The Disparities Solutions Center is committed to disseminating the latest information on disparities interventions, findings from important disparities research and health policy updates regarding disparities reduction efforts. In order to disseminate this information to the broadest possible audience in a stimulating and interactive manner, the DSC hosts several events each year:
The Schwartz Center, MGH Multicultural Affairs Office, and the DSC, collaborated to produce a film series to raise awareness around the issues of racial and ethnic disparities and cross-cultural care. The goal of the Film Series is to raise awareness of health disparities and cross-cultural care among health care providers through the screening of popular and documentary films, followed by expert panel discussions and question-and-answer periods. Through the use of this format, we aim to improve health care providers’ ability to understand and communicate with diverse patient populations, and be more skilled in cross-cultural communication.
Pediatric Health Disparities: Providing Cross-Cultural Family-Centered Care
Cross-Cultural Care: Caring for Transgender Patients
On Wednesday, March 30, 2011, as part of LGBT Health Awareness Week at MGH, the DSC/MAO Film Series explored the topic of transgender health and barriers to care, including a discussion of culturally competent approaches to patient care. We featured the short film, “TRANSforming Healthcare: Transgender Cultural Competency for Medical Providers.” Speakers included Ruben Hopwood, M.Div., Coordinator of the Transgender Health Program at Fenway Health; Pam Klein, RN, a nurse at Boston Health Care for the Homeless; Patricia Raney, MD, staff physician at Fenway Health, and Elizabeth Rivera-Valentine, Community Organizer & Web Designer of TransCEND; A New Program of AIDS Action Committee.
For more information about transgender health, click below:
Glossary of Key Terminology
Brief literature review
Crash: Stereotypes in Society...and Healthcare?
On Wednesday, December 15th at Massachusetts General Hospital, the Disparities Solutions Center (DSC) and the MGH Multicultural Affairs Office (MAO) co-hosted our eighth film series event focusing on the impact of stereotyping and unconscious bias in health care. We featured two short film segments from the movie Crash and ABC's 20/20: Race and Sex - What We Think (but Can't Say) about unconscious bias. These segments raised issues about how stereotypes and discrimination permeate our environments in both conscious and unconscious ways.
We had two expert panelists leading the discussion about these challenging issues and linking them to health care: Alexander Green, MD, MPH, is the Associate Director of the Disparities Solutions Center and author of the article “Implicit Bias among Physicians and its Prediction of Thrombolysis Decisions for Black and White Patients” and LeRoi Hicks, MD, MPH, an Assistant Professor in Medicine in the Division of General Medicine and Primary Care at Brigham and Women's Hospital and a Lecturer in Health Care Policy at the Harvard Medical School.
To learn more your own unconscious biases, take an Implicit Association Test, click here.
From the Rural to the Nation:
The Origin of the Community Health Center Model and
the Roots of Cross-Cultural Care
On Wednesday, April 7th at Harvard Medical School, the Disparities Solutions Center (DSC) and the MGH Multicultural Affairs Office co-hosted a film series that focused on the role of community health centers in providing care to diverse and underserved populations. We featured the documentary Out in the Rural: A Health Center in Mississippi (1969) about the Delta Health Center in Bolivar County, Mississippi. This film focuses on the use of health services to address the social determinants of health and developing community empowerment, while combining primary care with public health interventions. The keynote speaker was Jack Geiger, MD, M.Sci.Hyg, Arthur C. Logan Professor of Community Medicine Emeritus at the City University of New York Medical School. Dr. Geiger initiated the community health center model in the USA, founding and directing the nation's first two community health centers in the Mississippi Delta and in Columbia Point Boston. These centers became models for what is now a national network of more than 1000 community health centers serving some 17 million low-income and minority patients. In Massachusetts, 52 community health centers provide high quality health care to more than 760,000 state residents through 285 sites statewide.
To watch Out in the Rural: A Health Center in Mississippi, click here .
Environment, Education and Empowerment: Improving Nutrition and Addressing Obesity in Vulnerable Communities
On Wednesday, December 16th, 2009, the Disparities Solutions Center, the MGH Multicultural Affairs Office and the Schwartz Center co-hosted a film series on the growing obesity rates among children, in particular among African American and Latino children. We featured the documentary Nourishing the Kids of Katrina: the Edible School Yard which follows renowned chef Alice Waters' Berkeley "Edible Schoolyard" program as it contributes to the rebirth of the New Orleans uptown Green Charter School after its devastation from Hurricane Katrina. Speakers included, Robert Lee Grant, film maker and director, Sylvia R. Chiang-Raposo, MD, MPH, Manager of the Food and Fitness Initiative at MGH’s Revere CARES, and Kathy Cunningham, M.Ed, RD, LDN, Senior Program Manager/ Dietitian for the Chronic Disease Prevention and Control Unit at the Boston Public Health Commission.
