Literature Review

Q&A: Prioritizing health equity with Emory Healthcare’s Chief Transformation Office CDW Healthcare - Patient-Centered Care; by Teta Alim; 11/19/24 Most healthcare organizations regularly prioritize goals to improve the patient experience and increase clinician satisfaction, aligning with the Quintuple Aim. Atlanta-based Emory Healthcare created the role of chief transformation officer to focus on these areas, and in July 2023, Dr. Amaka Eneanya became the first to fill the role. ... What would you say were the top three lessons you learned during the first year in your new role? ENEANYA: It's been a great year. For lesson one, as someone coming from a different part of the U.S., ingraining yourself and getting to know the people and the culture of the organization that you’re in, that’s important to determine the change readiness of an organization. ... The second lesson is that change is exciting. There's a lot of trepidation with change, and part of being effective with change management and transformation is really garnering excitement. ... The third lesson that continues to be pervasive in my career is that health equity is poorly understood. ... You have to start with the basic foundation and concepts of health equity before you can make initiatives, otherwise people won't understand what you're doing, and they might have a visceral response to what you're doing because of the misinformation around health equity. 

Prevalence of unrecognized cognitive impairment in federally qualified health centersJAMA Network Open; Ambar Kulshreshtha, MD, PhD; Erik S. Parker, PhD; Nicole R. Fowler, PhD; Diana Summanwar, MD; Zina Ben Miled, PhD; Arthur H. Owora, PhD; James E. Galvin, MD; Malaz A. Boustani, MD, MPH; 10/24This cross-sectional study found that unrecognized cognitive impairment is ubiquitous among older adults from underrepresented, minoritized racial and ethnic groups and those who are socially vulnerable receiving primary care from FQHCs [federally qualified health centers]. To overcome the disparity in early detection of cognitive impairment, timely, equitable, scalable, and sustainable detection approaches need to be developed.

New Health Equity Guide from Center to Advance Palliative Care provides a roadmap to transform care for black patients with serious illness Cision PRWeb; by Center to Advance Palliative Care; 11/13/24 Having medical concerns dismissed, not being believed when reporting pain, and facing multiple barriers to care are just three of the experiences reported to Center to Advance Palliative Care (CAPC) in a focus group of Black patients with serious illness. In fact, when Black people in the United States are living with a serious illness like cancer, heart failure, or dementia, they experience disproportionately high suffering compared to white patients—often due to poor pain management, low-quality communication from their care teams, and high family caregiver burden. To address these inequities, CAPC has released a new, comprehensive guide, Advancing Equity for Black Patients with Serious Illness, to equip palliative care leaders and health equity change agents with practical tools to implement meaningful change. Drawn from research, examples of health equity initiatives from across the country, and the wisdom of health equity leaders, the guide provides a practical roadmap for transforming care for Black patients, and their families and caregivers.

Underrepresentation of Black men in physician assistant and associate trainingJAMA Network Open; Lucy W. Kibe, DrPH, MS, MHS, PA-C; Katrina M. Schrode, PhD; Samuel Paik, MPAS, PA-C; Dominique Frias-Sarmiento, MA; 10/24In this cohort study of PA applicants and matriculants, Black men remained substantially underrepresented despite overall growth of PA training programs. The low representation among matriculants was due in part to the low numbers of applicants but also to substantially lower matriculation success. This persistent underrepresentation highlights systemic barriers and underscores the need for targeted interventions to achieve a more representative health care workforce. To achieve equitable admissions, each PA program should aim to evaluate Black male applicants and matriculate Black men annually.

Funding approved for homeless hospice program SacCountyNews, Sacramento, CA; by Janna Haynes; 10/22/24 The Board approved, at its Oct. 22nd meeting, up to $1,137,788 in funding to complete construction on Joshua House, a facility that provides end-of-life comfort care for homeless individuals with terminal illnesses, after being discharged from an acute care hospital. Joshua’s House specifically provides a location for homeless patients to receive home-like hospice services when they, by definition, do not have a home to receive such care and may otherwise be unsheltered at the time of passing. Joshua’s House provides shelter, food, clothing and certain volunteer comfort services. In addition, YoloCares will provide licensed expert/specialized end-of-life care for individuals and families facing a life-limiting illness. Yolo Cares has provided high-quality hospice care across the six-county region for nearly 50 years. YoloCares also recently became an enhanced Care Management and Community Supports provider through CalAIM.

Palliative care access for indigenous populations: Removing barriers and reducing disparities ECRI, Plymouth Meeting, PA; by Eileen Cornish; 10/22/24 ... Indigenous populations across North America face barriers to healthcare due to a combination of historical, social, economic, and systemic factors. Key barriers include historical trauma and distrust, remote or rural geography, economic disparities, cultural differences, systemic racism, and discrimination.  ... For this topic, ECRI librarians identified 35 studies, including six systematic reviews, that discuss barriers to palliative care for Indigenous people across North America. ...  Removing Barriers: Here are several key takeaways from the studies we identified. Other barriers are likely exist; however, these common themes emerged from the studies identified in ECRI’s review.

Caring for Hindu patients at the end-of-life: A narrative review Cambridge University Press; by Brinda Raval Raniga, MD, Savannah Kumar, MD, Rebecca McAteer Martin, MD, and Craig D. Blinderman, MD; 10/3/24  This paper reviews the existing literature to identify specific challenges that may arise in the context of providing palliative and end-of-life (EOL) care for Hindu patients in the physical, psychological, and spiritual domains. We offer practical strategies where appropriate to mitigate some of these challenges. We review how the Hindu faith impacts EOL decision-making, including the role of the family in decision-making, completion of advance directives, pain management, and decisions around artificial nutrition and hydration (ANH) and cardiopulmonary resuscitation (CPR). 

