Reducing Disparities through Research and Translation Programs: A Focus on Researchers and Their Actions

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Reducing Disparities Through Research and Translation Programs: A Focus on Researchers and Their Actions

Dr. Debra Joy Pérez
Senior Program Officer
Robert Wood Johnson Foundation (RWJF)

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RWJF Commitment to Diversity

Diversity is a Core Value

Diversity and inclusion are core values of the Robert Wood Johnson Foundation, reflected in our Guiding Principles. We value differences among individuals across multiple dimensions including, but not limited to, race, ethnicity, age, gender, sexual orientation, physical ability, religion and socioeconomic status. We believe that the more we include diverse perspectives and experiences in our work, the better able we are to help all Americans live healthier lives and get the care they need. In service to our mission, we pledge to promote these values in the work we do and to reflect on our progress regularly.©

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Finding Answers: Disparities Research for Change

• Conduct systematic reviews of racial and ethnic health care disparities interventions.
• Grant funds to evaluate innovative, practical solutions.
• Disseminate results to encourage health care systems to address gaps in care.

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Systematic Reviews

Reviewed 200+ articles:

• Cardiovascular disease.
• Diabetes.
• Depression.
• Breast cancer.
• Cultural leverage.
• Pay-for-performance incentives.

Round 2:

• Ongoing.
• Cervical Cancer.
• Breast Cancer.
• Colorectal Cancer.
• Asthma.
• HIV/AIDS.

FAIR Database

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Systematic Review Lessons

• Multi-factorial interventions that address multiple leverage points along a patient's pathway of care.
• Culturally tailored quality indicator (QI) > generic QI.
• Nurse-led interventions with multidisciplinary teams and close tracking and monitoring of patients.

Chin MH, et al. Med Care Res Rev 2007; 64:7S-28S.

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Intervention Strategies

• Patient:
  • E.g., self-management, empowerment, narratives.
• Provider:
  • E.g., training, report cards.
• Health Care Organization:
  • E.g., system redesign, reminders, telehealth.
• Community:
  • E.g., community health workers, peer educators.
• Policy:
  • E.g., performance incentives.

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Lessons from Grantees

• Organization culture and Q/I infrastructure are critical.
• Knowledge/attitude interventions helpful but not sufficient.
• Context and tailoring are critical.
• Directly involve the target population.
• Multi-factorial, multi-target interventions.

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Knowledge, Attitudes, Data Helpful but not Sufficient

• Harvard Vanguard Medical Associates, Inc:
  • Physician Group Practice in Massachusetts.
  • Cultural competency training + disparity report cards.

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Lack of Awareness Among Providers

Image: A bar chart titled "Disparities in Health Care System" compares doctors' and the public's responses to questions about how often they think our health care systems treats people unfairly.

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Knowledge, Attitudes, Data Helpful but not Sufficient

"Not us."

• Results:
  • Increased acknowledgement of disparities.
  • No change in clinical outcome:
    • Sequist, et al., J Gen Intern Med 2008. 23(5): 678-684.
    • Sequist, et al., Ann Intern Med 2010.152: 40-46.

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Disseminating Interventions

Assess:

• Target Population.
• Interventions.
• Goodness-of-fit.
• Stakeholders.
• Organizational Capacity.

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Disseminating Interventions

• Select:
  • Decide to adopt or adapt intervention.
  • Make necessary changes.
• Prepare:
  • Organization.
  • Pretest.
    • Staff.
    • Community advisory board.
    • Patients.

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Disseminating Interventions

• Pilot:
  • Develop implementation plan, policies, protocols.
  • Test.
• Implement:
  • Collect process and outcome data.

McKleroy, V. S. et al. (2006). Adapting evidence-based behavioral interventions for new settings and target populations. AIDS Education and Prevention 18, Supplement A, 59-73.

