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Patient-Centered Care and Health Equity AOC
(Approved 4/11/2017)
Pathway under which the AOC will fall:
Population Sciences, with some work in Clinical and Operations research.
Program Leaders:
- Monika Safford, M.D., Division Chief, General Internal Medicine
- Fred Pelzman, M.D., Medical Director, WCIMA
- Oliver Fein, M.D., Assistant Dean and Professor of Clinical Healthcare Policy and Research
- Joseph Shin, M.D., Assistant Professor, General Internal Medicine
Individual Student Faculty Mentors in this AOC:
- Amanda Carmel, Medicine – GIM, patient education
- Brian Eiss, Medicine – Geriatrics and GIM, medical education
- Pamela Eliach, Medicine – GIM, medical education
- Lisa Kern, Medicine – Healthcare fragmentation
- Matt McCarthy, Medicine – Infectious Disease and GIM
- Molly McNairy, Medicine – Global Health, Implementation Science
- Janey Peterson, Medicine – Behavioral Health
- Erica Phillips, Medicine - Obesity
- Monika Safford, Medicine – Health Disparities Research, Community-Engaged Research
- Martin Shapiro, Medicine - Health Disparities Research, Community-Engaged Research
- Joseph Shin, Medicine – Health Disparities Research
Description of Proposed AOC:
The AOC on Patient-Centered Care and Health Equity focuses on helping to prepare medical students to become future clinicians, researchers, educators, and advocates who wish to build careers in advancing patient-centered care and health equity across a variety of disciplines. How these activities can be advanced through influencing health policy is another important focus of this AOC. Students will identify a mentor to develop a unique scholarly project that will focus on improving health disparities through one of several potential frameworks and approaches including (although not limited to): 1) innovations in patient engagement, education, and communication, 2) health and human rights, 3) health care disparities research, and 4) health care policy and advocacy.
Significance:
As defined by the CDC, “Health equity is attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.” While innovation is at the heart of medical advancement, large gaps in health outcomes continue to be prevalent across a variety of communities and populations. These may manifest in disparities in a variety of ways, 1) outcomes in chronic diseases such as hypertension, diabetes, chronic kidney disease, cardiovascular disease, and obesity, 2) a result of specific health care policies, 3) in settings of human rights abuses such as torture, war trauma, forced migration, trafficking, and abuses in correctional or detention settings, and further exacerbated by 4) ineffective patient or population education, engagement and activation, and ineffective utilization of newer communications/multimedia/web-based technologies.
Our AOC will give students access to mentors and projects that will highlight the cross-disciplinary strategies needed to address complex psychosocial, political, historical, educational, and technological factors that contribute to health disparities. While working on specific projects, students will be exposed to a broader community of researchers, clinicians, educators, tech innovators, policy experts, lawyers, and community advocates to enhance their career development and education.
Goals and Learning Objectives (skills, knowledge and attitudes):
- To learn to develop and implement rigorous research skills when conducting various levels of inquiry (literature review, systematic reviews/meta-analyses, interviews/focus groups, experimental data from educational interventions, large epidemiologic data sets, etc.)
- To develop trauma-informed interview and research skills and strategies for use when evaluating, caring for, or conducting research with vulnerable populations (i.e. conducting forensic medical/psychiatric/gynecologic evaluation of asylum-seekers, interviewing survivors of trafficking, vulnerable/under-served minority groups, etc.)
- To enhance communication skills while working within a multidisciplinary research team, presenting at research meetings/conferences, writing manuscripts for publication in peer-reviewed literature, writing reports of medico-legal affidavits, and/or conducting advocacy with key stakeholders.
- To develop functional understanding of legal and policy framework pertinent to the project of study (i.e. asylum/immigration health law, mechanisms of public/private financing of health care, institutionalized racism, etc.)
- To incorporate dimensions of cultural competency in all aspects of work with health equity including development of appropriate educational tools, patient care, research and advocacy.
- To incorporate understanding of psychosocial factors and key social determinants of health and their impact on health outcomes and disparities while conducting clinical care, research and advocacy.
- To develop skills in collaborating with key stakeholders in specific populations and communities to translate data, needs and priorities into potential interventions.
- To enhance awareness of factors that lead to improved empathy, self-care, and professional growth and satisfaction while working with vulnerable populations, health disparities, health services research and policy advocacy.
Core Activities and/or Practical Experiences
- Weekly DGIM Research in Progress Meetings (Fridays at lunchtime)
- Regular Research Group Meetings (i.e. PALS [Wednesdays 2-3 pm, Health and Human Rights, etc.)