Clearing a path for diverse leadership Becker's Hospital Review; by Mariah Taylor; 9/20/24 Creating a diverse nurse workforce and leadership team takes intentionality. "Diversity doesn't happen by itself. It takes effort, thought and planning," Jesus Cepero, PhD, RN, chief nursing officer, senior vice president patient care services at Palo Alto, Calif.-based Stanford Medicine Children's Health, told Becker's. Dr. Cepero first joined Lucile Packard Children's Hospital Stanford four years ago and said part of what made him comfortable joining was seeing the diverse team of executives already at the hospital. "Since then, our diversity at the executive level has grown," he said. "This shift has transformed our culture, promoting a sense of safety and belonging, which is key to fostering a diverse and inclusive workforce." Now, he oversees 3,500 employees and one of his priorities is to further diversity work at the system. Here are his three guidelines for building a more diverse workforce and leadership team:

Companies committed to DEI but may talk about it differently: surveyMcKnight's Senior Living; by Kathleen Steele Gaivin; 9/19/24Social impact is a growing corporate strategy, even if it isn’t talked about, according to the results of a survey by the Association of Corporate Citizenship Professionals and YourCause from Blackbaud. “The 2024 results show how the current landscape of corporate social impact is both dynamic and demanding, reflecting a field that is a priority to key stakeholders, including employees, customers, investors and community,” according to ACCP, which surveyed 125 companies in April. Ninety-six percent of the companies reported a continued commitment to diversity, equity and inclusion, or DEI, initiatives... DEI has become a polarizing political issue this year, according to ACCP. That doesn’t mean that companies are backing away from their commitments, but they may be changing the way they talk about DEI.Publisher's note: The Louisiana ~ Mississippi Hospice & Palliative Care Organization, a Hospice & Palliative Care Today sponsor, has a Health Disparities and Inequities Taskforce that has completed, among several other things, a Standards of Excellence certification process around diversity, equity, inclusion, and belonging.

Racial disparities in cancer stage at diagnosis and survival for adolescents and young adultsJAMA Network Open; Kekoa Taparra, MD, PhD; Kaeo Kekumano, BS; Ryan Benavente, BS; Luke Roberto, BS; Megan Gimmen, BS; Ryan Shontell, PhD; Henrietta Cakobau; Neha Deo, MD; Connor J. Kinslow, MD; Allison Betof Warner, MD, PhD; Curtiland Deville, MD; Jaimie Z. Shing, PhD, MPH; Jacqueline B. Vo, PhD, MPH, RN; Manali I. Patel, MD, MPH; Erqi Pollom, MD, MS; 8/24This cohort study of AYA [adolescent and young adult] patients suggests that stage at diagnosis and survival varied across races for the 10 deadliest AYA cancers. ... the risk of late-stage diagnosis was significantly higher for Asian, Black, and Native Hawaiian or Other Pacific Islander patients compared with White patients. However, compared with White patients, the risk of death was significantly higher for American Indian or Alaska Native, Black, and Native Hawaiian or Other Pacific Islander patients but lower for Asian patients. These results support the need for tailored interventions and informed public policy to achieve cancer care equity for all races.

Rita and Alex Hillman Foundation announces $500,000 in funding for nine projects to improve serious illness and end of life care Globe Newswire; by Rita & Alex Hillman Foundation; 9/10/24 The Rita and Alex Hillman Foundation ... announced nine grants to support innovative, early-stage interventions that address the serious illness and end of life needs of marginalized populations. The $500,000 in funding, part of a collaborative effort with The Arthur Vining Davis Foundations, will advance nursing-driven initiatives that improve care for diverse populations and expand access to high-quality end of life services. ... This year’s grants demonstrate a commitment to the design, development, and delivery of better and more equitable care. The 2024 HSEI grant recipients are:

ASCO palliative care expert panel provides recommendations to integrate health equity into guideline development OncLive, Cranbury, NJ; by Kyle Doherty; 9/4/24 The ASCO Palliative Care Expert Panel [American Society of Clinical Oncology], in collaboration with ASCO’s Health Equity and Outcomes Committee, has published recommendations for integrating health equity measures into future guideline updates. Recommendations advocated for partnerships with increased representation from historically marginalized groups and patient and community-based advocates; a reinforcement of implicit bias training for Expert Panel members as a component of guideline preparation; stratified recommendations and/or guidelines for additional groups; and the review and appraisal of future recommendations by the Expert Panel, patient as well as community advocates, and ASCO reviewers for the inclusion of proper health equity measures before publication.

Healthcare leaders navigate pushback to health equity programsModern Healthcare; by Mari Devereaux; 8/27/24Brewing opposition to health systems' programs on equitable care for patients of color could make health systems need to justify or reframe their efforts. A nonprofit conservative law firm earlier this month filed a federal civil rights complaint with the Health and Human Services Department against Cleveland Clinic, alleging its minority stroke program and minority men’s center discriminate against other patients. The center and program offer treatments, prevention services and specialist referrals tailored to meet the needs of Black and Latino patients... [Alternatively...] “There's a war on DEI and health equity right now, because people don't really understand what's happening in these programs,” said Dr. Georges Benjamin, executive director of the American Public Health Association. Health equity programs aren’t giving more care to one patient versus another based on race or ethnicity, Benjamin said. Instead, they are identifying high-risk patients with a likelihood for poor outcomes, who are often people of color, and putting together resources to help those individuals get the same care as others, he said.