorer health status compared to heterosexual and cisgendered peers. The Society of General Internal Medicine (SGIM) is a leading organization representing academic physicians and recognizes that significant physical and mental health inequities exist among LGBTQ + communities. As such, SGIM sees its role in improving LGBTQ + patient health through structural change, starting at the national policy level all the way to encouraging change in individual provider bias and personal actions. SGIM endorses a series of recommendations for policy priorities, research and data collection standards, and institutional policy changes as well as community engagement and individual practices to reduce bias and improve the well-being and health of LGBTQ + patients.
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Affiliation(s)
| | | | - Carl G Streed
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Rita S Lee
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Viraj V Patel
- Montefiore Health System and Albert Einstein College of Medicine, New York City, NY, USA
| | - Ryan Nall
- University of Florida College of Medicine, Gainesville, FL, USA
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Patel SY, Baum A, Basu S. Prediction of non emergent acute care utilization and cost among patients receiving Medicaid. Sci Rep 2024; 14:824. [PMID: 38263373 PMCID: PMC10805799 DOI: 10.1038/s41598-023-51114-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/30/2023] [Indexed: 01/25/2024] Open
Abstract
Patients receiving Medicaid often experience social risk factors for poor health and limited access to primary care, leading to high utilization of emergency departments and hospitals (acute care) for non-emergent conditions. As programs proactively outreach Medicaid patients to offer primary care, they rely on risk models historically limited by poor-quality data. Following initiatives to improve data quality and collect data on social risk, we tested alternative widely-debated strategies to improve Medicaid risk models. Among a sample of 10 million patients receiving Medicaid from 26 states and Washington DC, the best-performing model tripled the probability of prospectively identifying at-risk patients versus a standard model (sensitivity 11.3% [95% CI 10.5, 12.1%] vs 3.4% [95% CI 3.0, 4.0%]), without increasing "false positives" that reduce efficiency of outreach (specificity 99.8% [95% CI 99.6, 99.9%] vs 99.5% [95% CI 99.4, 99.7%]), and with a ~ tenfold improved coefficient of determination when predicting costs (R2: 0.195-0.412 among population subgroups vs 0.022-0.050). Our best-performing model also reversed the lower sensitivity of risk prediction for Black versus White patients, a bias present in the standard cost-based model. Our results demonstrate a modeling approach to substantially improve risk prediction performance and equity for patients receiving Medicaid.
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Affiliation(s)
- Sadiq Y Patel
- Clinical Product Development, Waymark, San Francisco, CA, USA.
- School of Social Policy and Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA, 19104, USA.
| | - Aaron Baum
- Clinical Product Development, Waymark, San Francisco, CA, USA
- Icahn School of Medicine at Mt Sinai, New York, NY, USA
| | - Sanjay Basu
- Clinical Product Development, Waymark, San Francisco, CA, USA
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Center for Vulnerable Populations, San Francisco General Hospital/University of California San Francisco, San Francisco, CA, USA
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Mora N, Arvanitakis Z, Thomas M, Kramer H, Morrato EH, Markossian TW. Applying Customer Discovery Method to a Chronic Disease Self-Management Mobile App: Qualitative Study. JMIR Form Res 2023; 7:e50334. [PMID: 37955947 PMCID: PMC10682919 DOI: 10.2196/50334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/22/2023] [Accepted: 10/05/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND A significant health challenge is evident in the United States, with 6 in 10 adults having a chronic disease and 4 in 10 adults having 2 or more. Chronic disease self-management aims to prevent or delay disease progression and disability and reduce mortality risk. The evidence to support the use of information technology tools, including mobile apps, web-based portals, and web-based educational interventions, that support disease self-management and improve clinical outcomes is growing. Customer discovery and value proposition design methodology is a form of stakeholder engagement and is based on marketing and lean start-up business methods. As applied in health care, customer discovery and value proposition methodology can be used to understand the clinical problem and articulate the product's hypothesized unique value proposition relative to alternative options that are available to end users. OBJECTIVE This study aims to describe the experience and findings of academic researchers applying the customer discovery and value proposition methodology to identify stakeholders, needs, adaptability, and sustainability of a chronic disease self-management mobile app (CDapp). The motivation of the work is to make mobile health app interventions accessible and acceptable for all segments of patients' chronic diseases. METHODS Data were obtained through key informant interviews and analyzed using rapid qualitative analysis techniques. The value proposition framework was used to build the interview guide. The aim was to identify the needs, challenges (pains), and potential benefits (gains) of the CDapp for our stakeholders. RESULTS Our results showed that the primary consumers (end users) of a CDapp were the patients. The app adopters (decision makers) can be medical center leaders including population health department managers or insurance providers, while the consumer adoption influencers (influencers or saboteurs) are clinicians and patient caregivers. We developed an ecosystem map to visualize the clinical practice workflow and how an app for chronic disease management might integrate within an academic health care center or system. A value proposition for the identified customer segments was generated. Each stakeholder segment was working within a different framework to improve patient self-management. Patients needed help to adhere to self-care activities and they needed tailored health education. Health care leaders aim to improve the quality of care while reducing costs and workload. Clinicians wanted to improve patient education and care while reducing the time burden. Our results also showed that within academic medical centers, there were variations regarding patients' self-reported abilities to manage their diseases. CONCLUSIONS Customer discovery is a useful form of stakeholder engagement when designing studies that seek to implement, adapt, and sustain an intervention. The customer discovery and value proposition methodology can be used as an alternative or complementary approach to formative research to generate valuable information in a brief period.
