The Vanderbilt University Medical Center (VUMC) Office of Health Equity (OHE) is pleased to announce the recipients of the first Health Equity Innovation Awards (HEIAs). The awards, which were initiated to close gaps for individuals facing social, cultural, geographic and economic barriers to health care, support innovative ideas and solutions aimed at advancing health equity.
The initial call for proposals went out February 2020. In it, the OHE requested projects focused on access to care, institutional partnerships, education, data utilization and socio-economic factors.
“Certain communities experience systematically worse health outcomes because of social and economic factors,” said VUMC Vice President for Health Equity Consuelo Wilkins, MD, MSCI. “Advancing health equity ensures that all people can attain their highest level of health, regardless of where they live or social circumstances.”
The OHE received 35 proposals from across VUMC, spanning departments, and centered primarily on increasing health care access, expanding internal health equity education offerings, addressing health disparities and the social determinants of health. In total, eight proposals were funded with $7,500. Highlights for each funded award are provided below.
Vanderbilt Familiar Faces Rideshare
Vanderbilt Familiar Faces’ (VFF) Rideshare Program is designed to provide transportation via existing programs like Uber or Lyft to VFF patients who do not have access to personal vehicles or financial support to utilize community transportation resources.
“One of the biggest barriers we have recognized in getting consistent care for our VFF patients is lack of access to transportation to our clinic,” VUMC Hospitalist and assistant professor of Clinical Medicine, Merranda Holmes, MD, who is team lead for the project, explained. “By helping remove the large burden some of our patients face in simply making it to a clinic appointment, we can address acute and chronic health concerns before our patients seek care at the hospital and improve their health and well-being.”
Lack of transportation often results in missed mental health, specialist and dialysis appointments for VFF patients. Those missed appointments often lead to hospitalizations and pose a drastic inequity in access to health care and lead to poor health outcomes. With COVID-19 amplifying these known needs, several VFF patients with chronic medical conditions may also not feel safe or have other barriers to using public transportation. Rideshare services aim to address these barriers.
Visualizing Health Equity
“Visualizing Health Equity through Patient-Reported Health Status,” a project led by VUMC assistant professor and cardiologist Justin M. Bachmann, MD, MPH and senior project manager Emily Kerney, utilizes Patient-Reported Outcome Measures (PROMs) to understand health equity. Bachmann is the medical director for Patient-Reported Outcomes Measurement at the VUMC Office of Population Health.
“PROMs take outcomes that matter to patients, such as how far they can walk, whether they can participate in activities of daily living, et cetera, and turn those outcomes into a number,” Bachmann explained. “What we’re seeking to do is to evaluate those outcomes across age, sex, ethnicity, race and other characteristics to provide a lens for health equity at the population level.”
PROMs accomplish this in the form of questionnaires that allow patients to describe the impact of their health status and clinical care on their everyday lives. The questionnaires are tailored to individual patients based on the care they receive and administered during clinic visits, serving as a clinician-patient communication aid during routine clinical practice. “We believe PROMs are a fundamental part of personalized medicine, and an excellent way to measure health equity,” Bachmann said.
Gender-Affirming Primary Care Educational Modules
The goal of “Gender-Affirming Primary Care Education Modules” is to train more health care providers, both in and out of Vanderbilt, on the administration of hormone therapy for transgender patients.
According to Del Ray Zimmerman, director of VUMC’s Office for Diversity Affairs and LGBTQ Health, transgender patients historically have endured lengthy wait times because of a lack of knowledgeable providers and other structural barriers.
“Access to gender-affirming care is a significant barrier for transgender patients,” he said. “By expanding our provider network and using an informed consent model of care, we can make an indelible impact on health outcomes for this vulnerable population.”
Zimmerman works with Shayne Taylor, MD, assistant professor of Medicine, and LGBTQ Health research analyst Keanan G. Gottlieb on the project, hoping to curb –and, ultimately, eliminate –barriers to accessing healthcare for transgender patients.
