Long before the COVID-19 pandemic brought pervasive health inequities to the forefront of the nation’s attention, underserved populations were known to be at greater risk of chronic disease, such as metabolic disease and cardiovascular disease. COVID-19 only exacerbated the existing challenges faced by certain communities including systemic racism, higher rates of poverty, lack of access to high-quality health care, and fewer economic and educational opportunities, to name a few. Decreased access to testing and treatment coupled with the aforementioned risk factors meant that these communities disproportionately bore the brunt of the pandemic. Even as the COVID-19 pandemic abates, these pervasive health inequities demand immediate attention.
As the data available to address these disparities grows, researchers and policymakers are grappling with how to implement evidence-informed interventions to reduce health inequities when treating chronic diseases. By evaluating such interventions, policymakers and health care institutions will be able to make informed decisions to promote more effective and equitable use of diagnostic tests, vaccines, and medicines and better evaluate how these interventions positively or negatively impact health equity.
To accomplish this mission, the Preparedness and Treatment Equity Coalition (PTEC), in partnership with AcademyHealth and data partners IQVIA and Milliman, recently awarded grants and data access to four multi-disciplinary research teams who are identifying metrics and outcome measures that can be used to encourage practices that decrease inequity in the health care system.
“Approaches to solving equity require diverse viewpoints and funding mechanisms that encourage non-traditional stakeholders to help identify solutions. We are glad to partner with the PTEC to identify cross functional teams of researchers and practitioners who are working to advance greater equity and social justice,” said AcademyHealth President and CEO Lisa Simpson.
The research teams will focus on solutions for vaccine equity and conditions that disproportionately affect Black, Latinx, Asian, and Native American communities, such as cardiovascular and metabolic disorders.
“This research will result in more validated approaches to measure and address some of the health consequences of racism,” said PTEC’s Chief Scientific Officer, Benson Hsu, who treats children from marginalized racial and ethnic groups in South Dakota.
Among the funded programs, the research team led by Dr. Melissa Chinchilla of AltaMed, a Los Angeles-based federally qualified health center, is focusing on the Latinx population, a group that is at higher risk for both diabetes and housing instability, and one that has often been overlooked within the field of housing and homelessness research. Community health centers offer housing instability detection and are increasingly the source of health care for low-income Latinx communities. The team will leverage community health center electronic health records, medical claims data, and focus groups to map out the timing and methods for housing instability identification during clinical encounters. The team plans to develop key guidelines for how diabetes management can be tailored for patients that are housing unstable and lay out a plan to pilot changes as a part of diabetes care intervention.
Another team, led by Dr. Andrew Anderson and colleagues from Tulane University, Columbia and University of California San Francisco seek to improve the measurement of health care equity. To do this, they will validate a prototype known as the Health Equity Index (HEI). Researchers will determine the association between HEI score for hypertension and heart-failure preventable hospitalizations and measures of high-quality primary care for the Medicare population. Additionally, they will assess the impact of the COVID-19 pandemic on HEI scores for preventable hospitalizations related to these conditions. This project will be the first to assess the robustness of a health equity measure that can use near real-time data. The results of this project will highlight which minority groups among the Medicare population are experiencing the largest inequities in care, potential drivers of those inequitable outcomes, and the robustness of the measure.
The Minnesota Community Measurement team, led by Julie Sonier, will examine inequities in vascular and diabetes care to identify drivers of variation in outcomes for Black, Latinx, Asian, and Native American communities in Minnesota. The researchers plan to develop a robust data infrastructure in Minnesota to gather complete, high-quality clinical data on health care quality for diabetes and vascular care. This information will be used to develop new methods for the Minnesota Medicaid program and other payers to monitor and integrate data on drivers of health disparities and to inform enhancements in payment policies and resource delivery. Results from this project can be used to accelerate national progress toward measuring outcomes of care to expose health inequities.
Finally, Dr. Stephen Crystal and colleagues from Rutgers University will consider how community and patient level characteristics and common comorbidities, such as opioid use disorder and severe mental illness, affect care and consider how care delivery could be modified. The study will incorporate novel measures of community vulnerability, including the Minority Health Social Vulnerability Index. The team also plans to examine COVID-19 vaccination rates in relation to factors such as cardiovascular conditions, community social vulnerability, and behavioral health comorbidities.
In partnership with PTEC, AcademyHealth will be supporting grantees as they conduct their research and share their findings. More information about PTEC’s mission and programs is available here.