Keeping an eye on inequities
With all of these advances, says Tuuli, there are still many challenges, and health care disparities are foremost among them.
“Equal access to quality care is our goal, but I will say it's a goal that is not fully realized,” says Tuuli. There are several reasons for that. For some women, living conditions make it difficult for them to capitalize on care. For others, it could be insurance-related, or transportation, or mistrust for the health care system. Without improving those situations within the community, says Tuuli, patients may delay care, which can increase the chance of complications.
Tuuli notes that Brown and Women & Infants Hospital take equity very seriously. “We break down outcomes of our patients by race and ethnicity, and we have started targeted programs to tackle some of these complications that seem to be disparate between our patient populations. For example, we're having conversations around community health workers who may be able to go to the homes of the most vulnerable of our patients and check their blood pressures and check on them and connect them back to the health care system.”
Tuuli knows that achieving equity is critical and complex. “If these things were easy, somebody would have solved them by now,” he says. But he also says that this generation of trainees and junior faculty are “very conscious of these disparities and are committed to making progress. And I believe we will.”
There are some tangible outcomes clinicians can measure, such as what proportion of Black babies die within the first month of birth versus others; or how many Black women develop complications from preeclampsia as compared to other racial groups. Providers can also measure patient experience and divide those experiences by race and ethnicity. This way, says Tuuli, they can see what Black patients are saying about their care experience, which is not always the same in terms of quality.
To achieve equity, there also must be a workforce where providers look like the communities they serve.
“There is data to suggest that patients who are cared for by physicians and providers of their same race and ethnicity tend to have better outcomes,” says Tuuli.
All Brown and Women & Infants Hospital trainees, physicians, and nurses receive diversity training to understand the basis of unconscious bias and the role it can play in health care, but there is additional value in a provider’s ability to relate to their patients culturally. It allows them to build trust, says Tuuli, and that can result in patients being more compliant with things like taking medication, which translates into better health outcomes.
“I think this multifaceted approach — both at the point of taking care of patients, where we ensure and take conscious efforts to be equitable, as well as developing our workforce — is the way we can get to a place where our providers, our physicians, our nurses reflect the community that we serve,” says Tuuli. “I think that will be an important component in achieving equitable care for our patients.”