A UC Berkeley School of Public Health study found disparities in patient care and heart failure readmissions between Black and white patients.
While Zuckerberg San Francisco General Hospital and Trauma Center succeeded at reducing its readmission rate for heart failure through its quality improvement program, the disparity persisted between white and Black patients’ readmission rates for heart failure, according to study co-author and campus public health graduate student Morrise Richardson.
The study was initially completed as a project for a qualitative improvement course Richardson took in fall 2019 to complete the public health graduate program but was then published in the independent publishing company Mary Ann Liebert, Inc.
“We were interviewing patients and providers about how to better integrate an equity framework into quality improvement work for patients with heart failure,” said study co-author and campus alumnus Raj Fadadu in an email. “Prior interventions led to decreases in readmission rates for all patients, but black patients were still having high readmission rates compared to other racial groups.”
After the interviews, the team put together a data analysis of the common themes detailed in the feedback it received and offered recommendations to improve patient care, added study co-author and cardiologist Jonathan Davis.
According to Richardson, Black patients can face additional barriers to primary care, as a result of institutional racism or perceived racism. He added that doctors may not fully understand the experience and relationship Black patients have with health care providers.
“We ended up finding out that some patients didn’t really feel listened to or didn’t feel like they had a lot of trust with the doctor,” Richardson said. “You don’t rebuild to replicate, because you’ll get the same results. You rebuild to reimagine and address the issues that a lot of black patients face.”
Richardson hopes more work and effort goes into reducing health disparities in addition to reducing readmission rates.
Fadadu said further action includes the integration of health equity frameworks into quality improvement projects to ensure health care providers are addressing structural issues contributing to poor health outcomes.
The next steps for health care systems include increasing screening for social determinants of health, optimizing physical space and creating more comprehensive implicit bias training, Fadadu added.
“There’s the social determinants of health impacts where everyone can come into the clinic, but what happens when they leave the clinic? What’s their life like at home?” Davis said. “What’s their access to medications, healthy foods, exercise and things like that? This is something that impacts all of us, whether it’s directly or indirectly.”
Davis currently researches congestive heart failure and is working toward creating a better heart failure care system, including visualizing ways to specifically help Black patients in terms of outreach, engagement and education.
He stressed the significance of raising awareness that these disparities exist so health care providers can be more mindful and take better care of everyone that enters a clinic.
“When you reduce health disparities, you’re making a healthier community, a healthier workforce, a healthier family structure, a more proactive community and better care for the next person that comes in,” Richardson said. “You’re helping construct a better society and it all starts with health because if you don’t have good health, what can you actually do?”