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Affiliation(s)
- Nallely Mora
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University of Chicago, Maywood, IL, United States
| | - Zoe Arvanitakis
- Rush Medical College, Rush University Medical Center, Chicago, IL, United States
| | - Merly Thomas
- Center for Health Innovation and Entrepreneurship, Parkinson School of Health Sciences and Public Health, Loyola University of Chicago, Maywood, IL, United States
| | - Holly Kramer
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University of Chicago, Maywood, IL, United States
- Department of Medicine, Loyola University of Chicago, Maywood, IL, United States
| | - Elaine H Morrato
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University of Chicago, Maywood, IL, United States
| | - Talar W Markossian
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University of Chicago, Maywood, IL, United States
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Agniel D, Cabreros I, Damberg CL, Elliott MN, Rogers R. A Formal Framework For Incorporating Equity Into Health Care Quality Measurement. Health Aff (Millwood) 2023; 42:1383-1391. [PMID: 37782880 DOI: 10.1377/hlthaff.2022.01483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Quality measurement is an important tool for incentivizing improvement in the quality of health care. Most quality measurement efforts do not explicitly target health equity. Although some measurement approaches may intend to realign incentives to focus quality improvement efforts on underserved groups, the extent to which they accomplish this goal is understudied. We posit that tying incentives to approaches on the basis of stratification or disparities may have unintended consequences or limited effects. Such approaches might not reduce existing disparities because addressing one aspect of equity may be in competition with addressing others. We propose equity weighting, a new measurement framework to advance equity on multiple fronts that addresses the shortcomings of existing approaches and explicitly calibrates incentives to align with equity goals. We use colorectal cancer screening data derived from 2017 Medicare claims to illustrate how equity weighting fixes unintended consequences in other methods and how it can be adapted to policy goals.
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Affiliation(s)
- Denis Agniel
- Denis Agniel , RAND Corporation, Santa Monica, California
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Copado IA, Brewster AL, Epstein SD, Brown TT, Rodriguez HP. Collaborative Learning Among Health Care Organizations to Improve Quality and Advance Racial Equity. Health Equity 2023; 7:525-532. [PMID: 37731789 PMCID: PMC10507920 DOI: 10.1089/heq.2023.0098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 09/22/2023] Open
Abstract
Background The study examined stakeholder experiences of a statewide learning collaborative, sponsored and led by Blue Cross Blue Shield of Massachusetts (BCBSMA) and facilitated by the Institute for Healthcare Improvement (IHI) to reduce racial and ethnic disparities in quality of care. Methods Interviews of key stakeholders (n=44) were analyzed to assess experiences of collaborative learning and interventions to reduce racial and ethnic disparities in quality of care. The interviews included BCBSMA, IHI, provider groups, and external experts. Results Breast cancer screening, colorectal cancer screening, hypertension management, and diabetes management were focal areas for reducing disparities. Collaborative learning methods involved expert coaching, group meetings, and sharing of best practices. Interventions tested included pharmacist-led medication management, strategies to improve the collection of race, ethnicity, and language (REaL) data, transportation access improvement, and community health worker approaches. Stakeholder experiences highlighted three themes: (1) the learning collaborative enabled the testing of interventions by provider groups, (2) infrastructure and pilot funding were foundational investments, but groups needed more resources than they initially anticipated, and (3) expertise in quality improvement and health equity were critical for the testing of interventions and groups anticipated needing this expertise into the future. Conclusions BCBSMA's learning collaborative and intervention funding supported contracted providers in enhancing REaL data collection, implementing equity-focused interventions on a small scale, and evaluating their feasibility and impact. The collaborative facilitated learning among groups on innovative approaches for reducing racial disparities in quality. Concerns about sustainability underscore the importance of expertise for implementing initiatives to reduce racial and ethnic disparities.