For more information about the film or if you'd like to to order a copy, please visit: www.NourishingTheKids.org.
Cross-Cultural Care at End of Life: Exploring a Patient’s Perspective
On October 28th, the Disparities Solutions Center, the MGH Multicultural Affairs Office and the Schwartz Center co-hosted our fifth event in this series as we explore cross-cultural issues at end of life. The session featured “Stanley”, part of the three-part Caring at the End of Life series. The film presented a comatose patient whose family and healthcare team were in conflict over how long to continue with the treatments that are keeping him alive. They confronted difficult ethical questions about patient autonomy versus the needs of the family, about who is in a position to judge what another person would want, about the role and impact of religious faith. Following the film there was an interactive panel discussion with Dr. Eric Hardt, Associate Professor of Medicine at the BU School of Medicine, Dr. Erica Wilson, Palliative Care Physician at MGH, and Michael McElhinny, MDiv, Director of Chaplaincy at MGH. The goal of this program was to improve health care providers’ ability to understand and communicate with diverse patient populations and be more skilled in cross-cultural communication as it pertains to end of life.
Return to the Killing Fields: Cross Cultural Care and the Cambodian Experience
On April 14, 2009, the fourth event in this series took place in the Amphitheater at the Joseph B. Martin Conference at Harvard Medical School. The event focused on the experience of Cambodian refugees and immigrants during the Khmer Rouge period, the impact of the experience on survivors, and the unique aspects of providing health care to this community. Selections from two documentaries were shown: “Return to the Killing Fields”, which provides an overview and history of the Khmer Rouge regime, and the award-winning “S21: The Khmer Rouge Killing Machine”, which documents the reunion of 2 survivors of the Khmer Rouge’s Tuol Sleng Prison and the former prison guards when they return to the site. Following the excerpts from the documentaries, there was a discussion on providing cross-cultural care to Cambodian patients with two panelists, Dr. Richard Miller, Medical Director of Khmer Health Advocates, and Chhan Touch, Family Nurse Practitioner at Metta Health Center in Lowell, MA.
"Becoming American” part of UNNATURAL CAUSES: Is Inequality Making us Sick?
The third event in this series was held on Tuesday, October 7th, 2008 in Their Conference Room at Massachusetts General Hospital. The film shown was “Becoming American”part of the PBS documentary UNNATURAL CAUSES: Is Inequality Making us Sick? The film highlights the positive aspects of health and culture that newly arriving Latino immigrants bring to the US. Following the film, guest panelists Dr. Byron Garcia and Dr. Enrique Caballero and moderator Dr. Alexander Green of the DSC commented on the issue raised in the film and responded to questions from the audience.
La Ciudad (the City)
The second in the series, was held May 5th, 2008 from 5:30-7:30 pm in the Thier Conference Room at Massachusetts General Hospital. Two selections, “Bricks” and “Puppeteers” from the film La Ciudad (The City) were shown, telling stories of loss, love, frustration, and hope as recent immigrants arrive in a large city and struggle to build their lives, their communities and their dreams - including grappling with the American health care system and culture. David Riker, the filmmaker and director, Dr. Jim O’Connell of Boston Healthcare for the Homeless, and Dr. Elizabeth Barnett, co-editor of the recently published volume “Immigrant Medicine,” then commented on the issues depicted in the film.
Miss Evers’ Boys
The first event in this series was held on January 17, 2008 from 5-7 pm in the O’Keeffe Auditorium at Massachusetts General Hospital. The film shown was Miss Evers’ Boys, which is based on the Tuskegee Syphilis Study. Dr. Michael Byrd, medical historian from the Harvard School of Public Health and a physicianat Beth Israel Deaconess Medical Center and Dr. Linda Clayton, Associate Medical Director, Division ofMedical Assistance of the Commonwealth of Massachusetts then commented on the historical context ofthis study, and how it fits in with African-American health care in the US. The audience was invited to ask questions of the panelists and also engage in informal networking with them and other attendees over light refreshments.
Hold Your Breath – Film Screening
On May 2nd, 2007, The Disparities Solutions Center, in partnership with Active Voice, Harvard Medical School and the HMS Cross Cultural Care Committee, hosted a screening of the medical documentary “Hold Your Breath” at Harvard Medical School. The film follows the life and death of Mohammad Kochi, who fled his native Afghanistan to start a new life with his family in California, poignantly illuminating the complexities of cross-cultural communication, religion and contemporary medicine in America through Mr. Kochi’s battle with cancer. Following the film screening, The Disparities Solutions Center presented a panel discussion and facilitated a question and answer session. Nearly 125 people attended the screening, including medical students, interpreters, physicians, social workers, community representatives and medical school faculty.
