An article in the March 16 issue of JAMA Surgery summarizes the research and funding priorities for addressing health care disparities in the United States, which were identified at the inaugural National Institutes of Health (NIH)–American College of Surgeons (ACS) Symposium on Surgical Disparities Research.1 The ACS and the National Institute on Minority Health and Disparities (NIMHD) cohosted the conference, which took place in May 2015 at the NIH campus, Bethesda, MD.2
“The goal of the symposium was to create a national research agenda that could be used to prioritize funding for research. We conducted an extensive literature review of existing research, organized the results by theme, and asked attendees to identify what they saw as the top priorities for each theme,” said Adil Haider, MD, MPH, FACS. Dr. Haider is the lead author of the JAMA Surgery article; Vice-Chair, ACS Committee on Health Care Disparities; and Kessler Director, Center for Surgery and Public Health, a joint initiative of Brigham and Women’s Hospital, Harvard Medical School, and the Harvard T.H. Chan School of Public Health, Boston.
Defining themes and priorities
The themes discussed at the symposium were as follows: patient and host factors, systemic factors and access issues, clinical care and quality, provider factors, and postoperative care and rehabilitation. The leading research and funding priorities – identified by the more than 60 researchers, surgeon-scientists, and federal leaders who attended the symposium, and articulated in the JAMA Surgery article – are as follows:
• Improve patient-provider communication by teaching providers to deliver culturally dexterous care and measuring its impact on elimination of surgical disparities.
• Foster engagement and community outreach and use technology to optimize patient education, health literacy, and shared decision making in a culturally relevant way; disseminate these techniques; and evaluate their impact on reducing surgical disparities.
• Evaluate regionalization of care versus strengthening safety-net hospitals within the context of differential access and surgical disparities.
• Gauge the long-term impact of intervention and rehabilitation support within the critical period on functional outcomes and patient-defined perceptions of quality of life.
• Improve patient engagement and identify patient expectations for postoperative and postinjury recovery, as well as their values regarding advanced health care planning and palliative care.
The authors of the JAMA Surgery article concluded that “The NIH-ACS Symposium on Surgical Disparities Research succeeded in identifying a comprehensive research agenda.” In particular, they noted that future research is needed in the areas of patients’ perspectives, workforce diversification and training, and systematic evaluation of health technologies to reduce surgical disparities. Within the context of the larger literature focused on disparity-related research, results also call for ongoing evaluation of evidence-based practice, rigorous research methodologies, incentives for standardization of care, and building on existing infrastructure to support these advances.
Just the beginning
The ACS is “confident that this is just the beginning of a much larger effort and hopeful that the National Institutes of Health and the NIMHD will continue to work with the ACS to build upon the foundation that was set during the symposium by establishing a funding stream to support this important research. Together, we can foster systemic change, effectively eliminating surgical and other health care disparities,” said L.D. Britt, MD, MPH, DSc(Hon), FACS, FCCM, FRCSEng(Hon), FRCSEd(Hon), FWACS(Hon), FRCSI(Hon), FCS(SA)(Hon), FRCSGlasg(Hon), ACS Past-President and Chair, ACS Committee on Health Care Disparities. Dr. Britt is the Brickhouse Professor of Surgery, Eastern Virginia Medical School, Norfolk, and played a critical role in the creation of the committee and in defining the committee’s deliverables, which included a national symposium.
1. Haider AH, Dankwa-Mullan I, Maragh-Bass, et al. Setting a national agenda for surgical disparities research: Recommendations from the National Institutes of Health and American College of Surgeons Summit. JAMA Surg. March 16, 2016. Available at http://archsurg.jamanetwork.com/article.aspx?articleid=2503437. Accessed March 28, 2016.
2. Schneidman D. No quality without access: ACS and NIH collaborate to ensure access to optimal care. Bull Am Coll Surg. 2015;100(8):52-62. Available at: bulletin.facs.org/2015/08/no-quality-without-access-acs-and-nih-collaborate-to-ensure-access-to-optimal-care. Accessed March 28, 2016.