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Affiliation(s)
- Ivan A. Copado
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, California, USA
| | - Amanda L. Brewster
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, California, USA
| | - Sarah D. Epstein
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, California, USA
| | - Timothy T. Brown
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, California, USA
| | - Hector P. Rodriguez
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, California, USA
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Osuagwu C, Khinkar RM, Zheng A, Wien M, Decopain J, Desai S, McElrath E, Hinchey E, Mueller SK, Schnipper JL, Boxer R, Shannon EM. A Public Health Critical Race Praxis Informed Congestive Heart Failure Quality Improvement Initiative on Inpatient General Medicine. J Gen Intern Med 2023; 38:2236-2244. [PMID: 36849864 PMCID: PMC9970115 DOI: 10.1007/s11606-023-08086-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 02/07/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Prior evaluation at our hospital demonstrated that, compared to White patients, Black and Latinx patients with congestive heart failure (CHF) were less likely to be admitted to the cardiology service rather than the general medicine service (GMS). Patients admitted to GMS (compared to cardiology) had inferior rates of cardiology follow-up and 30-day readmission. OBJECTIVE To develop and test the feasibility and impacts of using quality improvement (QI) methods, in combination with the Public Health Critical Race Praxis (PHCRP) framework, to engage stakeholders in developing an intervention for ensuring guideline-concordant inpatient CHF care across all patient groups. METHODS We compared measures for all patients admitted with CHF to GMS between September 2019 and March 2020 (intervention group) to CHF patients admitted to GMS in the previous year (pre-intervention group) and those admitted to cardiology during the pre-intervention and intervention periods (cardiology group). Our primary measures were 30-day readmissions and 14- and 30-day post-discharge cardiology follow-up. RESULTS There were 79 patients admitted with CHF to GMS during the intervention period, all of whom received the intervention. There were similar rates of Black and Latinx patients across the three groups. Compared to pre-intervention, intervention patients had a significantly lower 30-day readmission rate (18.9% vs. 24.8%; p=0.024), though the cardiology group also had a decrease in 30-day readmissions from the pre-intervention to intervention period. Compared to pre-intervention, intervention patients had significantly higher 14-day and 30-day post-discharge follow-up visits scheduled with cardiology (36.7% vs. 24.8%, p=0.005; 55.7% vs. 42.3%, p=0.0029), but no improvement in appointment attendance. CONCLUSION This study provides a first test of applying the PHCRP framework within a stakeholder-engaged QI initiative for improving CHF care across races and ethnicities. Our study design cannot evaluate causation. However, the improvements in 30-day readmission, as well as in processes of care that may affect it, provide optimism that inclusion of a racism-conscious framework in QI initiatives is feasible and may enhance QI measures.
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Affiliation(s)
- Chidinma Osuagwu
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Roaa M Khinkar
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amy Zheng
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew Wien
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Jennifer Decopain
- School of Nursing, MGH Institute of Health Professions, Charlestown, MA, USA
| | - Sonali Desai
- Division of Rheumatology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Quality and Safety, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Erin McElrath
- Department of Medicine, Brigham and Woman's Hospital, Boston, MA, USA
| | - Emily Hinchey
- Department of Medicine, Brigham and Woman's Hospital, Boston, MA, USA
| | - Stephanie K Mueller
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jeffrey L Schnipper
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Robert Boxer
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Evan Michael Shannon
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Room, Los Angeles, CA, 812, USA.