The Keeping Current Seminar Series, which was launched in 2006, features informative presentations from experts in the field; context, perspectives and opinions from key health care stakeholders; and opportunity for discussion from all participants and attendees.
Racial Disparities after Massachusetts Health Reform: Does Expanded Insurance Coverage Impact Variation in Surgical Care?
This seminar featured a presentation by Andrew Loehrer, MD, Research Fellow at the Codman Center for Clinical Effectiveness in Surgery, General Surgery Resident at the Massachusetts General Hospital and a Disparities Solutions Center Associate. Racial disparities in access to and outcomes of surgical care persist for a multitude of surgical diseases, with racially diverse patients being more likely to present with advanced surgical disease and less likely to undergo standard-of-care surgical procedures as compared to white patients. This seminar examined racial disparities in surgery before and after the 2006 insurance expansion while providing potential insights into the impact of national health reform on racial disparities in surgical disease.
To learn more about this study or to request slides for this presentation, please contact Dr. Loehrer at email@example.com.
Hearing All Voices: Race, Ethnicity, Language, and the MGH Patient Experience
This seminar featured a presentation by Karen Donelan, ScD, EdM, Senior Scientist at the Mongan Institute for Health Policy at Massachusetts General Hospital. Measuring patient-reported outcomes is an essential component of quality assessment, yet patient experience surveys often under-represent racial, ethnic, and linguistic minorities. This seminar highlighted the results of surveys conducted in 2012 and 2004 for the MGH Disparities Committee with the support of the Center for Quality and Safety. The design employs sampling and data collection techniques to assure representative samples of patients by race, ethnicity, and language. The presentation explored trends in patient satisfaction over time, as well as opportunities for institutionalizing continual assessment of patient satisfaction in domains connected to racial, ethnic, and linguistic disparities in health care.
To learn more about this study or to request slides for this presentation, please contact Dr. Karen Donelan at KDonelan@partners.org.
Professional Language Interpretation and Inpatient Length of Stay and Readmission Rates
This seminar featured a presentation by Mary Lindholm, MD, Clinical Associate Professor of Family Medicine and Community Health at the University of Massachusetts Medical School in Worcester, Massachusetts, and by Lee Hargraves PhD, Research Associate Professor of Family Medicine and Community Health at the University of Massachusetts Medical School. This seminar highlighted the speakers’ published paper “Professional Language Interpretation and Inpatient Length of Stay and Readmission Rates”, which shows that the length of a stay in the hospital for Limited English Proficiency (LEP) patients was significantly longer when professional interpreters were not used at admission and/or discharge.
Bridging the Digital Divide in Health Care: The Role of Health Information Technology (HIT) in Addressing Racial and Ethnic Disparities
Dr. Lenny Lopez, Attending Physician, Brigham and Women’s Hospital, Instructor in Medicine, Harvard Medical School, Assistant at Mongan Institute for Health Policy, and Senior Faculty at the Disparities Solutions Center at Massachusetts General Hospital presented recommendations for how health care organizations might adopt, expand, or tailor their HIT systems to better address disparities. Dr. Adrian Zai, Clinical Director of Population Informatics at Massachusetts General Hospital and instructor in Medicine at Harvard Medical School, provided commentary and discussed where the field is heading.
Emergency Department Utilization: Who uses the Emergency Department and Why?
The seminar featured a presentation from Alden Landry, MD, MPH, emergency medicine physician and Director of Outreach for the Office of Multicultural Affairs at Beth Israel Deaconess Medical Center, and Aetna/Disparities Solutions Center HealthCare Disparities Fellow. Dr. Landry presented on emergency department utilization for low acuity complaints. The presentation focused on patient demographics of emergency department utilizers for primary care treatable conditions, patients’ rationales for emergency department use, and issues that impact patients’ choice of where to receive care.
Click here to download:
Robert Wood Johnson Foundations's report entitled: Emergency department utilization and capacity
National Hospital Ambulatory Medical Care Survey: 2008 Emergency Department Summary Tables
Patient Characteristics and Physician Quality Scores: Implications for Racial/Ethnic Disparities
The seminar featured a presentation from Clemens Hong, MD, MPH, a physician researcher in the General Medicine Division at MGH and primary care practitioner at the MGH Charlestown HealthCare Center. Dr. Hong presented on Patient Panel Mix and Its Relationship to Physician Clinical Performance Measures and Pay-for-Performance: Implications for Resource Allocation and Disparities in Health Care Delivery. The New York Times featured Dr. Hong's research on this topic.
