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).
I think that the generations that Thomas et al. describe are complementary, and each have their important role in health disparities research. My research is is on 2nd and 3rd generation work. First, we don't know if social risk factors on an individual-level or neighborhood level are associated with home dialysis uptake in ESRD patients. We also seek to evaluate if social risk factors are associated with hospitalization and readmission, which is unknown in the dialysis population but has been described in CHF and other populations. In other research which falls into the 3rd generation, we aim to determine the effect of alternative payment models on kidney care disparities. For example, ESRD patients in the Medicare Shared Savings Program often benefit from additional care coordination services and other programs. These programs may differentially target patients with more social risk factors, so could potentially mitigate disparities. On the other hand, health systems that serve patients with more social risk factors are more likely to be financially penalized by alternative payment models, which may worsen kidney care disparities.
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.
Bringing interventions to a setting where individuals frequently visit is certainly an idea that can be applied to dialysis patients. While this is still a health care setting, bringing all needed care into the dialysis unit, including PCP appointments, chronic disease management, and mental health services may improve outcomes in this population, although would be logistically challenging. Another example where kidney care could be brought into the community is kidney disease screenings. Patients at risk for kidney disease may not be tied into care but could be screened in community settings such as churches, community centers, etc. It is important to note that urine dipstick alone is an insensitive screening method, because it only detects ~70% of microalbuminuria, and this method lacks eGFR measurement.