2014 10:39:54 AM

Health Disparities

Training in Health Disparities: We have developed interdisciplinary programs to train the future Health Disparities (HD) researchers, professionals and paraprofessionals with the aim of increasing minority participation in clinical trials. For example, the LSUHSC-New Orleans-MBCCOP, in partnership with the NIH-funded Dillard-LSUHSC Minority Health and Health Disparities Research Center in New Orleans, provides opportunities for undergraduate and medical students to engage in mentored research during the summer and throughout the academic year. These two programs have also partnered with MBPCC and Northwestern University in Chicago to develop a two-year Clinical Research Associates (CRA) program to train African American nurses to become certified clinical researchers. Thirty one nurses have been trained in the past four years by the program. In addition, the LSUHSC-MBCCOPs, in partnership with the Louisiana Breast and Cervical Health Program, have provided training opportunities and development of patient navigators who have made a significant contribution to ameliorating cancer health disparities in our hospitals and clinics. The LSUHSC-MBCCOPs and NCCCP at MBPCC have required the attendance of the clinical research associates and physicians at training opportunities provided during the cooperative group meetings and professional societies.

Community Based Participatory Research (CBPR): The scientific literature in cancer prevention and control has demonstrated that interventions that are designed and delivered with community input are more effective. The initial community outreach program of our MBCCOPs has matured into CBPR programs whereby our scientists meet at the community setting to discuss their research and understand the needs of the community. Together scientists and community members design research projects to be conducted with community participation. One example is the recently awarded Community-Academic Partnership to Address Health Disparities in New Orleans (NIH-NIMHD R24MD008121). Through this program The LSUHSC-New Orleans Cancer Center, the Lower Ninth Ward Community, and the federally qualified community health center (St Cecilia), have partnered on a number of projects that include: HPV-related cervical cancer prevention, increasing cancer early detection, obesity, exercise, improving the built environment to facilitate health and wellness, black men’s health, and increasing access to the medical home.

Health Literacy in the Underserved Minority Communities: Drs. Terry Davis and Connie Arnold from LSUHSC-Shreveport have pioneered the study of health literacy and its effect on patient care and the interventions needed to overcome this barrier. For the past 30 years, Dr. Davis has led an interdisciplinary team investigating the impact of patient literacy on health and healthcare. Her work helps define better written/printed documents for low-literate patients. In addition, she has developed activities aimed at training staff to increase communication efficacy with patients being recruited to participate in research studies. Seminal achievements include development of the Rapid Estimate of Adult Literacy in Medicine (REALM) and creation of user- friendly patient education and provider training materials that are used nationally. A list of relevant publications by Drs. Davis and Arnold are included in the Reference Section.

Tobacco Cessation Initiative: In 2002, through the use of an excise tax on cigarettes, Dr. Sarah Moody-Thomas from the LSUHSC School of Public Health, in partnership with Louisiana’s safety-net healthcare system, created the Tobacco Control Initiative (TCI) aimed at facilitating the implementation of the US Public Health Service Clinical Practice Guideline for the Treatment of Tobacco Use in the LSU Health network of public hospitals. The goal of the program is to reduce the prevalence of tobacco use by identifying all tobacco users and providing evidence-based treatments that are appropriate for and acceptable to the patient population. The TCI offers standardized cessation services and provides designated personnel, clinician training, behavioral counseling, free or low cost pharmacotherapy and quit line referral. Performance appraisal and feedback are used to ensure cessation and services are integrated into routine care for all patients. The program emphasizes identification of all eligible patients (smokers), ensures that each patient receives the appropriate intervention and standardizes interventions system-wide. This structure and support allow the program to identify sub-groups of patients and specify patient behaviors to target with more focused interventions. The TCI uses electronic health record (EHR) supported, clinic based interventions. The extent and aggressiveness of the electronically-maintained tobacco-related information used by the program led to being recognized by the National Association of Public Hospitals for its innovative use of information technology to advance performance improvement. Although implemented prior to Meaningful Use (MU) standards, the questions asked of patients and the data collected within the LSU Health system are in close alignment with and performance exceeds Stage 2 MU criteria. This “real world” data indicates 90% of patients are screened for tobacco use at least quarterly, and annually more than 60,000 unique patients (approximately 29% of this low-income under-insured population) report smoking within the past 30 days. The main outcome measure, “sustained quit rate,” defined as the fraction of recent smokers who make a quit attempt and sustain cessation for over 90 days, stands at 7%. The TCI program provides a framework within which many population health programs can be developed, implemented, and evaluated.

New Initiatives

Increased use of Louisiana Databases to address Health Disparities: The HarmonIQ database and the LTR plan to develop “use cases” to support team-focused mining datasets for research and cancer disparities that are unique to Louisiana. This approach will allow investigators to use the Big Data infrastructure provided by the LSU Center for Computation and Technology and  to ask questions on health disparities. This model uses a multidisciplinary team approach that brings together biomedical scientists and data scientists. An example of such studies is described below.

Obesity and Cancer Outcomes in Louisiana: A high prevalence of obesity and a high mortality in cancer are found in Louisiana. Although obesity promotes chronic inflammation and may promote carcinogenesis in some tumors, the correlation between these two conditions in the population of Louisiana is unknown. A multidisciplinary team of experts in obesity, nutrition, and cancer epidemiology (LTR) are developing case studies exploring what types of cancers appear to be related to obesity in the Louisiana population, how obesity influences the treatment options, and what relation exists between obesity and tumor stage at diagnosis. These questions will be used in a project currently in the planning stages that will be queried through the various databases starting with the LTR, LaHIE and HarmonIQ. The results will be vetted and discussed by the multidisciplinary team and hypotheses can be generated for studies that will test the hypotheses and hopefully draw conclusions that may have clinical application or result in intervention studies.