- David Rogers Colloquium (Wednesday afternoons)
- Department of Medicine Grand Rounds (Wednesday mornings)
- Global Health Grand Rounds
- Department of Health Care Policy and Research Grand Rounds
- Monthly/Bi-monthly WCCHR and PHR trainings, conferences, and networking events
- Conduct assigned forensic asylum seeker health evaluations
- Attendance/Participation/Presentations at regional and national conferences (i.e. Society of General Internal Medicine, Society of Hospital Medicine, American College of Physicians, Physicians for a National Health Program, various Health Disparities Research Symposia, Consortium of Universities in Global Health, American Public Health Association, Academic Consortium on Criminal Justice Health, Physicians for Human Rights Asylum Network, etc.)
General ideas for evaluating student performance:
Students will be evaluated based on the feasibility, clarity, and quality of the Scholarly Project and associated deliverables (abstracts, posters, manuscripts, presentations, etc.). Active participation in core AOC activities, and demonstration of preparation, professionalism, and adherence to deadlines with regular progress updates for their Scholarly Project will also be taken into account.
Examples of suggested Student Scholarly Projects (by sub-AoC):
1) Innovations in Patient Engagement, Education and Communication
Patient Activated Learning System (PALS) – Students will work with mentors to review the literature to create evidence summaries in response to specific patient questions about health and medications. They will also develop patient-facing text that translates this evidence into easily understood language, contribute to development of multimedia “knowledge objects” that assist in communicating the critical information, and evaluating PALS content including formal experimental tests of comprehension, knowledge retention and satisfaction.
Educational materials available to our patients about their health has been of limited quality, and lack of knowledge and answers to the many questions they have likely leads to lost health opportunities. The PALS was created to address this glaring need. Easy to understand, rigorously researched, online answers to questions about medications, symptoms, diseases, side effects, and more, will help our patients get what they need to move towards a healthier life.
Students teamed with faculty mentors will perform extensive research in the literature to find the best answers to the questions our patients have, and then present them in a clear and thoughtful way in our web-based learning environment. Searches will include primary sources, large databases and interviews with topic experts to gain consensus opinion when no clear answer exists. The teams will produce numerous entries for the program, each encompassing the equivalent of an in-depth scholarly review article on selected topics, coupled with an easy to understand, multimedia "knowledge object" that conveys the crucial information in simple language.
2) Health and Human Rights
- Experiences of Sex Trafficking Victims in Healthcare Settings – Assisting with ongoing qualitative research among survivors of sex trafficking to better understand their experiences in healthcare settings and potential missed opportunities for victim identification and linkage to appropriate services and assistance. Developing improved training/screening tools for improved identification of victims of human trafficking and assisting with linkage to appropriate and desirable services and assistance.
- Asylum Health Project - Analysis of data from asylum-seekers evaluated by Physicians for Human Rights and/or the Weill Cornell Center for Human Rights, describing demographic information, trauma history/trauma pattern and associations with medical and psychiatric illness. Specific sub-groups may also be analyzed (i.e. minors/unaccompanied minors, LGBTQ asylum seekers, women, domestic violence victims, those held in immigration detention, etc.).
- Health Disparities in Immigration Detention - Develop a project examining health disparities among groups and individuals held in immigration detention.
- Pain Assessment and Management – Investigating the prevalence of chronic pain among survivors of torture, the effectiveness of standard pain assessments in this population, and the impact of long-term pain management interventions.
- Quality improvement research - Evaluating the effectiveness of care coordination services, and appropriate and timely linkage to community-based resources.
3) Healthcare Policy and Advocacy
- Single-Payer Health Care Reform – Work closely with regional and national physician-advocates on developing and implementing effective, evidence-based legislative advocacy projects.
- Healthcare Costs, Utilization and Financing - Analyzing health care utilization, care coordination and care fragmentation patterns, and possible studies involving secondary analysis of national data sets to identify disparities in health care utilization, financial impact of insurance and healthcare services, and health outcomes.
4) Healthcare Disparities Research
- Reasons for Geographic And Racial Differences in Stroke (REGARDS) Study – This national cohort study funded by NINDS and NHLBI offers opportunities for students to design and carry out studies in the context of a national epidemiology cohort. Past projects have included the study of cumulative vulnerabilities to health disparities and incident diabetes, and a comparison of risk factors for usual and micro-size myocardial infarction.
- Obesity Research – Students will have the opportunity to develop research projects utilizing data from the Weight Management Practice databases in order to evaluate quality of care, transitions of care, health disparities and evaluation of education programs.
- Ten-year outcomes of HIV-infected patients in Haiti – Students will have the opportunity to join ongoing research on a variety of topics in this area, in close collaboration with a mentor with an active research program in Haiti.
- Hypertension Pragmatic Research – Students will join a large clinical trial now underway being conducted at 80 primary care practices in Alabama and North Carolina. Numerous opportunities exist to develop small projects that rest on this $8.5 million infrastructure.
- Healthcare Fragmentation – Students will join an ongoing research program examining the correlates and consequences of fragmented healthcare, especially how such fragmentation affects individuals vulnerable to health disparities.