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New Connections: Research Network for Under-represented Scholars

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Rationale and Context

• Only 5 percent of the full professors in the U.S. are black, Hispanic, or Native American.
• Faculty of color remain a very small part of the professoriate. Whites constituted 95 percent of all faculty members in 1972, and 83 percent in 1997.
• The percentage of African American faculty members at all levels has been remarkably stagnant—4.4 percent in 1975 and 5 percent in 1997—and almost half of all black faculty teach at historically black colleges.
• The increase in Hispanic faculty has been slow: from 1.4 percent in 1975 to 2.8 percent in 1997.

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Rationale and Context

• Minorities earned 16% of the master's degrees and 18.6% of the doctorates in 2000. Whites accounted for 79.3% of all earned doctorates in 2000, followed by Asians at 7.8%; other minority groups combined accounted for 10.8%.
• Blacks were most represented in education (12.4%)—and were underrepresented in most arts and sciences fields—while Asians earned 17.5% of engineering doctorates.
• The proportion of black faculty at predominantly white colleges and universities today—2.3%—is virtually the same as in 1979.
• Members of all minority groups, men and women, are less likely to be tenured than whites—and are also more likely than whites to work at less prestigious institutions.

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Diversity of the Pipeline

The Facts of the Matter

Percent of under-represented minority students in nursing (BSN), medical, and dental schools in 2008:

• Nursing—18.4%.
• Medical—14.5%.
• Dental—12.2%.

Under represented minority students include Black/African American, Hispanic/Latino, and American Indian/Alaska Native.

American Association of Colleges of Nursing (2009). 2008-2009 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing.
American Dental Education Association.
Association of American Medical Colleges (2008). AAMC Data Warehouse: Applicant Matriculant file.

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Importance of Diversity

"Despite the importance of diversity in health professions, African Americans, American Indians and Alaska Natives, many Hispanic/Latino populations, and some Asian American (e.g., Hmong and other Southeast Asians) and Pacific Islander groups (e.g., Native Hawaiians) are grossly underrepresented among the nation's health and health care professionals."

Source: In the Nation's Compelling Interest: Ensuring Diversity in the Health and Health Care Workforce (2004).

"...past research [has show] that faculty of color can enhance the overall quality of education at higher education institutions, for example, by serving as role models, advisors, and leaders.".

Source: Irvine, J.J. (1991). Making teacher education culturally responsive. Diversity in teacher education. Washington, DC: American Association of Colleges for Teacher Education.

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Image: A pie chart titled "Representation of Ethnic Minorities in Nation's Full-Time Instructional Faculty, Fall 2007" shows the following data:

• White: 76.8%.
• Black: 5.4%.
• Hispanic: 3.6%.
• American Indian/Alaska Native: 0.5%.
• Asian/Pacific Islander: 7.6%.
• Race/ethnicity unknown: 1.7%.
• Non-resident alien: 4.4%.

Source: Digest of Educational Statistics 2008 (NCES 2009-020). Table 249.

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Why We Care

• Studies reflect that increased diversity of the health care workforce enhances communication between providers and patients from multicultural backgrounds; promotes patient satisfaction; improves access to care; and assists in addressing disparities in health outcomes.
• Health professionals from underrepresented minority backgrounds tend to disproportionately serve minority and other underserved populations.

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New Connections: Program Activities

• Grantmaking:
  • Call for Proposals:
    • Round 1-4 from 2006 to 2009.
    • Round 5 awards start Nov 2010.
    • Round 6 CFP released early 2011.
• Career Development:
  • Mentoring:
    • Project mentors.
    • Liaisons at RWJF.
  • Training Events.
    • Symposium.
    • Research and Coaching Clinic.
• Outreach:
  • Social Media.
  • Regional Meetings.
  • Professional Meetings:
    • Presentations.
    • Networking Events.

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New Connections: Applicants

Historically underrepresented groups in RWJF Programming (R&E) activities:

• Black.
• Latino/Hispanic.
• Asian/Pacific Islander.
• First-in-family college graduate.
• Low-income community.

New to RWJF:

• First-time grantee of Foundation.

Apply as either:

• Junior Investigator:
  • ≤ 10 years from receipt of doctorate.
• Mid-Career Consultant:
  • Between 10-15 years of experience.