SPARK GRANT RECIPIENTS

Maternal Health Equity Among Patients with Limited English Proficiency

Rose Molina, MD, MPH, Assistant Professor of Obstetrics, Gynecology, and Reproductive Biology at Harvard Medical School; Obstetrician-Gynecologist at Beth Israel Deaconess Medical Center and The Dimock Center; Core Faculty at Ariadne Labs

Evidence suggests that individuals with limited English language proficiency experience lower quality maternal health care due to structural barriers and communication challenges. Cultural brokers—defined as a person who bridges groups of different cultural backgrounds for the purpose of producing change—play a key role in overcoming these barriers between patients and health care teams. However, it is not always clear how these individuals can most effectively be integrated into health care teams. This project will identify best practices for collaboration among cultural brokers, health care teams, and pregnant patients. The findings will inform co-development of a communication tool to enhance trust and therapeutic alliance among patients with limited English proficiency and their health care teams.

Creating a New Standard for Morbidity and Mortality Conferences

Mary Brindle, MD, MPH, Director of the Safe Surgery Safe Systems Program at Ariadne Labs; Scientific Director of the Province of Alberta Surgery Strategic Care Network; Professor of Surgery and Community Health Sciences at the University of Calgary

Alex Hannenberg, MD, Faculty Member of Safe Surgery Safe Systems Team at Ariadne Labs; Adjunct Clinical Professor of Anesthesiology at Tufts University School of Medicine

Adverse events in surgery often result from system and team-based flaws, yet strategies to learn from these events are not always focused on these dimensions of care. Nearly all medical centers use departmental Morbidity and Mortality Conferences (MMCs) for case reviews, but there is little standardization in how they are used, what their goals are, and who is involved. This project seeks to create an implementation tool to guide health care systems in running high-quality perioperative multidisciplinary and interprofessional MMCs that will support teams in developing team-based solutions to safety concerns.

Testing a Checklist for Improving Endovascular Thrombectomy for Stroke

Sandeep Kumar, MD, Associate Professor of Neurology, Harvard Medical School

Magdy H. Selim, MD, PhD, Professor of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center

Stroke is a leading cause of long-term disability and death worldwide. Endovascular thrombectomy (EVT) has been shown to be very effective for enhancing recovery from acute ischemic strokes when used appropriately. However, a lack of timely access in community health settings deprives its benefits to a large number of stroke patients, thereby decreasing its effectiveness in real-world settings. In 2021 a Spark Grant funded initial work to develop a checklist to triage potential candidates for EVT. Now in their second year of funding, this team will conduct a study to test the acceptability and feasibility of the tool at community hospitals in Massachusetts.

Improving Equity in Oncology Care Quality with Practice Feedback

Nancy Keating, MD, MPH, Professor of Health Care Policy, Department of Health Care Policy, Harvard Medical School; Professor of Medicine and Practicing General Internist, Brigham and Women’s Hospital

Mary Beth Landrum, PhD, Professor of Health Care Policy, Department of Health Care Policy, Harvard Medical School

Anna Sinaiko, MPP, PhD, Assistant Professor of Health Economics and Policy, Department of Health Policy and Management

While research shows persistent racial inequities in cancer treatments, quality assessments have rarely measured these disparities, and few metrics are available for practices to know if they are providing similar care to all patients. This project was launched in 2021 to develop an audit-and-feedback intervention to provide oncology practices with actionable, race-specific data about their performance in delivering equitable and high-quality care to all patients relative to other oncology practices. In their second year of work, the team will continue to develop their intervention and aim to demonstrate feasibility and acceptability through a pilot study.

Optimizing Supervision of Community Health Workers in Remote Settings

Matthew Bonds, PhD, Assistant Professor, Department of Global Health and Social Medicine, Harvard Medical School

Karen Finnegan, PhD, Research Associate in the Department of Global Health and Social Medicine, and Managing Director of Pivot Science

Community health that expands beyond the formal health care system is key to achieving universal health coverage, particularly in low-income, rural locations such as Madagascar. Since 2014, Pivot, a nongovernmental health care organization, has partnered with the Madagascar government to strengthen the health system of one district. Community health workers are an integral component of this effort, but global evidence to guide community health worker supervision is lacking. This project aims to develop a new protocol and tools for data-informed supervision of community health workers and to study the impact of this supervision on quality of care and health worker motivation. In year one of this work, the team developed a user-tested version of the supervision protocol and data dashboard. In year two, they will hold a convening to seek final input on the tools from stakeholders, implement the tools with community health workers, and evaluate the impact.

