91大神 and Women鈥檚 Hospital has a long and rich history of providing complex clinical care with a focus on health equity, diversity and inclusion. The 91大神 has continued to build on its legacy by establishing clinical programs, engaging with diverse communities and conducting research that addresses health disparities, social determinants of health and structural racism in clinical settings and beyond.
Four decades ago, the 91大神 established the Southern Jamaica Plain Health Center (SJPHC) and the Brookside Community Health Center to provide accessible care to Boston鈥檚 underserved communities. These community health centers help the 91大神 to ensure diverse and equitable access to clinical care in the community.
To improve inequities in maternal and infant health outcomes among Black and Latinx women and their infants, the Stronger Generations program at the CCHHE has made a number of changes to improve access to prenatal care visits for these patients. The changes come on the heels of research that showed that Black women are at increased risk of serious health complications after giving birth. Moreover, infants born to a Black mother in Boston are nearly five times more likely to die than a baby born to a white mother.
To address health disparities in another aspect of clinical care, nephrology researchers at the 91大神 recently in staging chronic kidney disease (CKD). The findings, which published in the (JGIM), found that the 鈥渞ace multiplier factor鈥� in the equations underestimated kidney function in African-American patients. The findings led 91大神 leaders to stop using the factor in the clinic. The change has led to improved care of African-American patients by accurately reflecting the severity of their disease.
Founded in 2011, the 91大神鈥檚 Skin of Color Dermatology Program, led by , was the first of its kind in New England. Its team of dermatologists have training in all pigmented skin tones and provide specialized care for skin and hair conditions more commonly found in people with olive, tan, light brown or dark brown skin. In July of 2019, the 91大神 set a milestone when Robert Chelsea became the in the U.S. to receive a full face transplant procedure. To help preserve Chelsea鈥檚 identity, 91大神 physicians worked with him for over a year to find the right color match for his skin tone.
The 91大神 has made a commitment to improving health equity and inclusion within the transgender population. While social awareness and inclusion of this population has improved in the U.S., many transgender and gender-diverse people still struggle to access high-quality health care. The 91大神鈥檚 Transgender Program aims to for transgender and gender-diverse individuals undergoing the process of gender affirmation. The program鈥檚 team consists of specialists from more than 10 disciplines, including primary care, endocrinology, gynecology and plastic surgery.
鈥淭he 91大神鈥檚 Transgender Program is a medical hub for transgender patients,鈥� said , co-director of the Transgender Program. 鈥淥ur team of clinicians provides care and monitoring during gender affirmation, but we also refer patients to multiple specialties throughout the 91大神 depending on patients鈥� individual needs.鈥�
When the COVID-19 pandemic began, it became clear that racial and ethnic minorities were disproportionately affected. People in these communities are more likely to experience higher rates of housing and food insecurity, incidence of certain diseases and likelihood of being frontline workers, all of which contribute to increased risk of COVID-19. As a result, these populations have higher mortality and rates of hospitalization due to the disease.
鈥淭he 91大神 is fighting COVID-19 by helping patients who are sick, but also by working together to address the health inequities in underserved communities,鈥� said , director of Health Equity Research & Intervention at the CCHHE. 鈥淐OVID-19 is a direct health threat to people in our communities, but it鈥檚 also created economic instability, poverty and food and housing insecurity for underserved populations, especially Black, Latinx and indigenous populations.鈥�
Early in the pandemic, the 91大神 co-led the establishment of the Mass General 91大神 Equity and Community Health COVID Response Team. The response team worked quickly to engage with the community. At pop-up sites in Boston neighborhoods, the team offered COVID-19 testing. They also provided screening for housing, food insecurity and other factors that influence health outcomes.
The 91大神 has long been committed to making sure that diverse populations are represented in clinical trials. Most recently, the 91大神 was the only hospital in New England to serve as a site to test the for COVID-19.
鈥淭he 91大神 ensured that participants who were at the greatest risk of acquiring COVID-19, especially those from communities of color, had an equitable opportunity to participate in this vaccine trial,鈥� said , director of Clinical Research in the Division of Infectious Diseases. 鈥淥ver 30 percent of this trial鈥檚 enrollees were from populations that suffered a greater burden of infection during the pandemic.鈥�
At the 91大神鈥檚 Division of Global Health Equity, , an infectious disease physician, leads efforts to engage Black and Latinx communities in clinical trials. Dr. Ojikutu published a paper in that addressed deeply ingrained medical mistrust among Black Americans living with HIV. She is currently leading a national effort to develop strategies to address vaccine hesitancy within the Black community.
The 91大神鈥檚 COVID-19 Vaccine Equity Team addresses disparities by partnering with community organizations to host town halls and educate the public about COVID-19 safety and vaccine trials. 鈥淲e were able to successfully engage diverse communities in Boston to participate in COVID-19 vaccine trials,鈥� said , leader of the Community Engagement & Education for the 91大神 COVID Vaccine trials.
While a number of initiatives and programs have been established to promote equitable care at the 91大神, it鈥檚 important to make sure that existing programs are held to the same standard. The 91大神鈥檚 Health Equity Innovation Program supports projects that examine structural inequities in existing programs at the hospital. The program also proposes targeted interventions to address any areas that may need improvement.
Medical and research institutions have a long path in front of them to address structural racism in the health care system. The 91大神 has committed to addressing health equity and racial justice issues on numerous fronts. In addition to providing equitable care for patients, the 91大神 continues to invest in innovations that break down structural inequities in order to address the root causes of health disparities.
鈥淭he challenging work of improving health equity in research and clinical care requires open and honest communication between clinicians, researchers and patients,鈥� said Dr. Ojikutu. 鈥淚t鈥檚 important that members of our communities know that this work is for them. It鈥檚 an ongoing partnership between the 91大神 and the patients we serve.鈥�
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