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Recruiting Residents to Reduce Health Disparities

As an essential hospital in Cleveland, MetroHealth Medical Center – the teaching hospital for Case Western Reserve University – sees firsthand the negative effect health disparities can have on patients. In 2004, Case Western and MetroHealth launched the Center for Reducing Health Disparities, which engages residents in research on the root causes of disparities and potential interventions. As a result of residents’ research, MetroHealth has adopted several new care delivery strategies that have improved patient care processes.

The MetroHealth medical residency program comprises approximately 60 students, with one or two residents conducting research through the center at a time. Research projects last for about 3 months each and can focus on topics ranging from communication to population health.

According to Daryl Thornton, MD, MPH, medical director of the medical intensive care unit at MetroHealth and director of center research, one of the center’s primary aims is to identify the next generation of people who will help eliminate health disparities. “Practicing health care now is more complex than ever before,” Thornton says. “It is difficult to just be a doctor because doctors are expected to also understand the latest research and the factors that impact patients before and after they see them.”

In an effort to give MetroHealth residents a global perspective on delivering high quality care, the center targets research that analyzes health disparities from novel angles. For example, during the recent housing crisis, some center research focused not on the people who left their homes, but on those who stayed behind. The results showed that issues including crime and lack of sanitation services – such as trash collection – negatively affected neighborhood residents’ health and well-being.

Meanwhile, other resident research projects have led to patient safety improvements inside the hospital. In 2010 and 2011, one medical resident focused on more accurately identifying patients with delirium, a life-threatening condition typified by an acute decline in attention and cognition. Overall, his research found that about 25 percent of MetroHealth’s medical intensive care unit patients who had delirium were not being identified. The resident then used the findings to help MetroHealth incorporate a delirium assessment tool into its electronic health record and worked with physicians to change their care plans based on the assessment’s result, a process that now is the hospital’s standard of care.

“Most of our residents didn’t have research experience prior to working with us, and many enter our program with trepidation and fear,” Thornton says. “However, once they see how a research question directly relates to what they face on the wards daily, they ultimately leave their training with an appreciation of what goes into research, how to read a study and how to apply the findings to their own patients.”

In addition to exposing medical residents to health disparities research, Thornton notes that MetroHealth’s program underscores the important position safety net hospitals occupy in the research field. “This type of program is really something unique [safety net hospitals] can offer because we’re at ground zero. The problems we’re facing as organizations are ones that the next generation is going to have to deal with,” Thornton says. “We can be at the forefront of the field by training medical residents to take part in quality improvement research projects that identify ways to eliminate health disparities.”

To learn more about Case Western and MetroHealth’s Center for Reducing Health Disparities, please contact:
Daryl Thornton, MD, MPH
Medical Director, Medical Intensive Care Unit
MetroHealth Medical Center
dthornton@metrohealth.org
(216) 778-3732

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