Mental Health, Acculturation, and Cancer Screening among Hispanics
Hispanics are the fastest growing minority in the United States. In this community, cancer is the leading cause of death. High rates of anxiety and depression, due in part to the acculturation process, can affect the likelihood of cancer screening. On Wednesday, June 2nd, Lina Pabon-Nau, MD, MPH, the current Aetna Foundation Health Care Disparities Fellow with the Disparities Solutions Center, discussed her current work looking at anxiety and depression and how they affect cancer screening in Hispanics of different levels of acculturation. Following her discussion, Lidia Schapira, MD, medical oncologist at the Gillette Center for Breast Oncology at Massachusetts General hospital and an Assistant Professor of Medicine at Harvard Medical School, provided a commentary on Dr. Pabon-Nau's work. To view the powerpoint slides from Dr. Pabon-Nau's discussion, click here.
Emerging Trends and Challenges in Health Care Delivery for LGBT Patients
On Wednesday, March 31st, Graham McMahon MD, M.M.Sc., Assistant Professor of Medicine at Harvard Medical School and faculty in the division of endocrinology, diabetes and hypertension at Brigham & Women’s Hospital, and Jennifer Potter, MD, Director of the Women’s Health Center at Beth Israel Deaconess Medical Center, Director of Women’s Health at Fenway Community Health Center, and co-editor of The Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health presented on emerging trends and challenges in health care delivery for Lesbian, Gay, Bisexual, and Transgender (LGBT) patients. The session included an overview of disparities in care, unique health needs, as well as practical clinical recommendations to improve care delivery for LGBT patients.
Disparities in Cancer Treatment and Outcomes for People with Disabilities
On Thursday, September 10th, Dr. Lisa Iezzoni, Director of the James J. Mongan, M.D. Institute for Health Policy, Massachusetts General Hospital, and Professor of Medicine, Harvard Medical School, discussed disparities in cancer treatment and outcomes for people with disabilities. For more information on disparities and disabilities, please see Public Health Goals for Persons with Disabilities: Looking Ahead to 2020.
Racial and Gender Disparities in Emergency Room Triage
On Wednesday, June 3rd, Dr. Lenny Lopez, Attending Physician, Brigham and Women’s Hospital, Instructor in Medicine, Harvard Medical School, and Aetna/Disparities Solutions Center HealthCare Disparities Fellow presented his current work looking at racial and gender differences in emergency room triage and test ordering among patients presenting with chest pain. Although disparities in cardiac management and outcomes are well known, this study looks at potential sources for disparities early in the clinical process. This presentation is a follow-up to an earlier Keeping Current by Dr. Andrew Wilper on waits to see an emergency department physician.
The Role of Community Health Centers in Addressing Racial/ethnic Disparities in Health Care
On Wednesday, April 22nd, Dr. LeRoi Hicks, Instructor in Health Care Policy and Associate Professor at Harvard Medical School and Zoila Torres Feldman, RN, MSPH, Executive Director of Kit Clark Senior Services and Former President and Chief Executive Officer of Great Brook Valley Health Center presented on the role of community health centers in addressing racial/ethnic disparities in health care. The seminar aimed to provide insight into the challenges/successes of implementing and evaluating community-based quality improvement programs from both a research/evaluation perspective and an "in-the-field" perspective. For more information see, several featured articles by Dr. Hicks on the quality of chronic disease care and improving the management of chronic disease in community health centers.
Disparities in Diabetes Care: Physician Performance and Racial Disparities in Diabetes Mellitus Care
On October 8th, 2008, Dr. Thomas Sequist, Assistant Professor of Medicine and Assistant Professor of Health Care Policy at Brigham and Women's Hospital and Harvard Medical School, presented his paper "Physician Performance and Racial Disparities in Diabetes Mellitus Care", followed by question and answer. The event was attended by 48 members of the MGH community and 87% of responding participants rated the event “excellent” and “very good”.
Waits to See An Emergency Department Physician: U.S. Trends and Predictors, 1997-2004
On Wednesday, March 26th, 2008, Dr. Andrew Wilper presented his paper “Waits to See An Emergency Department Physician: U.S. Trends and Predictors, 1997-2004”, which focuses on disparities in the emergency setting, and discussed the implications of race on emergency department waiting times, triage patterns, and other emergency measures and outcomes.
