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 current research interests in disparities in the ICU lie in the first and generation framework for health disparities research. While there is a limited amount of data looking at general outcomes like death and length of stay in the ICU for different racial groups, there is not much beyond that. I am interested in further defining some of the disparities that we see (first what impact English language proficiency has on sedation practices), and then determining what factors contribute to this. As factors like income, socioeconomic status or position, and other determinants are rarely evaluated for critical care patients, it will be interesting to see what contributions they have. My larger research goals that are more targeted toward third and fourth generation work are around how we can better provide transitions of care and health education for people of different language, education, and literacy levels in the ICU. Limitations will be in first defining those disparities in the first- and second-generation stages, and also trying to determine appropriate interventions.
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.
The types of interventions described in the above papers seem more appropriate for primary-care settings and chronic health conditions. Applying a similar model in the ICU would be novel, but more challenging. I have been thinking about developing a way to study the outcomes of having a language-concordant health promoter of sorts used for patients and their families who identify as limited-English proficient (LEP). Having an available resource to guide someone through the novel and foreign experience of being in the ICU could have greater benefits than just interpretation of current health status – which should be a standard of care that I think we are not meeting for many of our LEP patients and their families. We know through patient and family advisory council discussions that even for those with English proficiency that the experience of being admitted or transferred to an academic tertiary care center ICU is rife with unexpected obstacles and challenges beyond just the immediate health of the patient.