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NIH launches research program to reduce health disparities in surgical outcomes

The National Institute on Minority Health and Health Disparities (NIMHD), part of the National Institutes of Health, has launched an initiative to support research to better understand and address disparities in surgical care and outcomes for disadvantaged populations. The new surgical disparities research program will involve collaborations among several NIH institutes and centers, along with the Agency for Healthcare Research and Quality. Full funding levels will be determined by the number of meritorious grant applications received.

Health disparities are the differences in health status and outcomes that are most often observed across different racial and ethnic populations, as well as across differing socioeconomic status. These disparities can include higher rates of chronic disabling conditions, greater co-morbidity, and greater risk of premature death, as well as poorer quality of life, worse functioning and prolonged recovery from disease.

Research has demonstrated that the benefits of surgical procedures are not equal across the population. For example, a study of surgical disparities in the United States showed an increase in surgical mortality rates among patients with lower socioeconomic status independent of race, age, access to care, hospital facility or insurance status.

“Disparities in surgical care can result in poorer functional outcomes, prolonged rehabilitation, recovery and lower quality of life, particularly for disadvantaged population groups,” said NIMHD Director Eliseo J. Pérez-Stable, M.D. “Racial and ethnic minority and low-income population groups are often times disproportionately affected by access, availability and affordability to the most advanced health care services.”

Research suggests that as much as 11-30 percent of the global burden of disease requires surgical care or anesthesia management or both – a figure that underscores the fundamental role of surgery as part of the essential health care. According to the Centers for Disease Control and Prevention, approximately 51 million inpatient and 53 million outpatient surgical cases are performed in the United States each year. These numbers account for an appreciable share of the healthcare costs and resources.

“We need to better understand the integral role of optimal access to safe surgical care and medical management, which has not been well studied in health services or health disparities research,” said Dr. Pérez-Stable.

The research initiative, which has been approved by the National Advisory Council on Minority Health and Health Disparities, provides R01 and R21 opportunities to understand and address disparities in surgical care and outcomes. It also builds on the concerted efforts of the American College of Surgeons (ACS) and its affiliated institutions in improving access, quality and safe surgical care for all population groups. This includes the establishment of a national research agenda to address surgical disparities, launched by the ACS in May 2015, following a symposium on disparities in surgical care and outcomes held on the NIH campus in Bethesda, Maryland. More than 60 experts from the academic surgical community and Federal agencies deliberated during the two-day meeting to identify research priorities within each of five areas that affect surgical outcomes: patient characteristics, clinician characteristics, healthcare system and access, clinical care and quality, and post-operative care and rehabilitation.

Five overarching priorities for the ACS to carry forward were identified for surgical disparities research:

  1. Improving patient-clinician communication by helping clinicians deliver culturally dexterous, competent care and measuring its effect on the elimination of disparities.
  2. Fostering engagement and community outreach by using technology to optimize patient education, health literacy, and shared decision making in a culturally relevant way; disseminating these technologies; and evaluating their effect on reducing surgical disparities.
  3. Improving care at facilities with a higher proportion of minority surgical and trauma patients. This includes evaluation of regionalization of care versus strengthening of safety-net hospitals with the context of differential access and surgical disparities.
  4. Evaluating the longer-term effect of acute interventions and rehabilitation support within the critical period of injury or illness on functional outcomes and patient-defined perceptions of quality of care.
  5. Improving patient centeredness by identifying expectations for postoperative and post-injury recovery. This includes adhering to patient values regarding advanced health care planning and palliative care needs.

A summary of the symposium was published in JAMA Surgery.

“The research agenda put forward by the ACS has provided a tremendous opportunity for NIMHD to advance scientific knowledge of what causes surgical disparities and effective solutions to address them,” said Irene Dankwa-Mullan, M.D., acting deputy director, Division of Extramural Research at NIMHD. “The new research program will examine hypotheses based on published or evidence-based surgical methods that identify new indications or approaches to improving access, care coordination, outcomes, safety and quality of surgical care for health disparity populations.”