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Goldman J, Lo L, Rotteau L, Wong BM, Kuper A, Coffey M, Rawal S, Alfred M, Razack S, Pinard M, Palomo M, Trbovich P. Applying an equity lens to hospital safety monitoring: a critical interpretive synthesis protocol. BMJ Open 2023; 13:e072706. [PMID: 37524554 PMCID: PMC10391806 DOI: 10.1136/bmjopen-2023-072706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION Hospital safety monitoring systems are foundational to how adverse events are identified and addressed. They are well positioned to bring equity-related safety issues to the forefront for action. However, there is uncertainty about how they have been, and can be, used to achieve this goal. We will undertake a critical interpretive synthesis (CIS) to examine how equity is integrated into hospital safety monitoring systems. METHODS AND ANALYSIS This review will follow CIS principles. Our initial compass question is: How is equity integrated into safety monitoring systems? We will begin with a structured search strategy of hospital safety monitoring systems in CINAHL, EMBASE, MEDLINE and PsycINFO for up to May 2023 to identify papers on safety monitoring systems generally and those linked to equity (eg, racism, social determinants of health). We will also review reference lists of selected papers, contact experts and draw on team expertise. For subsequent literature searching stages, we will use team expertise and expert contacts to purposively search the social science, humanities and health services research literature to support the development of a theoretical understanding of our topic. Following data extraction, we will use interpretive processes to develop themes and a critique of the literature. The above processes of question formulation, article search and selection, data extraction, and critique and synthesis will be iterative and interactive with the goal to develop a theoretical understanding of equity in hospital monitoring systems that will have practice-based implications. ETHICS AND DISSEMINATION This review does not require ethical approval because we are reviewing published literature. We aim to publish findings in a peer-reviewed journal and present at conferences.
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Affiliation(s)
- Joanne Goldman
- Centre for Quality Improvement and Patient Safety, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Wilson Centre, University of Toronto/University Health Network, Toronto, Ontario, Canada
| | - Lisha Lo
- Centre for Quality Improvement and Patient Safety, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Leahora Rotteau
- Centre for Quality Improvement and Patient Safety, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Brian M Wong
- Centre for Quality Improvement and Patient Safety, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ayelet Kuper
- Department of Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Wilson Centre, University of Toronto/University Health Network, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Maitreya Coffey
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Shail Rawal
- Department of Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Myrtede Alfred
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Saleem Razack
- Department of Pediatrics and Centre for Health Education Scholarship, The University of British Columbia, Vancouver, British Columbia, Canada
- BC Children's Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Marie Pinard
- Centre for Quality Improvement and Patient Safety, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Patricia Trbovich
- Centre for Quality Improvement and Patient Safety, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- North York General Hospital, Toronto, Ontario, Canada
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Granger BB, Engel J. Measurement Strategies for The Joint Commission Health Care Disparities Standard: Defining Hospital-Based Requirements-Part 1. AACN Adv Crit Care 2023; 34:154-160. [PMID: 37289620 DOI: 10.4037/aacnacc2023668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Bradi B Granger
- Bradi B. Granger is Director, Heart Center Nursing Research Program, Duke University Health System, and Professor, Duke University School of Nursing, 307 Trent Dr, Durham, NC 27710
| | - Jill Engel
- Jill Engel is Vice President, Heart and Vascular Services, Duke University Health System, Durham, North Carolina
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Chareonthaitawee P, Bullock-Palmer RP, Calnon DA, Gomez Valencia JA, Malhotra S, Polk DM, Phillips L, Sciammarella MG, Thompson RC, Mieres JH. The American Society of Nuclear Cardiology Diversity, Equity, and Inclusion mission statement. J Nucl Cardiol 2023; 30:1254-1257. [PMID: 36972000 DOI: 10.1007/s12350-023-03238-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 03/29/2023]
Affiliation(s)
| | | | | | | | | | - Donna M Polk
- Accreditation Council for Graduate Medical Education, Chicago, IL, USA
| | - Lawrence Phillips
- Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Maria G Sciammarella
- Division of Cardiology, Zuckerberg San Francisco General Hospital, UCSF, San Francisco, CA, USA
| | - Randall C Thompson
- Saint Luke's Mid America Heart Institute and the University of Missouri - Kansas City, Kansas City, MO, USA
| | - Jennifer H Mieres