Listening: a trainee-directed Equity Assessment and Plan
The “Listening: a trainee-directed Equity Assessment and Plan” (LEAP) proposal intends to drive necessary change to improve health equity at VUMC through a novel trainee-directed approach.
VUMC Radiology & Radiological Sciences associate professor Lucy B. Spalluto, MDMPH and VUMC ambulatory chief resident Pierce Trumbo, MD describe a two-phase approach for LEAP. “Phase 1 will assess trainees’ knowledge, experience and interest in health equity,” Spalluto explained. “In phase 2, we will work with stakeholders to develop an action plan to improve health equity at VUMC.”
“The LEAP proposal is focused on VUMC trainees, residents and fellows,” Trumbo added.
The proposal is a collaboration between VUMC’s Department of Internal Medicine and Department of Radiology. Spalluto and Trumbo aim to pair the needs expressed by VUMC trainees with the knowledge of the Office of Health Equity and other institutional experts to amplify VUMC’s health equity efforts.
Evidence-Based Health Equity
Catherine Hammack-Aviran, a bioethicist for VUMC’s Center for Biomedical Ethics and Society, is spear-heading the “Evidence-Based Health Equity” project to decrease health disparities. Hammack-Aviran’s project will examine policies for the top academic medical centers in the United States to inform VUMC’s policies and practices related to health equity.
“To do that, I want to look at all of the policies that might be related to equity, diversity, inclusion, things like that,” she explained. “Ask how this works, what gaps remain, what issues are solved and what new ones arose.”
“It’s one thing to have a policy on paper,” Hammack noted. “It’s another to implement it in the real world.”
Investigating Barriers to Healthy Food
VUMC Center for Biomedical Ethics and Society program coordinator for the Rooted Community Health Program John Compton is leading the “Investigating Barriers to Healthy Food” program to better understand what obstacles low-income individuals face when trying to buy healthy food.
“We know there’s a relationship between low income and food access,” Compton explained. “This can also be complicated by car access, neighborhood geography and variety of variables. We want to understand what’s going on with this population.”
To do this, the project will interview VUMC employees with annual incomes of $35,000 or less. Compton hopes to learn directly from the medical center community what barriers they face and, ultimately, find a way to mitigate those circumstances.
“By understanding, we can optimize food-related programing within VUMC to support vulnerable staff,” Compton said.
Health Equity Elective for Residents
The “Health Equity Elective for Residents” — developed by VUMC’s Department of Emergency Medicine provider Shannon Markus, MD, MPH and VUMC associate program director for Emergency Residency Carmen Wolfe, MD — aims to teach residents how to describe factors that create health inequities, how those factors prevent individuals from reaching their full health potential and how to identify opportunities for improvement in the health care system.
“We realized there’s a lack of health equity education, and residents throughout the last 12-24 months have expressed a desire for it,” Markus explained.
The program provides a flipped classroom learning model, with case discussions and simulation sessions to drive home its objectives in an interactive way. Participants will also be required to do a quality improvement project to create innovative healthcare solutions for the greater Nashville community.
“We thought this would be a great opportunity to provide that health equity education,”Markus noted.
Eliminating Race-Based eGFR
“Eliminating Race-Based eGFR,” a project by VUMC post-doctoral research fellow Sophia Kostelanetz, MD, MPH, eliminated race as a variable in kidney function tests in June 2020, and since then the team has studied the process of change nationally. Likewise, they’ve sought to better understand the social determinants of health underlying measured differences in kidney function.
“As we all know, race is a social construct,” Kostelanetz said. “It’s not biology.”
Estimated Glomerular Filtration Rate, or eGFR, measures a patient’s level of kidney function and helps determine stages of kidney disease. In equations for calculating this, Black patients were systematically assigned higher values than non-Black patients.
Kostelanetz, alongside other students and residents, concluded such measurement was more harmful than beneficial. She and her team hope to continue working in research and advocacy to eliminate the use of race in individual clinical algorithms both at VUMC and nationally.
To learn more about the Office of Health Equity, and for more detail on the Innovation Awards including future award calls, go to: https://www.vumc.org/healthequity/welcome-office-health-equity.