Health Disparities and Access to Care
We seek to understand the nature of disparities in surgical health care for disadvantaged populations. The average American undergoes nine operative procedures during their lifetime. And we know that disparities exist throughout medical care and surgical care is no exception. The BWH CSPH seeks to not only study these disparities in the receipt of surgical care for disadvantage populations but, moreover, to understand the sources of these disparities to inform the public health and public policy debate about the means to combat this dilemma.
Over the past three decades, research has shown that disparities in outcome exist between racial/ethnic minorities and white Americans in a myriad of diseases. In a recent review in Medical Care, researchers claim that 86,000 health-related deaths could be averted if races were treated equally. Disparities have also been documented by insurance coverage, age, and gender. Little systematic information has been collected about the extent to which standard surgical procedures involved in healthcare - a key element of overall quality of care – are delivered to disadvantage populations in the United States.
As increased attention to quality of healthcare has spurred organizations to evaluate the quality of care and patient safety, we, the Brigham and Women’s Hospital Center for Surgery and Public Health believe that the elimination of healthcare disparities needs to be exalted on the national agenda.
The BWH Center for Surgery and Public Health’s vision is to increase knowledge of surgical care in the United States and internationally to improve quality and access to care for all. To better understand the processes of care within the organization that may mediate disparities, a Surgical Research Portal (SRP) was has been created. Utilizing the American College of Surgeons-National Surgical Quality Improvement Program as its foundation, the CSPH has developed a systematic methodology of capturing surgical data to facilitate consistent documentation for a more reliable, complete and valid research database with the hope of linking process and outcome to generate a “Disparities Dashboard” within the institution. The SRP production includes the following documents: History and Physical, Brief Operative Note, Follow-up Note, Mortality and Morbidity Reports/Events Note.
Regionally, the BWH CSPH has been engaged with the communities of Boston and Massachusetts to bring practical community-based strategies to eliminate health care disparities. We have orchestrated church-based educational forums where “toolkits” are given to empower patients to better navigate an increasingly complex healthcare system. Examples include “shop around for the right primary care physician”, “bring a list”, and “bring an advocate”. We hope to continue to build upon these church and community based programs to create functional change in the health care system as patients learn to more strongly advocate for their health and partner with their physicians to receive the best care possible.
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