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Almquist L, Walker SC, Purtle J. A landscape assessment of the activities and capacities of evidence-to-policy intermediaries (EPI) in behavioral health. Implement Sci Commun 2023; 4:55. [PMID: 37218006 DOI: 10.1186/s43058-023-00432-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/30/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND A significant gap exists between the production of research evidence and its use in behavioral health policymaking. Organizations providing consulting and support activities for improving policy represent a promising source for strengthening the infrastructure to address this gap. Understanding the characteristics and activities of these evidence-to-policy intermediary (EPI) organizations can inform the development of capacity-building activities, leading to strengthened evidence-to-policy infrastructure and more widespread evidence-based policymaking. METHODS Online surveys were sent to 51 organizations from English-speaking countries involved in evidence-to-policy activities in behavioral health. The survey was grounded in a rapid evidence review of the academic literature regarding strategies used to influence research use in policymaking. The review identified 17 strategies, which were classified into four activity categories. We administered the surveys via Qualtrics and calculated the descriptive statistics, scales, and internal consistency statistics using R. RESULTS A total of 31 individuals completed the surveys from 27 organizations (53% response rate) in four English-speaking countries. EPIs were evenly split between university (49%) and non-university (51%) settings. Nearly all EPIs conducted direct program support (mean = 4.19/5 [sd = 1.25]) and knowledge-building (4.03 [1.17]) activities. However, engagement with traditionally marginalized and non-traditional partners (2.84 [1.39]) and development of evidence reviews using formal critical appraisal methods (2.81 [1.70]) were uncommon. EPIs tend to be specialized, focusing on a group of highly related strategies rather than incorporating multiple evidence-to-policy strategies in their portfolios. Inter-item consistency was moderate to high, with scale α's ranging from 0.67 to 0.85. Ratings of respondents' willingness to pay for training in one of three evidence dissemination strategies revealed high interest in program and policy design. CONCLUSIONS Our results suggest that evidence-to-policy strategies are frequently used by existing EPIs; however, organizations tend to specialize rather than engage in a breadth of strategies. Furthermore, few organizations reported consistently engaging with non-traditional or community partners. Focusing on building capacity for a network of new and existing EPIs could be a promising strategy for growing the infrastructure needed for evidence-informed behavioral health policymaking.
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Affiliation(s)
- Lars Almquist
- Department of Health Systems and Population Health, University of Washington, Seattle, USA.
| | - Sarah Cusworth Walker
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Jonathan Purtle
- Department of Public Health Policy and Management, New York University, New York City, USA
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A matter of trust: Commitment to act for health equity. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2023; 11:100675. [PMID: 36693301 DOI: 10.1016/j.hjdsi.2023.100675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/23/2023]
Abstract
We believe these recommendations constitute "minimum requirements" for health care organizations to move toward greater health equity. As health systems, standards-setting organizations, national and private purchaser organizations, and thought leaders, we represent organizations in the health care ecosystem that can both advise on strategies for adopting the recommendations and have the power and leverage to cause their implementation. We commit individually and collectively to use our leverage to propel their implementation at our own institutions and across the county. We very much hope others will join us.
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Hilliard‐Boone T, Firminger K, Dutta T, Cowans T, DePatie H, Maurer M, Schultz E, Castro‐Reyes P, Richmond A, Muhammad M, Pathak‐Sen E, Powell W. Stakeholder-driven principles for advancing equity through shared measurement. Health Serv Res 2022; 57 Suppl 2:291-303. [PMID: 35802002 PMCID: PMC9660421 DOI: 10.1111/1475-6773.14031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To advance equity by developing stakeholder-driven principles of shared measurement, which is using a common set of measurable goals that reflect shared priorities across communities and systems, such as health care, public health, and human and social services. DATA SOURCES From October 2019 to July 2021, we collected primary data from leaders in cross-systems alignment, measurement, and community engagement-including community members and community-based organization leaders-across the United States. STUDY DESIGN In partnership with equity and community engagement experts, we conducted a mixed-methods study that included multiple formative research activities and culminated in a six-week, stakeholder-engaged modified-Delphi process. DATA COLLECTION Formative data collection occurred through an environmental scan, interviews, focus groups, and an online survey. Principles were developed using a virtual modified Delphi with iterative rapid-analysis. Feedback on the final principles was collected through virtual focus groups, an online feedback form, and during virtual presentations. PRINCIPAL FINDINGS We developed a set of five guiding principles. Measurement that aligns systems with communities toward equitable outcomes: (1) Requires upfront investment in communities; (2) Is co-created by communities; (3) Creates accountability to communities for addressing root causes of inequities and repairing harm; (4) Focuses on a holistic and comprehensive view of communities that highlights assets and historical context; and (5) Reflects long-term efforts to build trust. Using an equity-focused process resulted in principles with broad applicability. CONCLUSIONS Leaders across systems and communities can use these shared measurement principles to reimagine and transform how systems create equitable health by centering the needs and priorities of the communities they serve, particularly communities that historically have been harmed the most by inequities. Intentionally centering equity across all project activities was essential to producing principles that could guide others in advancing equity.
