Welcome to the program. I'm your host
Neal Howard here on Health Professional
Radio. Thank you so much for tuning in.
Our guest is Dr. Jason Wasfy, Assistant
Msedical Director in Massachusetts
General Physicians Organization, Director
of Quality and Analytics at Mass General
Hospital Heart Center. And he's joining
us today to talk about his work and the
research and topics that he presented at
the American Heart Association's
scientific sessions. Welcome to Health
Professional Radio. Dr. Jason Wasfy. Thank
you so much. I'm delighted to be here and
I appreciate your interest in my work.
A brief background about yourself. Talk
about how you got into your field and
what your role is there at Mass General?
Thank you. I am really
passionate about improving the quality
of care we deliver to patients with
heart disease. And for a number of years,
it wasn't totally clear how I could best
do that but I had a lot of mentors who
are highly clinical and really
committed to patients they serve. But
increasingly, I saw that my best role
might be in trying to understand with a
high degree of rigor, what interventions
we could help our patients with the most?
So a lot of what we do is we try to
improve healthcare delivery to
cardiology patients at Mass General. But
importantly, we study those interventions
in detailed ways to make sure that we
understand in great detail what these
interventions are doing for our patients
if they're useful because if they're
useful, we want to expand them, we want to
share them with other institutions so
that larger population can benefit from
this type of knowledge. Now you recently
gave a presentation based on your
research. What research and toppings did
you present? The presentation was
actually mostly a summary of other
people's work. We're very interested in
disparities between different types of
patients. So it's well known that certain
types of clinical outcome, black patients
for example have much poorer outcomes in
certain areas than white patients, you know
women patients compared to male
patient, patients with different
socioeconomic status. So this is a
critically important area of
investigation for a number of reasons -
first of all, we want a healthcare
system that is equitable and helps
everyone. And so understanding how to do
that I think we first have to understand
why the outcomes are different
populations.
But there's another point that I think
is really important to make which is
that studying disparities between
different types of patient clinical
outcomes may give us information that
help all patients because if
there's ways in which we're not
delivering care that's affecting certain
populations, it may still be affecting
populations other than minority
populations or underserved populations
in other ways so that it gives us basic
understanding of how to deliver care in
a more efficient way that's helpful to
the needs of our patients. What was one
of the most eye-opening findings of some
of the research that you were presenting?
And again, this isn't
our primary work but it's not that I've
summarized and synthesized for the
presentation. I think there's a very
striking differences between black
patients and white patients in terms of
hospital readmission rates. A lot of that
has to do with the different hospitals
that patients tend to go to but
there are differences even within the
same hospitals between racial and ethnic
group. So I think that if they're very
striking findings, the magnitudes are
pretty significant. And we really have to
do more to understand that so again I
think that understanding this better
will help the populations that are
having these worse outcomes but it also
may give us a fundamental understanding
about how to improve the quality of care
for all patients. With that quality of
care is concerned, did you say discover
as a ratio between what was a physical
aspect of the disparity and an
environmental aspect of the disparity
even within the hospital? Yes.
Some other groups have done very
sophisticated statistical analyses
disentangle effects of hospitals from
effects of patient, a lot of this is done
by a Dr. Karen Joynt Maddox and
Dr. Ashish Jha looking at you know,
there's certain hospitals that more
black patients tend to go to because
it's
we know where they are and there are
other hospitals that more white patients
tend to go to. But through techniques and
statistical analysis and
regression techniques, you can
disentangle the effects of the hospitals
from the effects of the individual
patients. So it does appear that both
matter, it appears that the hospitals
that more often serve black patients
have higher readmission rates for
example. But even when you look at the
same hospitals, white patients at these
hospitals have lower readmission rates
than black patients. So that suggests
that there's two things going on, there's
something related to race directly but
there's also something related to the
hospital's, the different racial ethnic
groups tend to go to. Was the
research confined to cardiovascular
patients only? The stuff that I'm
presenting, yes. It's all about acute
myocardial infarction heart attacks and
congestive heart failure. Did you find
similar not maybe as severe readmission
rates but at least some type of
readmission rate based on the ratio of
white to black in say more white
patronized hospitals?
It's an
interesting statistical problem
because they're more white patients in
American and black patients. The
hospitals that serve more white patients
have very, very low numbers of black
patients. So the most interesting
analyses are the patients at the
hospital that serve more black patients
because they tend to be more mixed.
Otherwise, you run into problems with
statistical sort of low numbers and hard
to distinguish between groups. But what
is pretty clear is that black patients
are readmitted more often than white
patients. And then at hospitals that
serve high numbers of black patients,
even the white patients at those
hospitals get readmitted more often than
the white patients at the hospitals that
serve white patients. So a lot of this is
heavy statistical stuff, but it really
does matter, it does suggest there's two
reasons why black patients are being
rated with hospital more often - one is
related to potential quality of care
issues as hospitals that serve black
patients so that helps us because we can
implement the quality improvement
strategy
is directed at those hospitals. But there
also seems to be issues around specific
patients then we really have to struggle
a lot with thinking through our duty of
unconscious biases as clinicians, are we
delivering care in a way that's better
for some patients and less good for
other patients? Are there differences
between patients in terms of how they
respond to our therapies? Those are the
sorts of questions I think that need to
be struggled through so that we can
improve health equity but also improve
the quality of care for all patients.
So what trends in research do you see
towards that end? Our group in particular
were very interested in building upon
some of this work that has been done by
others in understanding the effects of
health reform. So we're very interested
in that there's been a number of
analyses that have focused on passage of
the Affordable Care Act of 2010. So a lot
of the elements of the Affordable Care
Act were focused on improving the
quality of care. What we want to also do
is assess how that, you
know these programs improve the quality
of care, we believe that some of them did
but there's still some unanswered
questions. But also in improving the
quality of care is we increase the
quality of care for all populations
equally, the populations
have worse clinical outcomes in some
cases, black patients and women
patients, patients from poorer
communities.
It's the improvement affect them as much
that it affects other patients. I think
those critically important questions
because it will assess how health reform
A, improves the quality of care but B,
even if it improves the quality care, we
want to make sure it's done so in an
equitable way. Now, where can we go and
get some more information about some of
the information that you presented
recently? I'm certainly happy to
share the slides with anyone. I
think a lot of it references, previous
work like people like Karen Joynt Maddox,
and Maddox and Ashish Jha have been
previously published in the academic
literature. Well, I thank you for
joining us today, some fascinating
information. I'm hoping you'll come back
and give us some more in the future. It's
my pleasure. I really, really appreciate
your interest in these important topics.
You've
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