Project Title: “Improving Methods for incorporating Social Determinants of Health Data with Clinical Data”
Sponsor: Weill Cornell Medicine Office of the Dean (Dean’s Diversity and Healthcare Diversity Award)
Project Description: Social and environmental factors strongly determine health outcomes, but are rarely available in electronic health record data sets. In this 1-year project, we supplemented a hospital data set with factors about the patients’ neighborhoods, such as poverty level, public transportation access, and tree cover. We used these factors to supplement a previously validated model that predicts the likelihood of being readmitted to the hospital after discharge. Overall, the social factors did not allow us to predict the chance of readmission more accurately. However, we found that they did improve the predictive power for patients in certain vulnerable groups, such as those who receive Medicaid or are over age 65. The social factors that we can infer from patient neighborhood may be most influential among disadvantaged populations.
Timeline of Project: July 2018-July 2019
Project Title: “Making Numbers Meaningful- Improving Evidence-Based Communication of Numbers in Health”
Sponsor: National Library of Medicine (NIH)
Project Description: Laboratory results, health risk information, environmental indicators of air and water quality. People increasingly have access to massive amounts of data, which could potentially help them understand and manage their health conditions. However, numbers are extremely difficult for many people to understand, and low numeracy is especially prevalent among individuals with less education. That means without assistance, many if not most of our patients will not benefit from this flood of data. Fortunately, a growing body of evidence is available from the psychology, education, and medical literature about how to format and explain numerical information to patients. In this 4-year project, we are collecting and organizing the evidence through a systematic review, and building an online environment to help writers and web developers apply it to their documents and products. The long-term goal is to ensure that medical and health data is always presented in a way that all of our patients can understand and use.
Timeline of Project: September 2018-May 2023
Project Title: WCM Catchment Prostate Cancer Health Impact Program (pCHIP)
Sponsor: Dean’s Health Disparity Research Award
Project Description: Prostate cancer is the most common cancer in the world among men, with significant racial/ethnic disparities in treatment and survival observed. Our project focuses on AA men (a racial group that has the lowest prostate cancer survival rates in New York City, State, and the US) and H/L men (an ethnic group that is less likely to receive therapy for prostate cancer compared to Whites, even when they have more aggressive disease) in the NYPH Brooklyn/Queens catchment. Evidence from randomized clinical trials support the efficacy of decision navigation, with navigated patients showing greater confidence in their decisions about cancer treatment and less regret, both after initial consultation and follow up, when compared to patients in the control group [1, 2]. Despite this evidence supporting decision navigation as a feasible, acceptable, and effective strategy among newly diagnosed men with prostate cancer no studies to our knowledge have specifically focused on DNI among AA and H/L men. Therefore, our team has an opportunity to not only improve access for this group but also pioneer a proven methodology among this vulnerable population. Our study will explicitly identify the influences of shared decision makers along the cancer continuum, which is crucial for elucidating potential social and contextual factors that may contribute to disparities in prostate cancer treatment and prognosis among AA and H/L men. If successful, our proposed intervention has widespread applicability to the treatment of other cancers (e.g. colorectal cancer) that are prevalent among racial/ethnic minorities.
Timeline of Project: July 1, 2019-June 30, 2020
Co-PIs: Madeline Sterling, MD, MPH and Nicola Dell, PhD
Project Title: Exploring The Impact of Technology to Address Workflow, Training, and Equity Issues Faced by Home Health Aides Caring for Adults with Heart Failure
Sponsor: Robert Wood Johnson Foundation
Project Description: Home health aides often serve as the eyes and ears for patients in the home, but few studies and interventions have focused on their contributions to patient care. In heart failure, a chronic disease that requires a high degree of self-care, home health aides assist patients frequently (they weigh them, prepare low salt meals, remind them to take medications, etc.), but the majority have not received training on the disease and often have trouble reaching other members of the healthcare team by phone when they try to report clinical changes in the field. Dr. Madeline Sterling (Assistant Professor of Medicine, Weill Cornell Medicine) and Dr. Nicola Dell (Assistant Professor, Cornell Tech) think that technology could help.
Drs. Sterling and Dell, both members of the Cornell Center for Health Equity, were awarded a two-year grant from Robert Wood Johnson Foundation to examine how technology impacts home health aides’ workflow while caring for patients with heart failure in the community. In addition, they will examine ways in which technology could improve training and equity among this workforce. The 2-year grant is part of an RWJF initiative exploring how technology’s impact on infrastructure could help or hinder efforts to improve health equity in the United States.
This project will be carried out with 1199SEIU – Home Care Industry Education Fund of the 1199 Service Employees International Union (SEIU) United Healthcare Workers East — the largest healthcare union in the nation. The Home Care Education Fund is led by Faith Wiggins, who is a member of the Cornell Center for Health Equity.
Timeline of Project: September, 2019- September, 2021
Project Title: Understanding Racial and Ethnic Differences in Utilization of Hematopoietic Cell Transplantation for Hematologic Malignancies
Sponsor: Dean’s Diversity and Healthcare Disparity Research
Project Description: Hematopoietic cell transplantation (HCT) is a potentially life-saving therapy for many diseases including hematologic malignancies, bone marrow failure syndromes, autoimmune disorders, and other hereditary disorders. However, past work has shown that Non-Hispanic Black (NHB) and Hispanic patients are significantly less likely to receive HCT than Non-Hispanic White (NHW) patients for leukemia, lymphoma, and multiple myeloma. The reasons for these patterns are not well-understood. We therefore propose a mixed methods study to understand the reasons for these differences in utilization and to identify barriers and facilitators to transplantation among racial/ethnic minorities. The conceptual framework for our proposal is the Andersen model of healthcare utilization, a well-established framework for understanding both individual and societal determinants of healthcare utilization. Specific Aim 1 will identify contemporary racial differences in utilization of autologous HCT in the linked Surveillance, Epidemiology, End Results (SEER)-Medicare database, controlling for determinants of health services utilization. The SEER-Medicare database is a valuable tool for following a large subset of cancer patients in the United States through diagnosis and treatment of their cancer. Specific Aim 2 will identify barriers and facilitators to HCT from the patient’s perspective using semi-structured interviews. We will conduct interviews at NewYork-Presbyterian Weill Cornell Medicine (a high-volume transplant center) and Brooklyn Methodist Hospital (a community referral source). By identifying predictors of HCT utilization and barriers to transplantation among NHB and Hispanic patients, we will provide critical information needed to develop interventions to improve utilization of HCT for these patients.
Timeline of Project: July 1, 2020- June 30, 2021