R01NR020752

Improving Chronic Disease Outcomes Across the Lifespan by Addressing Structural Racism - Project Summary

Structural racism is embedded in societal structures that limit opportunities and resources for racialized groups. This manifests as social determinants of health (SDOH) - the social circumstances in which people are born, live, and age - and as racial/ethnic health disparities. Professional medical organizations and insurers recommend screening for and addressing adverse SDOH within healthcare delivery. As a result, healthcare systems, especially those serving low-income patients, are implementing SDOH screening.

Despite this rapid uptake, critical knowledge gaps remain regarding the equitable implementation and effectiveness of SDOH screening/referral systems on improving disease outcomes. Our team's work on the We Care SDOH system, which leverages existing clinical staff and workflows to address families' social needs, has demonstrated its effectiveness in increasing referrals to social services and receipt of resources among low-income families. We Care has been cited as an evidence-based SDOH intervention by the American Academy of Pediatrics.

However, our recently completed hybrid effectiveness-implementation randomized controlled trial (RCT) found significantly higher rates of double loss among caregivers of color (compared to white caregivers), whereby their unmet needs were not addressed despite being disclosed. These results are likely due to suboptimal implementation related to multiple levels of discrimination that caregivers of color face in the healthcare and social service systems.

With an interdisciplinary team of SDOH, implementation, antiracism, and practice-based researchers, we will apply an antiracism lens to We Care and develop an implementation toolkit aimed at mitigating unequal treatment for patients of color. We will conduct a hybrid effectiveness-implementation study with a stepped wedge cluster RCT design in four large family medicine (FM) clinics that serve racially/ethnically diverse low-income families from Worcester, Massachusetts.

Our specific aims are to:

(1) Refine the We Care implementation protocol using an antiracism lens and community engagement approach to:
(a) Conduct key informant interviews with families to identify racism-related barriers to SDOH screening/referral.
(b) Present these barriers to systems-level stakeholders to elicit input on strategies to address patient concerns.
(c) Create an antiracist-informed toolkit for the implementation of SDOH screening/referral systems.

(2) Implement We Care by deploying the refined protocol in FM practices and assess implementation outcomes including equity, appropriateness, and patient-centeredness.

(3) Evaluate the effectiveness of We Care on prevalent pediatric and adult chronic disease outcomes.

This proposal has the potential to create novel community- and patient-engaged strategies for implementing SDOH screening and referral systems into healthcare and social service systems, with the potential to reduce racial/ethnic health inequities. It is aligned with the National Institute on Minority Health and Health Disparities' mission and Healthy People 2030's overarching goal to "eliminate health disparities."

