By Katie Adams, MedCity News
July 5, 2022
When people hear about a healthcare accelerator, they usually think of an incubator program in which digital health companies receive investments for strengthening their technology. That is not the case for Boston Medical Center’s Health Equity Accelerator.
After being inundated with data on racial health disparities that continue to disproportionately affect Black and Brown patients in the U.S., BMC launched the accelerator in November. Its goal is to quicken the timeline between discovering inequities and implementing action plans to address them, said Elena Mendez-Escobar, co-executive director of the accelerator.
“BMC has a history of 150 years as a safety net hospital, so it’s always been focused on health equity,” she said. “Many institutions have worked on health equity for a long time, but they haven’t had the explicit and intentional focus on race and ethnicity that we think is lacking.”
Seventy percent of BMC’s patients identify as Black or Latino, according to Mendez-Escobar. Because of this, the hospital not only has a responsibility to close racial health equity gaps, but it also has a wealth of its own data to dive into to understand which disparities are affecting patients of color the most.
The accelerator’s researchers analyzed BMC data to identify the following five clinical areas with the most pressing racial health inequities: maternal and child health, infectious diseases, behavioral health, chronic conditions, and oncology and end-stage renal disease. To address the health inequities in these clinical areas, the accelerator forms cross-functional teams of clinical experts, researchers and healthcare staff to talk with patients and determine which changes BMC should make to its care delivery models.
For example, after the accelerator’s researchers found that BMC’s Black maternity patients were 1.7 times more likely to experience severe complications during birth than its White maternity patients, it put together a multidisciplinary team. The team — which featured doulas, midwives, physicians, operational experts and researchers — examined the problem by completing literature reviews, applying analytics to EMR data and conducting focus groups with patients.
Within a couple months, they found the main reason why BMC’s Black patients are having more complications has to do with preeclampsia, a serious pregnancy complication characterized by high blood pressure. Preeclampsia’s only cure is delivery, so a patient’s care team must make quick decisions about inducing labor or undergoing a C-section. The longer it takes for these decisions to be made, the higher the patient’s risk of hemorrhaging. The accelerator’s research found that care teams were taking longer to make these decisions for Black patients, causing them to hemorrhage more.
BMC quickly took a number of steps to address this finding, such as expanding its doula program and disseminating patient-facing videos on preeclampsia to increase patient agency. The hospital also expanded its hypertension remote monitoring program so it could catch preeclampsia cases earlier and updated its clinical protocols so there is less variation in how long it takes to make child delivery decisions during preeclampsia episodes. To measure the impact of these changes, BMC will look at metrics such as preeclampsia complications and mortality rates among Black maternity patients.
Having the health equity accelerator in place allowed BMC to implement these interventions rapidly. Mendez-Escobar pointed out that the accelerator was established to speed up the clinical changes and outreach efforts that should always come as a result of health equity research.
Instead of focusing on copious research articles and yearslong trials, academic medical centers can often create an action plan for a health equity problem in three or four months if they have a dedicated program to do so, she said.