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 4thgeneration, comment on what 1rst and 2nd generation work was necessary as a foundation for your current work (or current interests).
I support an implementation science project geared towards improving ambulatory patient safety in the safety-net care system through integrated information technology solutions and workflows. Implementation science aims to understand the barriers and facilitators of the adoption and implementation of evidence-based interventions. I consider the multi-year project, led by a transdisciplinary team, to be a combination of all four generations of health disparities research frameworks. Our first aim is to detect gaps in the ongoing monitoring of high-risk conditions, and determine whether or not these gaps are experienced disproportionately by certain groups. Second, we plan to conduct problem analysis through interviews and focus groups with stakeholders, including patients, to understand why these gaps arise. Third, we will use human-centered methodologies to provide solutions, by conducting additional focus groups with patients and stakeholders to test and provide feedback on prototypes of potential health information technology (HIT) and associated workflow solutions. Last, we will implement the iterated HIT solution and associated workflow innovations by engaging responsible stakeholders and providing them with the materials they need to launch, adjust, and maintain these tools within outpatient clinical settings.
This project also draws on an evidence base of 1st and 2nd generation health disparities research to inform its focus; for example, existing research has demonstrated that patients in diverse health care settings experience gaps in provider-patient and inter-provider communication and coordination, longer wait times, inefficient use of care resources, unnecessary costs, and preventable patient harm (Tuot et al) due to factors such as poor access to HIT resources, non-user friendly HIT, fragmentation of care, unintegrated systems, lack of incentives, and poor access to patient portals (Tieu et al)
Tuot DS, Leeds K, Murphy EJ, et al. Facilitators and barriers to implementing electronic referral and/or consultation systems: a qualitative study of 16 health organizations. BMC Health Services Research. 2015;15:568. doi:10.1186/s12913-015-1233-1.
Tieu L, Sarkar U, Schillinger D, Ralston JD, Ratanawongsa N, Pasick R, Lyles CR. Barriers and Facilitators to Online Portal Use Among Patients and Caregivers in a Safety Net Health Care System: A Qualitative Study. J Med Internet Res 2015;17(12):e275
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. What aspects of this program might be generalizable to other areas of health? How might this apply to your area of research?
The barbershop hypertension intervention engages with the social determinants of health, defined as the “determinants of health which are outside the individual” by Jones et al, by its design entrenched in a social environment that has been shaped by and has responded to historical injustices. The selection of a cultural institution that serves as an open forum for community members to discuss health, among other topics, is generalizable to other areas of health. For example, we may be able to collect patient attitudes and opinions towards our intervention by recruiting patients from outpatient clinics, but may be able to design a more effective intervention by approaching a pre-existing community group in which patients who are seen in outpatient clinics in the safety-net setting already socialize.