University Of Massachusetts Medical School

NURSES UNDERSTAND THAT IMPROVING HEALTH AND WELL-BEING MEANS ADDRESSING PEOPLE'S NEEDS IN MULTIPLE SETTINGS, CONTEXTS, AND OVER THE WHOLE LIFE COURSE. SCIENCE SUPPORTED BY THE NATIONAL INSTITUTE OF NURSING RESEARCH (NINR) USES THIS HOLISTIC PERSPECTIVE TO IMPROVE INDIVIDUAL AND POPULATION HEALTH AND ADVANCE HEALTH EQUITY. NINR-SUPPORTED RESEARCH PROMOTES HEALTH AND WELL-BEING BY ADDRESSING NEEDS AT MULTIPLE LEVELS INDIVIDUAL, FAMILY, COMMUNITY, AND SOCIETAL LEVELS AND DEVELOPING TREATMENT AND PREVENTION STRATEGIES THAT ARE RESPONSIVE TO THE REALITY OF PEOPLE'S LIVES. NURSES KNOW PEOPLE, AND PEOPLE TRUST NURSES. PATIENT AND FAMILIES INTERACT WITH NURSES MORE THAN ANY OTHER CLINICIANS. NURSING SCIENCE USES THIS SPECIAL RELATIONSHIP TO BETTER UNDERSTAND PATIENTS, FAMILIES, AND COMMUNITIES AND THE MANY FACTORS THAT INFLUENCE THEIR HEALTH. NURSING SCIENCE SUPPORTED BY NINR USES THIS KNOWLEDGE TO DEVELOP STRATEGIES FOR IMPROVING HEALTH AND WELLNESS ACROSS POPULATIONS, HEALTH CARE SETTINGS, AND THE LIFESPAN, WITH AN EMPHASIS ON ACHIEVING HEALTH EQUITY. NINR-SUPPORTED SCIENTISTS HAVE DEVELOPED INTERVENTIONS FOR: SUPPORTING PARENTS OF PREMATURE INFANTS, PROMOTING HIV PREVENTION IN UNDERSERVED POPULATIONS, IMPROVING TRANSITIONAL CARE LEADING TO BETTER OUTCOMES AND COST-SAVINGS, AND HELPING INNER-CITY CHILDREN MANAGE ASTHMA. NURSING SCIENCE TRANSCENDS THE BOUNDARIES OF DISEASE AND RESEARCH DISCIPLINES TO BETTER UNDERSTAND THE EXPERIENCES OF INDIVIDUALS AND FAMILIES LIVING WITH ILLNESS AND TO DEVELOP PERSONALIZED APPROACHES THAT MAXIMIZE HEALTH AND WELL-BEING FOR INDIVIDUALS AT ALL STAGES OF LIFE, ACROSS DIVERSE POPULATIONS AND SETTINGS. NINR-SUPPORTED SCIENCE USES NURSING SCIENCE'S UNIQUE, PATIENT AND COMMUNITY-FOCUSED PERSPECTIVE AND WIDE REACH ACROSS CLINICAL AND COMMUNITY SETTINGS TO ADVANCE OUR UNDERSTANDING OF THE SOCIAL DETERMINANTS OF HEALTH: THOSE FACTORS THAT ARE AT THE ROOT OF THE INEQUITIES THAT WE SEE, SUCH AS FOOD INSECURITY AND ACCESS TO HEALTHCARE. NINR RESEARCH EFFORTS IN WELLNESS INVESTIGATE THE KEY BIOLOGICAL, BEHAVIORAL, AND SOCIAL FACTORS THAT PROMOTE LONG-TERM HEALTH AND HEALTHY BEHAVIORS AND PREVENT THE DEVELOPMENT OF ILLNESS ACROSS HEALTH CONDITIONS, SETTINGS, AND THE LIFESPAN. RESEARCH IN WELLNESS IS ALSO FOCUSED ON DEVELOPING AND TESTING CULTURALLY APPROPRIATE INTERVENTIONS TO PROMOTE HEALTH AND PREVENT ILLNESS IN MINORITY AND UNDERSERVED GROUPS. NINR ALSO SUPPORTS SCIENCE TO ASSIST INDIVIDUALS, FAMILIES, AND HEALTH CARE PROFESSIONALS IN MANAGING ADVANCED, SERIOUS ILLNESS, AND PLANNING FOR END-OF-LIFE DECISIONS. IN ADDITION, NINR PROMOTES TECHNOLOGICAL ADVANCEMENTS THAT ADDRESS A RANGE OF HEALTH CARE CHALLENGES AND FACILITATE THE DELIVERY OF REAL-TIME PERSONALIZED INFORMATION TO INDIVIDUALS AND FAMILIES, HEALTH CARE PROVIDERS, AND COMMUNITIES. FINALLY, NINR HAS A LONGSTANDING AND CONTINUING COMMITMENT TO DEVELOPING THE NEXT GENERATION OF NURSE SCIENTISTS: THOSE INDIVIDUALS AND TEAM MEMBERS WHO WILL CARRY THE FIELD OF NURSING SCIENCE INTO THE FUTURE. IN ORDER TO PREPARE AN INNOVATIVE, DIVERSE, AND TALENTED NEXT GENERATION OF NURSE SCIENTISTS, NINR SUPPORTS A VARIETY OF TRAINING OPPORTUNITIES FOR SCIENTISTS AND TRAINEES AT ALL CAREER LEVELS, PARTICULARLY THOSE AT AN EARLY CAREER STAGE WHO ARE SO CRITICAL TO SUSTAINING THE FUTURE OF INNOVATIVE RESEARCH AND HIGH QUALITY HEALTH CARE.

93.361 - Nursing Research

National Institute of Nursing Research (NINR) [HHS - NIH]

Worcester, Massachusetts 01655 United States

Single Zip Code

Understanding and Addressing the Impact of Structural Racism and Discrimination on Minority Health and Health Disparities (R01 Clinical Trial Optional) (RFA-MD-21-004)

Amendment Since initial award the total obligations have increased 272% from $889,418 to $3,310,322.