Beyond Access to Care: Addressing Disparities across the Healthcare Continuum

Health disparities are pervasive and persistent in the United States. Despite growing recognition that disparities exist, health inequities based on gender, race, socioeconomic status, and other demographic factors remain challenging to address.

PCORI-funded researcher Kyaien Conner, PhD, MPH, LSW, an associate professor of mental health law and policy in the College of Behavioral and Community Sciences at the University of South Florida, has focused on health disparities throughout her career and even recently helped draft legislation to foster health equity in Florida.

Helping Patients of Color Seek Care

As a clinical social worker who went on to pursue a Master of Public Health and doctorate in social work, Conner initially became involved in disparities research related to mental health. Some of her work has explored racial differences in the utilization of mental health services. Underutilization of mental health care has often been observed in communities of color.

Conner notes that through her work, she has witnessed the “value of peer educators” in helping people of color seek care for depression and other mental health conditions. Conner also explains she has been able to use her clinical and personal background “to develop culturally sensitive” behavioral health tools for underserved communities. Nevertheless, Conner laments that health disparities "still exist and in many areas are growing wider."

In 2020, Conner was awarded PCORI funding for health disparities research examining the role of peer support to reduce racial disparities related to hospital readmissions in Florida. Conner says PCORI’s focus on “community-engaged research” in a manner that truly “enhances community voices” prompted her to apply for funding. Conner adds that she especially appreciates PCORI’s emphasis on the “use of community expertise” to develop “meaningful, valuable, and hopefully, sustained,” patient-centered projects.

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Dismantling Disparities in Care Transitions

The transition period between being released from the hospital and following up for outpatient care can be a difficult time. The most vulnerable patients often experience recurrent symptoms following a hospital stay and may wind up back in the hospital without outpatient support. Rehospitalization is linked to worse health outcomes overall. Conner notes that older Black and Hispanic/Latino adults are more likely to be readmitted to the hospital than other older adults. One possible explanation for this disparity is that, historically, older people of color have not been well represented in research regarding healthcare transitions.

Conner plans to address this in her study by comparing interventions to help prevent hospital readmissions among Black and Hispanic/Latino older adults. One group of patients will meet with health coaches prior to being discharged from the hospital to discuss strategies for staying well. Another group will receive support both from health coaches and trained peer mentors. A third group will receive usual care from the hospital team. Conner hopes to determine whether the addition of peer mentor support will help patients feel more “connected to their community” and better able to identify resources to remain well at home.

Study recruitment was delayed by the COVID-19 pandemic but is expected to begin later this year. Conner is delighted that her team’s preliminary work has already had a positive impact on research infrastructure at the recruiting hospitals. She notes that the creation of staff positions to foster recruitment of diverse patient participants will have a beneficial effect on research beyond her individual study.

Journey to Health Equity

In 2021, Conner helped write a bill to increase financial and other resources for the Office of Minority Health and Health Equity in Florida. The bill was passed into law and requires each county health department in Florida to designate a liaison whose focus is health equity. Conner hopes that the implementation of this and other new policies will help to address structural racism as a "public health crisis."

As Conner notes, health disparities have deep roots in our country’s political, legal, and economic framework and "are about so much more than lack of access to health care." She adds that through the studies it funds, PCORI’s recognition of the widespread effects of systemic racism is central to ultimately achieving health equity.