1. After reading the article by Thomas et al., comment on where your research, or your research interests, fit into the generational framework for health disparities research. If your work is 1rst or 2nd generation, comment on how your work could lead in the future to 3rd or 4th generation work. If your work is 3rd or 4th generation, comment on what 1rst and 2nd generation work was necessary as a foundation for your current work (or current interests).
My interests on health-related disparities as a function of imaging are currently focused at the 1st generation level. We have such a poor understanding of the extent to which imaging may play a role in health care disparities that 1st generation work is a necessary place to begin our efforts in order to accurately define the scope of the challenge/need. Examining potential disparities in execution of radiology recommendations is of interest because this information is readily accessible within an electronic medical record. If disparities are identified based on patient demographics, provider factors, or specific diseases/imaging tests, this could lead in the future to 3rd/4th generation work with interventions designed to for example automatically directly communicate to patients the need to schedule follow-up imaging, create automated reminders for providers confirming receipt of an imaging recommendation, and/or embedding targeted communication/outreach efforts within disease specific clinics.
2. The barbershop hypertension intervention, while essentially a clinical services intervention operating at either the fence or safety-net level as described by Jones, has some engagement with the social determinants of health. Interventions like that described in the Gottleib article are designed to mitigate the impact of social determinants. How could you apply one of these two types of interventions to your area of research? Propose one or two interventions that engage with social determinants on some level.
It would be conceivable to apply an intervention similar to the one described by Gottleib to address any health-related disparities identified in imaging practice. Currently, referring clinicians may interact with their patients in a variety of ways: letters, voice mail, phone calls, ancillary staff. Patients could be randomized to different types of standardized communications in an effort to determine which maximizes adherence to a stated follow-up imaging recommendation. This set of comparative interventions may help to address a wide range of social determinants including race or neighborhood for socioeconomic status.