The first national agenda to understand and address surgical disparities, announced by the National Institutes of Health and the American College of Surgeons, will likely foster much needed change in addressing ethnic disparities in surgical practice.  Research priorities were announced in the March 16 JAMA Surgery, and are based on an inaugural NIH-American College of Surgeons Symposium on Surgical Disparities Research, held in May 2015, at NIH. On April 18th, NIH announced a Notice of Intent to Publish a Funding Opportunity, with the first R01 and R21 grant applications likely due in September, and the first awards expected in February 2017. According to NIH, the initiative will involve collaborations among several NIH institutes and centers, along with the Agency for Healthcare Research and Quality. The number of meritorious grant applications received will determine full funding levels.

“The real take-home message here is that the American College of Surgeons, the largest society of surgeons in the world, and the National Institutes of Health, are now taking this on as a priority issue,” says Dr. Paris Butler, Chief Resident in Plastic Surgery at Penn, and one of ten members on the American College of Surgeons’ Committee on Surgical Health Disparities.

The joint NIH-American College of Surgeons Symposium set the stage for developing national priorities. It brought together more than 60 top-flight researchers, surgeon scientists, and federal leaders to flesh out core priorities for a national agenda.

Five themes helped target priority areas, namely patient and host factors; systemic factors and access issues; clinical care and quality; provider factors; and postoperative care and rehabilitation:

Teaching providers to deliver culturally dexterous care to build patient rapport, and measuring its impact on eliminating surgical disparities;
Using electronic health records and technologies to optimize patient education, health literacy and shared decision-making in a culturally relevant way;
Examining regionalization of care versus strengthening safety-net hospitals in the context of differential access and surgical disparities;
Studying the long-term impact of intervention and rehabilitation within the critical period on functional outcomes and patient-defined perceptions of quality of life;
Improving patient engagement and identifying patient expectations for postoperative and post-injury recovery, advanced health care planning, and palliative care concerns.
Dr. Cary Aronson, Assistant Professor of Colon and Rectal Surgery, called the initiative “very valuable,” and said that it would amplify current community outreach efforts   through Penn’s Abramson Cancer Center. “We are doing a lot more structured events and community outreach,” he added.  Priority areas that Dr. Aronson sees as especially important include “patients not understanding risk factors, mistrust of doctors, and beliefs that surgery for cancer will make their cancer worse.”

The national agenda hopefully will extend research into disparities of patients with chronic care needs, including chronic, disabling neurologic diseases, according to Dr. Allison Willis, Assistant Professor of Surgery.  With funding and measurement to move this agenda forward, Dr. Willis hopes transformation will be possible. “In Parkinson’s disease, we have identified lower rates of patients getting basic care,” she said. “Very few minorities are being offered deep brain stimulation, yet it is highly effective for advanced Parkinson’s disease,” Dr. Willis added. In her own research, she found that only 1% of African Americans eligible for deep brain stimulation are offered it. ”

Dr. Jaya Aysola, Assistant Professor of Medicine and Pediatrics, and DIO for Health Equity and Inclusion, expressed excitement about the surgical disparities research initiative and noted that several priority areas in this initiative are not specific to surgical disparities and are essential to effective health care delivery more broadly.  She pointed out: “We all act with certain implicit biases or assumptions that may impact our care and therefore, training to raise awareness of these issues is vital for health care providers.” Dr. Aysola hopes her strategic agenda detailed in Penn Medicine’s Blueprint for Health Equity and Inclusion, will help address some of the system factors highlighted in this report.