work for which patients under which circumstances.
“We have about $1.3 billion to disperse to conduct
clinical research through 2019,” she said. PCORI’s
disparities program does “not fund studies that
describe disparities or even studies of what drives
disparities,” Dr. Hasnain-Wynia said. “We are very
focused on observational studies that can really help us
get to the solutions,” particularly research that would
assist in addressing notable gaps in clinical therapeutic evidence.
“Disparities are caused by multiple factors at multiple levels,” she added. “So there is no quick fix. If
there were, I think we would have made it long ago.”
Plotting the agenda
A central purpose of the symposium was to develop a
research agenda for the five cross-cutting themes men-
tioned earlier: patient factors, systemic factors and access,
clinical care and quality, provider factors, and postop-
erative care and rehabilitation. Dr. Dankwa-Mullan
set the tone for the thematic presentations, noting, “In
the health care setting, disparities often present as a
difference in the quality or quantity of care, but there
are really several other dimensions that may influence
disparities.” Health care disparities exist across many
clinical conditions and many health care settings, she
said. “Across the NIH, we are really interested in mea-
sures. What will actually reduce disparities?”
To help answer this question, Dr. Haider explained
that surgical residents were invited to present sum-
maries of existing literature relating to each theme,
followed by commentary from experts as to what
should be studied.
Navin R. Changoor, MD, a general surgery resident
at Howard University Hospital, Washington, DC,
said provider level factors refer to variations in practice patterns, such as provider bias, competencies, and
awareness, which may influence quality of care and
outcomes. Dr. Changoor also spoke about the lack of
diversity in the surgical workforce.
Olivia D. Carter-Pokras, PhD, associate professor in
epidemiology, University of Maryland School of Public
Health, Baltimore, said that little research has been
conducted on the impact of cultural competency edu-
cation. Current efforts to teach cultural competence
to physicians often reinforce stereotypes, she added
According to Dr. Carter-Pokras, some of the existing
literature on provider factors indicates that it is possible
for people to unlearn implicit biases.
“What we really need cultural competency education to evolve into is teaching skills that actually can
be applied to improve care, such as learning to work
with translators effectively,” she said.
Lisa Kodadeck, MD, a surgery resident at Johns Hopkins Hospital, said patient factors that affect surgical
disparities include demographics, physiology, SES,
and culture. According to Dr. Kodadeck, blacks are
less likely than whites to receive appropriate surgical services and have higher operative mortality rates
and morbidity. Hispanic patients, on the other hand,
experience similar or better operative mortality in comparison with white counterparts. In addition, patients
of lower SES are less likely to receive surgical services
and more likely to experience operative mortality.