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Working locally to reduce disparities

May 2008

Published in the May 2008 issue of Today’s Hospitalist

TALK ABOUT HEALTH CARE DISPARITIES in black Americans, and most people immediately think of higher disease rates. But Khan Nedd, MD, president of Hospitalists of West Michigan in Grand Rapids, says that the health care disparities he sees go much deeper.

A practicing hospitalist, Dr. Nedd helped launch the Grand Rapids African American Health Institute (GRAAHI), which promotes health care parity for African Americans through education, research and advocacy. The group has taken on a number of local initiatives, including raising awareness about hypertension through local churches. Dr. Nedd, who is chair of GRAAHI’s board of directors, spoke with Today’s Hospitalist.

Why is it important to look beyond disease prevalence when addressing health care disparities?
For African Americans, health care has historically been a luxury, so we are less tied to prevention, chronic disease management or good patient-provider relationships. African Americans are also more likely to think of disease in terms of a cure. And we have a much broader perception than whites that race has a negative impact on how we’ve been treated and will continue to be treated in any health care system.

Contrast that type of interface with our present health care model, which is based on prevention; chronic disease management; patient-provider relationships; and improving quality, safety, consumer satisfaction and standardization.

It is that difference that defines disparity. Unless we change how African Americans interface with health care, everything that we do on the health care side may perpetuate those same disparities.

What approach do you take to tackle disparities?
Quality is the engine that will drive the move to parity, so the first step is to capture quality data based on race, ethnicity and, probably, language.

Most institutions don’t do that kind of tracking, and I appreciate their concerns. But objective research and data analysis are central to the practice of medicine. Once you capture the data, you can drill down to see if, by race, ethnicity or language, people are not meeting benchmarks. Then, redesign programs to specifically address those patient subsets.

Does your hospital track those data?
Our hospital has a pilot collaborative with GRAAHI to track data for cardiac surgery and for heart failure.

How has your community work affected your clinical practice?
It’s changed my practice phenomenally. As hospitalists, we play a pivotal role in how a hospital functions. Hospitalist practice may present the best opportunity to address these issues through education and quality initiatives.