Health disparities and treatment compliance: Interview with a hospital case manager

Health Disparities Interview: Caitlin Ryan, Hospital Administrator

Boston, Massachusetts, a city of over 4-1/2 million souls (U.S. Census Bureau, 2014), has experienced a tremendous increase in diversity since it was founded by the Puritans in 1630. Just ten years ago, nearly a quarter of Boston residents had been born outside the United States and over 8% had trouble communicating in English (Boston Public Health Commission, 2005). No doubt, these percentages have increased over the past decade given the trends in the rest of the country (Cooper, 2012). By 2005, over half of Boston residents self-identified as a racial/ethnic minority and the Boston Public Health Commission (2005) reported that African-American and Hispanic Bostonians suffered from health and economic disparities; however, the authors of the report also found that even upper-income, well-educated African-American families experienced higher than average infant mortality. This finding, together with others, reveals that low income alone cannot explain the prevalence of health disparities in the Boston area; which in turn suggests that other factors, such as racism, clinician cultural incompetence, and limited access to quality healthcare services, also contribute to the prevalence of health disparities in the United States.

To gain a better understanding of how health and socioeconomic disparities impact health outcomes in Boston, especially among disadvantaged groups, an administrator for a local hospital was interviewed. The interviewee was asked about health disparities encountered in her work, barriers to eliminating health disparities, and recommendations for taking action.

The Interviewee

Caitlin Ryan (2015) is the Manager of Case Management at Spaulding Rehabilitation Hospital (SRH) in Cambridge, Massachusetts, a long-term acute care hospital ranked 6th in the nation by the U.S. News & World Report (Spaulding Rehabilitation Network, 2015). The Spaulding Rehabilitation Network is a member of Partners HealthCare, which includes Massachusetts General Hospital and Brigham and Women's Hospital, and serves as a destination for residents continuing their medical education through the Harvard Medical School's Department of Physical Medicine and Rehabilitation.

Ryan (2015) has served as SRH's Manager of Case Management for nearly 1-1/2 years, after serving as case manager for the same institution the previous 5-1/2 years. With a bachelor's degree in sociology, a Masters in Social Work, and a Masters in Public Health, Ryan has achieved remarkable success in her chosen career. Fortunately, Ryan was able to set time aside to answer questions about the major health and socioeconomic disparities she encounters in her work at SRH.

Discussion

From Ryan's perspective, the health disparities she encounters at SRH are caused by a lack of access to quality preventive care on a routine basis, poor family patient education, deficient clinician training concerning patient motivation, and clinician ignorance about the barriers minority patients' face. Her views are largely aligned with the health disparities action plan developed by the U.S. Department of Health and Human Services (2011), which focuses primarily on access to quality non-acute medical services. Other goals in the action plan include diversifying the clinical workforce, increasing clinician cultural competency, and educating the underserved about the benefits of preventive services.

Advanced practice nurses (APNs) have historically been at the forefront of providing quality healthcare to disadvantaged populations, but much more apparently needs to be done. Increasing the presence of APNs in disadvantaged communities will help to increase access to preventive care, while clinician training in the benefits of preventive services, provision of patient education, motivational encounters with patients, and increased cultural competency are additional steps that can be taken to reduce the prevalence of health disparities. If such efforts are successful, maybe the number of preventable complications due to chronic conditions treated at SRH would be reduced.