Learning LaboratoryKPCO African American Center of

Excellence Terri Richardson, MDPhysician Lead, AACE

March 2013

Diversity Rx 8th National Conference:Achieving Equity in an Era of Innovation and Health System Transformation

The Bottom Line“… the world’s ‘wealthiest nation’ can never be satisfied until we are the world’s healthiest.”

President Lyndon B. Johnson March 31, 1966

PerspectivesWe can never be the world’s healthiest

nation as long as disparities exist among our diverse population.

Eliminating health care disparities and achieving health equity will require a dedicated program and a multifaceted approach.

This work must be woven into the intricate fabric of our health care work.

2000 2001 2005 2006 2007 2008

LACE Proposal

Developed

LACE Established

Clinica De La Familia Founded

RELP team formed

RELP pilot project

AACE proposal

developed

African American Center of Excellence

Race and Ethnicity Data“The collection of race and ethnicity data is

the basic science of disparities and without it we don’t’ know where we’re doing, we don’t know if we’re improving, and we don’t know if the interventions we’re trying to implement are making a difference.” (Beal)

RELP- self reported race and ethnicity obtained during the clinical encounter

2000 2001 2005 2006 2007 2008

LACE Proposal

Developed

LACE Established

Clinica De La Familia Founded

RELP team

formed

RELP pilot project

AACE proposal developed

RELP roll out across KPCO

AACE Established

Centers positioned into Population & Prevention Services

African American Center of Excellence

4 I’sInformationInnovationIntegrationInfiltration

Learning LaboratoryFocus on InnovationLife in the Petri Dish

Innovation- FocusThe SeedFindings from the literatureThe process Outcomes

Primary: creating the evidence base, preferred voice

Secondary: general feedback, barriers

What We LearnedGeneral themes:

AA specific information

CaringCommunicationCultureTrust

Barriers:FearAnxiety/ depressionLack of knowledgeLack of positive

messages directed at AA

Negative family historyMen don’t want to go to

doctors.Don’t take

health/cancer seriously

AA Specific Information“Like when you watch TV, every time when

there is a disease or something, it is basically white people on there.”

“And the medicine is made for them and they get the help and the doctors that they need.”

And very seldom does it have anything to do with a minority person or….you know, African American.”

AA Specific Information“I think in some ways we really do break down

things -thinking that that is a White man's disease vs. this is a Black man's disease.”

“Maybe they should say what it is(statistics) for African Americans…. To say how it affects different cultures.”

“Give some more statistics about colon cancer and the number of people who get colon cancer, male vs. female, cultural things in there.”

Caring“And to me, you can tell …..when I show up for an

appointment here, I can tell what nursing staff or radiology or whatever dept. I'm in, I can tell which ones care and which one's don't.”

“You can tell the ones that have patient care in their interest.”

“I've only had a few people stop me and ask me are you ok? Can I get you something? Do you need assistance? That is something that can't be taught. Either that is part of your make up or it isn't. And

most of us can tell when it's not.”

Caring“So if you get someone that cares, you are

more comfortable with them and you are more willing to listen to them and to really consider what they are saying.”

Caring can improve care.

Communication“It was like always…like you say, when you go

to the doctor, he doesn't come to your level. He stay up here and he shout down to you.”

“If she is in a hurry, I'm in a bigger hurry.”“I think those two cancers [prostate and

colon] that doctors have not learned how to address the African American community to the seriousness.”

“Not what she said --- not what she said, but the way she said it.”

CommunicationAnd my mother is like the person who goes

with everyone because she does have medical terminology. I find sometimes, when we are with a doctor, I think some of us feel they are talking down to us and not telling us exactly what is going on. They deliberately talk above you. They don't talk down to your level.

I think that's why there is so much hesitation.

Culture“That's right. It takes a village, doesn't

it?”“Yeah. And roots and collard green leaves,

and all of that. Folklore has not been erased from our generation and I even see in my children.”

“One size fits all don't work in my program.”“If you notice on that now, it says one size

fits MOST!”

Culture“For them[doctors], you know, a lot of it is

when I go, it's you need to change your diet. I'm thinking to myself, I don't like what you all eat neither!

“..So down South is grease and more grease and more salt.”

“Yes. And then you fight that too.”“And then you throw a few veggies in there

just for color.”

Trust“Yeah. I agree with you. I think we …when it

comes to our health, we don't trust nobody but us. There you go. And I don't know if that's because of history and information that you've had.”

“Linguistically, she had the kind of voice that you wanted to hear because of the trust factor, ok.”

“Discuss African American doctors that are doing this research. It might make me go.”

Trust“Cause with me, I don’t care who you are or

where you are from or your background. I think everybody has to feel comfortable. And some voices can make you feel more at ease than others.”

“I just mean you know, sometimes as Black people, we want people that are in our field and also is looking after our interest because we feel they are more able to respond and identify with you. And I think as people, that is how it goes.”

ConclusionThe learning laboratory concept allows:

Thinking outside of the box Exploring new frontiers

Health care affords many “Petri dish” opportunities.

AACE, conducted a qualitative project to examine a novel concept that has the potential to improve the quality of care for African Americans.

Next steps are to take lessons learned and translate these into practice.

Thank YouTerri Richardson, MD

Kaiser Permanente Colorado Terri.Richardson@kp.org

303-360-1714