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Affiliation(s)
| | - Kirsten Firminger
- Health DivisionAmerican Institutes for ResearchChapel HillNorth CarolinaUSA
| | - Tania Dutta
- Health DivisionAmerican Institutes for ResearchArlingtonVirginiaUSA
| | - Tamika Cowans
- Health DivisionAmerican Institutes for ResearchArlingtonVirginiaUSA
| | - Holly DePatie
- Health DivisionAmerican Institutes for ResearchChicagoIllinoisUSA
| | - Maureen Maurer
- Health DivisionAmerican Institutes for ResearchChapel HillNorth CarolinaUSA
| | | | | | - Al Richmond
- Community‐Campus Partnerships for HealthRaleighNorth CarolinaUSA
| | - Michael Muhammad
- Center for Participatory ResearchUniversity of New MexicoAlbuquerqueNew MexicoUSA
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Gagliardi JP, Smith CM, Simmons KL, Tweedy DS. Racial Justice Beyond the Curriculum: Aligning Systems of Care With Anti-Racist Instruction in Graduate Medical Education. J Grad Med Educ 2022; 14:403-406. [PMID: 35991095 PMCID: PMC9380630 DOI: 10.4300/jgme-d-22-00056.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Jane P. Gagliardi
- Jane P. Gagliardi, MD, MHSc, is Associate Professor of Psychiatry and Behavioral Sciences, and Associate Professor of Medicine, Duke University School of Medicine
| | - Colin M. Smith
- Colin M. Smith, MD, is PGY-6 Chief Resident, Internal Medicine-Psychiatry, Duke University Medical Center
| | - Kirsten L. Simmons
- Kirsten L. Simmons, MD, MHSc, is a PGY-1, Department of Ophthalmology, W.K. Kellogg Eye Center, University of Michigan
| | - Damon S. Tweedy
- Damon S. Tweedy, MD, is Associate Professor of Psychiatry and Behavioral Sciences, Duke University School of Medicine, and Staff Psychiatrist, Durham VA Health Care System
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Patient-Centered Core Impact Sets: What They are and Why We Need Them. THE PATIENT - PATIENT-CENTERED OUTCOMES RESEARCH 2022; 15:619-627. [PMID: 35653038 PMCID: PMC9584872 DOI: 10.1007/s40271-022-00583-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/06/2022]
Abstract
A quote attributed to Mark Twain states, “What gets us into trouble is not what we don’t know. It’s what we know for sure that just ain’t so.” The growing focus on patient centricity has revealed a misalignment between what patients report as important to them about their disease and/or treatment, and the data collected in research and care. Decisions across healthcare are made using an evidence base most stakeholders acknowledge is inadequate. Patients might report that what is important to them are everyday life impacts, concepts that can be very different from the more typical clinical outcomes we often track. In this paper, we encourage expanding current thinking to all “impacts,” not only health outcomes, but also the other equally (and sometimes more important) concerns patients report as important to them. We propose that a patient-centered core impact set be developed for each disease or condition of interest, and/or subpopulation of patients. A patient-centered core impact set begins with gathering from patients and caregivers an inventory of all impacts disease and treatments have on a patient’s (and carers’ and families’) life. Then, through a formal prioritization process, a core set of impacts is derived, inclusive of but extending beyond relevant health outcomes. We offer several recommendations on how to move the goal of a patient-centered core impact set forward through collaboration, leadership, and establishment of a patient-centered core impact set development blueprint with supporting tools.
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Affiliation(s)
| | - Kedar Mate
- Institute for Healthcare Improvement, Boston, Massachusetts
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