Disparities in Health Care are Driven by Where Minority Patients Seek Care: Examination of the Hospital Quality Alliance Measures and Concentration and Quality of Hospitals that Care for Elderly Black Patients
On Thursday, January 24th, 2008, Dr. Joel Weissman, Senior Health Policy Advisor to the Secretary, Massachusetts Executive Office of Health and Human Services, former Senior Scientist at the MGH Institute for HealthPolicy, and Dr. Ashish Jha, Associate Professor of Health Policy and Management, presented their papers “Disparities in Health Care are Driven by Where Minority Patients Seek Care: Examination of the Hospital Quality Alliance Measures” and “Concentration and Quality of Hospitals that Care for Elderly Black Patients.” These papers each address the question of whether racial/ethnic disparities in health care are due more to the quality of the hospitals where minorities receive care or to differences in treatment within hospitals.
Implicit Bias among Physicians and its Prediction of Thrombolysis Decisions for Black and White Patients
At noon on Thursday, October 18, 2007, Dr. Alexander R. Green, Associate Director at the DSC, presented his article, "Implicit bias among physicians and its prediction on thrombolysis decisions for black and white patients." This ground breaking study gained national media coverage, featured by teh Boston Globe, National Public Radio, and Good Morning America.
The Nasi Report On Medicare and Disparities: What Can Centers For Medicare and Medicaid Services (CMS) Do?
On December 5th, 2006, Paul Van de Water and Bruce Vladeck discussed the findings and recommendations of the National Academy of Social Insurance Report “Strengthening Medicare’s Role in Reducing Racial and Ethnic Health Disparities.” A period for questions and discussion followed the presentation.
Listen or Download Audio*
Quality and Disparities In Health Plans: Is There A Link?
The Disparities Solutions Center launched their Racial and Ethnic Disparities – Keeping Current Series on November 28th, 2006 with an interactive web-based conference entitled “Quality and Disparities in Health Plans: Is There a Link?” Drs. Amal Trivedi, John Ayanian and Alan Zaslavsky presented and discussed the findings of their JAMA article “Relationship Between Quality of Care and Racial Disparities Within Medicare Health Plans.” Joining them to discuss the broader implications of this research was Sarah Scholle, PhD, Assistant Vice President for Research and Analysis from the National Committee on Quality Assurance.
Listen or Download Audio*
In 2008 the DSC launched the Looking Back Seminar Series, a counterpart to the DSC’s Keeping Current Seminar Series. The Looking Back Seminar Series focuses on key historical topics related to race and the health care system and highlights how they impact disparities today. These seminars are led by Drs. Michael Byrd and Linda Clayton, authors of the Pulitzer-prize nominated volumes “American Health Dilemma” which provide the history and experience of African-Americans in the US Health system.
Hospital Segregation and the Hill Burton Act
On Wednesday, June 4th 2008 from 12-1pm, the DSC held the inaugural event in its Racial and Ethnic Disparities: Looking Back Seminar Series. Drs. Michael Byrd and Linda Clayton presented “Hospital Segregation and the Hill Burton Act,” discussing how the Hill Burton Act of 1946 perpetuated the legacy of hospital segregation under the ‘”separate but equal” clause and how legacies of this pattern continue today which impact race, ethnic, gender, and class based disparities in health and health care.
U.S. Hospitals: Historical Legacies and Health Disparities
On Tuesday, February 17th, 2009 from 12-1:30 pm, the DSC held its second event in its Racial and Ethnic Disparities: Looking Back Seminar Series. Drs. Linda Clayton and Michael Byrd presented “U.S. Hospitals: Historical Legacies and Health Disparities”. The presentation traced the historical development of the American hospital system from the colonial era to the present by focusing on key structural and health policy landmarks and the medical and social implications that have led to unequal treatment. The seminar included a lecture by Drs. Byrd and Clayton and an audience question and answer session.
Racial and Ethnic Disparities and Dysfunction in Health and Health Care: Historical and Contemporary Issues
On Tuesday, October 5th 2010 from 12:00-1:30pm, the DSC
held its third event in its Racial and Ethnic Disparities: Looking Back Seminar Series led by Drs. W. Michael Byrd and Linda A. Clayton, nationally known health policy experts whose work heavily focuses on the medical history and health experience of African-Americans and other disadvantaged populations in the U.S. health system. They presented "Racial and Ethnic Disparities and Dysfunction in Health and Health Care: Historical and Contemporary Issues." The presentation explored how racial and ethnic disparities originated and evolved over time, including root causes initiating the need for cultural competence in the context of the U.S. health system’s eleven structural components. They include health care financing, medical and social culture, health system function/dysfunction, and other variables, such as social determinants.
Click here to view the slides: Part 1, Part 2.
A video of the presentation will be posted soon.