Reducing Disparities through Research and Translation Programs: A focus on researchers and their actions Dr. Debra Joy Pérez Senior Program Officer Robert Wood Johnson Foundation

A National Program of the Robert Wood Johnson Foundation RWJF Commitment to Diversity Diversity and inclusion are core values of the Robert Wood Johnson Foundation, reflected in our Guiding Principles. We value differences among individuals across multiple dimensions including, but not limited to, race, ethnicity, age, gender, sexual orientation, physical ability, religion and socioeconomic status. We believe that the more we include diverse perspectives and experiences in our work, the better able we are to help all Americans live healthier lives and get the care they need. In service to our mission, we pledge to promote these values in the work we do and to reflect on our progress regularly.© Diversity is a Core Value

A National Program of the Robert Wood Johnson Foundation Finding Answers: Disparities Research for Change Conduct systematic reviews of racial and ethnic health care disparities interventions Grant funds to evaluate innovative, practical solutions Disseminate results to encourage health care systems to address gaps in care

A National Program of the Robert Wood Johnson Foundation Systematic Reviews Reviewed 200+ articles –Cardiovascular disease –Diabetes –Depression –Breast cancer –Cultural leverage –Pay-for- performance incentives Round 2  Ongoing  Cervical Cancer  Breast Cancer  Colorectal Cancer  Asthma  HIV/AIDS FAIR Database

A National Program of the Robert Wood Johnson Foundation Systematic Review Lessons Multi-factorial interventions that address multiple leverage points along a patient’s pathway of care Culturally tailored QI > generic QI Nurse-led interventions with multidisciplinary teams and close tracking and monitoring of patients. Chin MH, et al. Med Care Res Rev 2007; 64:7S-28S.

A National Program of the Robert Wood Johnson Foundation Finding Answers Disparities Research for Change A National Program of the Robert Wood Johnson Foundation Intervention Strategies Patient –e.g. self-management, empowerment, narratives Provider –e.g. training, report cards Health Care Organization –e.g. system redesign, reminders, telehealth Community –e.g. community health workers, peer educators Policy –e.g. performance incentives

A National Program of the Robert Wood Johnson Foundation Lessons from Grantees Organization culture and Q/I infrastructure are critical Knowledge/attitude interventions helpful but not sufficient Context and tailoring are critical Directly involve the target population Multi-factorial, multi-target interventions

A National Program of the Robert Wood Johnson Foundation Finding Answers Disparities Research for Change A National Program of the Robert Wood Johnson Foundation Knowledge, Attitudes, Data Helpful but not Sufficient Harvard Vanguard Medical Associates, Inc. –Physician Group Practice in Massachusetts –Cultural competency training + disparity report cards

A National Program of the Robert Wood Johnson Foundation Lack of Awareness Among Providers

A National Program of the Robert Wood Johnson Foundation Knowledge, Attitudes, Data Helpful but not Sufficient “Not us” –Results: –Increased acknowledgement of disparities –No change in clinical outcome Sequist, et al., J Gen Intern Med (5): Sequist, et al., Ann Intern Med :

A National Program of the Robert Wood Johnson Foundation Disseminating Interventions Assess Target Population Interventions Goodness-of-fit Stakeholders Organizational Capacity

A National Program of the Robert Wood Johnson Foundation Disseminating Interventions Select Decide to adopt or adapt intervention Make necessary changes Prepare Organization Pretest –Staff –Community advisory board –Patients

A National Program of the Robert Wood Johnson Foundation Disseminating Interventions Pilot Develop implementation plan, policies, protocols Test Implement Collect process and outcome data McKleroy, V. S. et al. (2006). Adapting evidence-based behavioral interventions for new settings and target populations. AIDS Education and Prevention, 18, Supplement A,

New Connections: Research Network for under- represented scholars

A National Program of the Robert Wood Johnson Foundation Rationale and Context Only 5 percent of the full professors in the U.S. are black, Hispanic, or Native American. Faculty of color remain a very small part of the professoriate. Whites constituted 95 percent of all faculty members in 1972, and 83 percent in The percentage of African American faculty members at all levels has been remarkably stagnant—4.4 percent in 1975 and 5 percent in 1997—and almost half of all black faculty teach at historically black colleges. The increase in Hispanic faculty has been slow: from 1.4 percent in 1975 to 2.8 percent in 1997.

A National Program of the Robert Wood Johnson Foundation Rationale and Context Minorities earned 16% of the master’s degrees and 18.6% of the doctorates in Whites accounted for 79.3% of all earned doctorates in 2000, followed by Asians at 7.8%; other minority groups combined accounted for 10.8%. Blacks were most represented in education (12.4%)—and were underrepresented in most arts and sciences fields— while Asians earned 17.5% of engineering doctorates. The proportion of black faculty at predominantly white colleges and universities today—2.3%—is virtually the same as in Members of all minority groups, men and women, are less likely to be tenured than whites—and are also more likely than whites to work at less prestigious institutions.

A National Program of the Robert Wood Johnson Foundation The Facts of the Matter I Diversity of the Pipeline Percent of under-represented minority students in nursing (BSN), medical, and dental schools in 2008: Nursing % Medical – 14.5% Dental % Under represented minority students include Black/African American, Hispanic/Latino, and American Indian/Alaska Native American Association of Colleges of Nursing. (2009) Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing. American Dental Education Association. Association of American Medical Colleges. (2008). AAMC Data Warehouse: Applicant Matriculant file.

A National Program of the Robert Wood Johnson Foundation Importance of Diversity “Despite the importance of diversity in health professions, African Americans, American Indians and Alaska Natives, many Hispanic/Latino populations, and some Asian American (e.g., Hmong and other Southeast Asians) and Pacific Islander groups (e.g., Native Hawaiians) are grossly underrepresented among the nation’s health and health care professionals.” SOURCE: In the Nation’s Compelling Interest: Ensuring Diversity in the Health and Health Care Workforce (2004) “…past research [has show] that faculty of color can enhance the overall quality of education at higher education institutions, for example, by serving as role models, advisors, and leaders.” SOURCE : Irvine, J.J. (1991). Making teacher education culturally responsive. Diversity in teacher education. Washington, DC: American Association of Colleges for Teacher Education.

A National Program of the Robert Wood Johnson Foundation SOURCE: Digest of Educational Statistics 2008 (NCES ). Table 249

A National Program of the Robert Wood Johnson Foundation Studies reflect that increased diversity of the health care workforce enhances communication between providers and patients from multicultural backgrounds; promotes patient satisfaction; improves access to care; and assists in addressing disparities in health outcomes. Health professionals from underrepresented minority backgrounds tend to disproportionately serve minority and other underserved populations. The Facts of the Matter Why We Care

A National Program of the Robert Wood Johnson Foundation New Connections: Program Activities Grantmaking Call for Proposals –Round 1-4 from 2006 to 2009 –Round 5 awards start Nov 2010 –Round 6 CFP released early 2011 Career Development Mentoring –Project mentors –Liaisons at RWJF Training Events –Symposium –Research and Coaching Clinic Outreach Social Media Regional Meetings Professional Meetings –Presentations –Networking Events

A National Program of the Robert Wood Johnson Foundation New Connections: Applicants Historically underrepresented groups in RWJF Programming (R&E) activities: Black Latino/Hispanic Asian/Pacific Islander First-in-family college graduate Low-income community New to RWJF –First-time grantee of Foundation Apply as either: –Junior Investigator ≤ 10 years from receipt of doctorate –Mid-Career Consultant Between years of experience