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Accelerating Dissemination: Understand Disparities and Partner with Communities. William E. Cunningham, M.D., M.P.H. Professor of Medicine and Public Health, UCLA. NIH Panel May 9, 2008. Disclosures. Accelerating the Dissemination and Translation of Clinical Research into Practice.

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Accelerating dissemination understand disparities and partner with communities

Accelerating Dissemination: Understand Disparities and Partner with Communities

William E. Cunningham, M.D., M.P.H.

Professor of Medicine and Public Health, UCLA

NIH Panel

May 9, 2008


Accelerating dissemination understand disparities and partner with communities

Disclosures

Accelerating the Dissemination and Translation of Clinical Research into Practice

The Following Faculty have No Relevant Financial Relationships

with Commercial Interests

Dr. William Cunningham

Panel Discussion I: Public and Private-Sector Partners for Collaborative Translation


Disparities in healthcare

Disparities in Healthcare

  • Racial, ethnic, and socioeconomic disparities in care are common

  • General populations, older populations, children

  • Disease populations - CVD, CA, HIV, pain

  • Diagnostic, therapeutic, preventive care


Ways to address disparities

Ways to Address Disparities

  • Document disparities, explain them

  • Examine changes in disparities, explain

  • Evaluate interventions among minorities

  • Anticipate disparities, prevent them


Time trends in health care disparities

Time Trends in Health Care Disparities

  • Disparities greatest when treatment new

  • Magnitude of disparity diminishes over time

  • Disparity “reverses” when new treatment replaces standard treatment

  • Best chance to prevent disparities is to reduce initial gap


Diffusion of innovation

Diffusion of Innovation

Late Adopters

% Use in new technology

Early Adopters

Time

Source: Rogers, 1995


Accelerating dissemination understand disparities and partner with communities

Percent on HAART by Race in HCSUS

P=.002

P=.24

P=.001

P=.001

Eisenman, Cunningham. “Diffusion of HAART” AIDS Patient Care 2007


Community partnership needed to address disparities

Community Partnership Needed to Address Disparities

Many new technologies are being developed, but theydon’t always reach people who need them.

Minorities, low SES groups often “late adopters”, encounter barriers to accessing treatment

Phase II translational research needed to disseminate new technologies to needy groups

Partnering with affected communities essential for dissemination research and addressing disparities

Lenfant C. Clinical Research to Clinical Practice - Lost in Translation? N Engl J Med 2003;349:868-74.


Community based participatory research cbpr

Community-Based Participatory Research (CBPR)*

“A collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings”.

--W.K. Kellogg Foundation (2001)

*Community Partnered Participatory Research


Successful community partnership

Successful Community Partnership

Develop meaningful partnerships

Respect community diversity

Identify and mobilize community assets

Assure long-term commitment

Promote organic development of thought, networks, and cultivate leadership

Community advisory boards (CABs) are necessary, but not sufficient for partnerships


Summary recommendations

Summary Recommendations

  • Identify communities who are likely consumers of technology under development

  • Explore whether new technologies are relevant for conditions or groups where disparities are common or expected

  • Be thoughtful about the decision to partner - who, why, and how

  • Use a memorandums of understanding to guide the partnership and reduce conflicts

  • Look for win-win scenarios and foster long-term relationships


References

References

1.Jones L, Wells KB. Strategies for Academic and Clinician Engagement in Community-Participatory Partnered Research. JAMA 2007;297(4):407-10.

2.Lenfant C. Clinical Research to Clinical Practice - Lost in Translation? N Engl J Med 2003;349:868-74.


Backup slides

BACKUP SLIDES

To follow


Racial and ethnic disparities background data

Racial and Ethnic Disparities –Background Data

  • Infant mortality rates are twice as high among African-American infants as whites

  • Several minority groups suffer and die disproportionately from conditions such as cardiovascular disease, diabetes, asthma, cancer, and HIV/AIDS.


Racial and ethnic disparities background data1

Racial and Ethnic Disparities –Background Data

  • Hispanics and African Americans less likely to receive rehabilitative care after traumatic brain injury.

  • Hispanic and African-Americans receive less curative surgery than whites for non-small cell lung cancer;

  • Hispanics less likely to receive smoking cessation messages.


Racial and ethnic disparities background data2

Racial and Ethnic Disparities –Background Data

  • Hispanics and AA less likely to receive colorectal and breast cancer screening, and influenza immunization

  • American Indians, Hispanic, and AA less likely to receive prenatal care

  • African-Americans are referred less than whites for cardiac catheterization and bypass grafting;


Racial and ethnic disparities background data3

Racial and Ethnic Disparities –Background Data

  • African-Americans and Latinos receive less pain medication than whites for long bone fractures and cancer;

  • African Americans receive fewer referrals to renal transplantation,

  • African Americans receive lower quality treatment of pneumonia, congestive heart failure,

  • AA receive less treatment for HIV/AIDS


Racial and ethnic disparities background data4

Racial and Ethnic Disparities –Background Data

  • AA have lower utilization of preventive services covered by Medicare (e.g., immunizations and mammograms),

  • AA have lower utilization of several other procedures and levels of ambulatory care covered by Medicare.


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