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Dr. Nancy Kressin: Monitoring Health Disparities in Massachusetts
Photo of Nancy Kressin

Nancy Kressin, Ph.D.
Director, Health/Care Disparities Research Program, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
Massachusetts Health Disparities Monitoring System

Administered by the NHLBI Division of Cardiovascular Sciences, Clinical Applications and Prevention Branch
FY 2009 Recovery Act Funding: $1,886,428

A new project will examine how two of the most-talked about topics of 2009 — the economic downturn and healthcare policy and reform — affect health care disparities.  The project is funded by the National Heart, Lung, and Blood Institute through the American Recovery and Reinvestment Act (ARRA).

Research Focus: Nancy Kressin, Ph.D., and co-principal investigator William G. Adams, Ph.D., will evaluate racial, ethnic, gender, language, socioeconomic, and geographic disparities in cardiovascular health in Massachusetts. In particular, they'll monitor common cardiovascular risk factors and chronic conditions targeted by the national public health goals of Healthy People 2010: high blood pressure, high blood cholesterol, obesity/overweight, and tobacco use.

Massachusetts, having enacted healthcare reform in 2006, provides an ideal laboratory for the study. The legislation required that nearly all residents of Massachusetts have health insurance; as of January 2009, 97 percent of the population had complied. A new insurance product, Commonwealth Care, is available to low-income individuals. Although eligible subscribers pay either low or no monthly premiums, they must shoulder more out-of-pocket costs for office visits and services than before the 2006 reform.

"The effects of the additional copayments on the use of care, health outcomes, or disparities are not known," said Dr. Kressin, a health services and disparities researcher. "Indeed, it is possible that an unintended consequence of the new system is a worsening of disparities in cardiovascular health."

To answer this question, and to build the infrastructure for future health disparities research, Drs. Kressin and Adams will develop an extensive database that merges de-identified clinical information on children and adults cared for at two of New England's largest academic hospitals, including New England's largest safety net hospital (Boston Medical Center) and its affiliated community health centers, with insurance claim data from the Boston Medical Center HealthNet Plan.

"The disparities monitoring data we will provide can be used to observe local, even community-level, changes in disparities over time, examine the impact of policy changes, and better understand how screening and receipt of care are related to disparities," said Dr. Kressin. "The national impact we anticipate will come from the process and tools we are developing, which can be shared and implemented by other regions to monitor disparities with similar levels of detail."

Unlike traditional population-based methods of monitoring health disparities, which have limited detail about factors that may lead to health disparities, this study will incorporate detailed statewide clinical data from electronic health records of both children and adults.

"The researchers envision building upon this study to facilitate multi-site intervention studies of cardiovascular disease and other public health issues," Dr. Kressin added. "We anticipate extensive growth in the research enterprise focused on health disparities, not only our own efforts but also those conducted in collaboration with other colleagues locally and nationally."

Economic impact: "The ARRA grant allows us to develop a data infrastructure that we previously did not have the resources to develop," said Dr. Kressin. "Traditional funding mechanisms from NIH, foundations, and others do not generally support this type of infrastructure development."

Before the ARRA grant, two support staff, a data analyst and a research coordinator, had been in jeopardy of losing their positions due to funding cuts, according to Dr. Kressin. The grant will support part of the salaries of approximately ten scientists across the state of Massachusetts. In addition, the ARRA funding will support substantial work by a local technical firm.

Delving into disparities: "I became interested in cross-cultural psychology while travelling internationally and noticing the sharp contrasts between cultures and behavior between various countries," said Dr. Kressin, head of Boston University School of Medicine's Disparities Research Program. "In my dissertation [at Syracuse University], I applied this interest by comparing the experiences of medical students of different racial and ethnic backgrounds during training. Later, I began to study racial and ethnic differences in patients' perspectives about invasive cardiac procedures as a possible explanation for the disparities in the use of such healthcare services. This investigation launched my career into studying health and healthcare disparities."

Dr. Kressin said she would "love to identify one or more malleable factors that lead to disparities in health or health care, develop an intervention to address these, and have that intervention be successful in reducing disparities in health outcomes."

"This is the ongoing challenge in disparities research, because disparities are clearly a function of many factors related to the patient, their environment, the healthcare providers, and the broader system of care in which healthcare is provided. It remains difficult to know where best to intervene to lead to equity in health care and health outcomes."

This article originally appeared on the National Heart, Lung, and Blood Institute website.

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