Learning Laboratory KPCO African American Center of Excellence

Learning LaboratoryKPCO African American Center of Excellence Terri Richardson, MD Physician Lead, AACE March 2013 Diversity Rx 8th National Conference:Achieving Equity in an Era of Innovation and Health System Transformation

The Bottom Line • “… the world’s ‘wealthiest nation’ can never be satisfied until we are the world’s healthiest.” • President Lyndon B. Johnson March 31, 1966

Perspectives • We can never be the world’s healthiest nation as long as disparities exist among our diverse population. • Eliminating health care disparities and achieving health equity will require a dedicated program and a multifaceted approach. • This work must be woven into the intricate fabric of our health care work.

African American Center of Excellence RELP pilot project AACE proposal developed LACE Established Clinica De La Familia Founded LACE Proposal Developed 2000 2001 2005 2006 2007 2008 RELP team formed

Race and Ethnicity Data • “The collection of race and ethnicity data is the basic science of disparities and without it we don’t’ know where we’re doing, we don’t know if we’re improving, and we don’t know if the interventions we’re trying to implement are making a difference.” (Beal) • RELP- self reported race and ethnicity obtained during the clinical encounter

African American Center of Excellence Centers positioned into Population & Prevention Services RELP pilot project AACE proposal developed LACE Established Clinica De La Familia Founded LACE Proposal Developed 2000 2001 2005 2006 2007 2008 RELP team formed RELP roll out across KPCO AACE Established

4 I’s • Information • Innovation • Integration • Infiltration

Learning Laboratory Focus on Innovation Life in the Petri Dish

Innovation- Focus • The Seed • Findings from the literature • The process • Outcomes • Primary: creating the evidence base, preferred voice • Secondary: general feedback, barriers

What We Learned • General themes: • AA specific information • Caring • Communication • Culture • Trust • Barriers: • Fear • Anxiety/ depression • Lack of knowledge • Lack of positive messages directed at AA • Negative family history • Men don’t want to go to doctors. • Don’t take health/cancer seriously

AA Specific Information • “Like when you watch TV, every time when there is a disease or something, it is basically white people on there.” • “And the medicine is made for them and they get the help and the doctors that they need.” • And very seldom does it have anything to do with a minority person or….you know, African American.”

AA Specific Information • “I think in some ways we really do break down things -thinking that that is a White man's disease vs. this is a Black man's disease.” • “Maybe they should say what it is(statistics) for African Americans…. To say how it affects different cultures.” • “Give some more statistics about colon cancer and the number of people who get colon cancer, male vs. female, cultural things in there.”

Caring • “And to me, you can tell …..when I show up for an appointment here, I can tell what nursing staff or radiology or whatever dept. I'm in, I can tell which ones careand which one's don't.” • “You can tell the ones that have patient care in their interest.” • “I've only had a few people stop me and ask me are you ok? Can I get you something? Do you need assistance? That is something that can't be taught. Either that is part of your make up or it isn't. And most of us can tell when it's not.”

Caring • “So if you get someone that cares, you are more comfortable with them and you are more willing to listen to them and to really consider what they are saying.” • Caring can improve care.

Communication • “It was like always…like you say, when you go to the doctor, he doesn't come to your level. He stay up here and he shout down to you.” • “If she is in a hurry, I'm in a bigger hurry.” • “I think those two cancers [prostate and colon] that doctors have not learned how to address the African American community to the seriousness.” • “Not what she said --- not what she said, but the way she said it.”

Communication • And my mother is like the person who goes with everyone because she does have medical terminology. I find sometimes, when we are with a doctor, I think some of us feel they are talking down to us and not telling us exactly what is going on. They deliberately talk above you.They don't talk down to your level. • I think that's why there is so much hesitation.

Culture • “That's right. It takes a village, doesn't it?” • “Yeah. And roots and collard green leaves, and all of that. Folklore has not been erased from our generation and I even see in my children.” • “One size fits all don't work in my program.” • “If you notice on that now, it says one size fits MOST!”

Culture • “For them[doctors], you know, a lot of it is when I go, it's you need to change your diet. I'm thinking to myself, I don't like what you all eat neither! • “..So down South is grease and more grease and more salt.” • “Yes. And then you fight that too.” • “And then you throw a few veggies in there just for color.”

Trust • “Yeah. I agree with you. I think we …when it comes to our health, we don't trust nobody but us. There you go. And I don't know if that's because of history and information that you've had.” • “Linguistically, she had the kind of voice that you wanted to hear because of the trust factor, ok.” • “Discuss African American doctors that are doing this research. It might make me go.”

Trust • “Cause with me, I don’t care who you are or where you are from or your background. I think everybody has to feel comfortable. And some voices can make you feel more at ease than others.” • “I just mean you know, sometimes as Black people, wewant people that are in our field and also is looking after our interest because we feel they are more able to respond and identify with you. And I think as people, that is how it goes.”

Conclusion • The learning laboratory concept allows: • Thinking outside of the box • Exploring new frontiers • Health care affords many “Petri dish” opportunities. • AACE, conducted a qualitative project to examine a novel concept that has the potential to improve the quality of care for African Americans. • Next steps are to take lessons learned and translate these into practice.

Thank You Terri Richardson, MD Kaiser Permanente Colorado Terri.Richardson@kp.org 303-360-1714

Learning Laboratory KPCO African American Center of Excellence