Beyond Birth: Optimizing the Transition from Obstetric to Primary Care

Chloe Zera, MD, MPH, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center

The period of transition from pregnancy care to ongoing primary care represents a key opportunity to reduce short- and long-term adverse outcomes following birthing and delivery. Currently, there is little data to guide providers in improving outcomes, and there is an urgent need to explore models of care that support the changing focus of health during pregnancy and delivery to health beyond birth. This project aims to design and test a model to improve the hand-off from obstetric care to primary care for those at highest risk of morbidity in the year after birth, with the ultimate goal of developing a scalable intervention to bridge this gap. 

Developing a model for a joint provider-payer strategy to increase use of home-based palliative care

Anita Wagner, PharmD, MPH, DrPH, Associate Professor, Department of Population Medicine, a joint Department of Harvard Medical School and the Harvard Pilgrim Health Care Institute; Director, Harvard Pilgrim Health Care Ethics Program

Patricia Toro, MD, MPH, Associate Medical Director, Harvard Pilgrim Health Care

Research suggests that home-based palliative care offers numerous benefits, including improved quality of life and care that is less intensive, less costly, and more patient-centered. It may even prolong survival in some patients. Home-based palliative care has been shown to offer numerous benefits, including improved quality of life, potentially prolonged survival, and less intensive, less costly, more patient-centered care. However, the majority of patients who could benefit from home palliative care, including those with chronic, serious illnesses, do not receive it. The ability to identify eligible patients at a population level is a key barrier to more widespread use. This project aims to develop a scalable provider-payer collaboration to ensure rapid targeting of patients for whom home-based palliative care would be appropriate and address the barriers to adoption among payers and providers. 

Protocols for safe postpartum care at home for women delivering by cesarean section in rural Africa

Bethany Hedt-Gauthier, PhD, Associate Professor, Department of Global Health and Social Medicine, Harvard Medical School; Associate Professor, Department of Biostatistics, Harvard T.H. Chan School of Public Health

Cesarean sections (c-sections) are the most common surgery performed worldwide. Global protocols detail standards of care for the procedure and hospitalization; however, reviews suggest there is a lack of guidelines for post-discharge instructions, leading to inconsistent care messages and poor follow-up. This gap is particularly harmful for women at high risk for complications after discharge, most notably for surgical site infections, which are common in women delivering via c-section in sub-Saharan Africa. This project will begin building a foundation for development of protocols for postpartum care for women delivering via c-section. The protocols aim to improve consistency in discharge messages and quality of care and to set a reference point for future interventions, including those that incorporate use of community health workers.

Effect of Health Systems Expansion on Health Care Utilization and Outcomes

This project investigated the impact of hospital closures and consolidations on patient outcomes, costs, and physicians. Using a master dataset, the team evaluated trends in consultation of surgical practices, assessed differences in outcomes for surgeons operating at a single location versus multiple locations, and analyzed the effects of rural hospital mergers on hospital financial performance and patient outcomes. The team plans to produce peer-reviewed publications, and the results of initial analyses will serve as pilot studies for future grants. 

Behavioral Drivers of Mental Health Resiliency 

This project focused on increasing behaviors, such as meditation, sleep, exposure to nature, and physical activity, to reduce stress, anxiety, and mild depression. The team completed a landscape analysis of existing evidence and sought expert impact to inform development of a survey, administered to patients by primary care physicians, on stress, stressors, and resilience behaviors. The survey has undergone initial face validity testing, and the team continues to engage with experts.

Better Partnerships: Family Engagement in Pediatric Health

This project aimed to develop a solution to improve communication and strengthen relationships between pediatric providers and families or caregivers in order to improve follow-through of treatment plans for developmental delays. The resulting tool, the Clinician-Caregiver Conversation Roadmap, supports pediatric providers and caregivers in having more collaborative conversations about a child’s developmental care. The team at Brazelton Touchpoints Center is planning to disseminate the tool for broad public use. Efforts include collaboration with national organizations, journal publications, and the development of additional implementation supports, such as training webinars and handouts.