Vice President of Clinical Programs
“At Memora Health, I am fortunate to lead a team of individuals passionate about health equity at an organization equally passionate about this important topic! This article from McKinsey discusses the opportunities for digital health to improve health equity through improving access to care, addressing unmet needs, and considering the social context of care being provided. Underserved communities can access information and care in innovative, confidential, and responsive ways through digital health. From maternal health to cancer care and chronic disease management, I am excited and optimistic about our ability to impact care for patients who need it most!”
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Medical Director
“Non-compliance. Within the vast databases of our EHRs, this phrase haunts countless progress notes. A projection of a patient's failure to follow the plan, and often, a label carried from note to note as an indicator of who's to blame for a specific outcome. The problem is what we often perceive as a patient not caring about their care is more likely a reflection of a system that hasn't adequately prepared and equipped a patient to succeed. To document "non-compliance" without context is simply lazy and impacts the quality of patient care. Countless barriers exist when a patient exits the hospital or clinic, and understanding those barriers is the first step toward better outcomes and increased trust.”
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“When and how would you choose to reduce the amount of chemotherapy to take if you were a cancer patient? Reducing the amount of chemotherapy to receive may be the right choice for many patients, even before starting treatment. Cancer treatment is poison; it can be hard to know how much the body can take or how the effects may impact quality of life. It’s not a light topic, and hard to even imagine these kinds of conversations. But deciding on the best dose of medicine is a critical discussion for patients and their doctors to have - sometimes before treatment even starts. A survey of oncologists showed that dose reduction was reported to be used ~10% of the time at the initiation of treatment and ~89% of the time they discussed this decision with their patients. Patients often have a say in this decision, but even when they do, it can be tough to know if they have the information they need. Even doctors hope to better understand how to navigate the decisions of dose reductions. It is scary to think about all we don’t know about how to best treat cancer, but it also speaks to where we have many opportunities to learn and help improve those navigating these dark waters.”
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Clinical Programs Support Specialist
“A recent study by Sutter Health exposed bias in the devices used to measure blood oxygen, pulse oximeter, and how it impacts COVID-19 treatment for Black patients. If you are unfamiliar with pulse oximeters, this device goes on your finger when staff takes your vital signs and measures how much oxygen you have in your blood. It is one of the vital signs used to triage you and determine severity levels during your Emergency Room visits. The oxygen reading from the pulse ox is a primary guideline from the CDC to determine treatment for COVID-19. The research reveals that these inaccurate pulse ox readings may have “led Black patients to face a 4.5-hour delay in COVID-19 treatment” and decreased the probability of being admitted to the hospital for COVID. These results confirm a previous study from Dec. 2020 that determined pulse ox were less accurate for patients with darker skin and caused these patients to have an increased risk for hypoxemia (low oxygen levels in the blood). This study is important for COVID-19 treatment and other diagnoses that depend on this reading for clinical decisions, such as emphysema or COPD. Dr. Stephanie Brown states that “the findings underscore the fact that bias is not only human– it can be engrained in the devices, and tools clinicians rely on, too…”. We must continue to bring these findings to light and correct them. I applaud this organization’s steps to improve health equity, including “eliminating the race-based e-GFR calculation” to help thousands of Black patients improve their clinical outcomes.”
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Women’s Health Clinical Program Manager
“One of my favorite parts about being a member of the American College of Obstetricians and Gynecologists (ACOG) is getting the green journal delivered to my doorstep at the beginning of each new month. Although many great articles exist on these pages, I couldn't stop returning to the one on Pregnancy-Associated Homicide & Suicide. We know that maternal mortality in the US is increasing at a staggering rate & that the massive racial disparity associated with it is more prevalent than we could have ever imagined (threefold higher for non-Hispanic black women than non-Hispanic white women). Even more shocking is how the female victims identified in this pregnancy-associated homicide & suicide study's data set displayed 27% having had a known pregnancy status. They uncovered that pregnancy-associated homicide deaths made up 20.6%, and pregnancy-associated suicide deaths made up 8.8% of the deaths. That's a large portion of this population succumbing to the end of life in the avenue of suicide and homicide. They concluded that mental health problems, substance use disorder & intimate partner violence (IPV) are the preceding circumstances. Such great discussions were brought up revolving around these topics, and one worth highlighting was how universal screening for IPV, depression & anxiety in pregnant and postpartum women is paramount as best practice in the maternity care setting. Sadly, it was reported that only 39% of patients routinely get screened for IPV during prenatal care. This is eye-opening, and I hope that all healthcare workers in the maternal space can up their workflow to incorporate more screening for this population. It’s abundantly clear there’s a need, and we all need to do our part in contributing to addressing these preventable deaths.”
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Clinical Programs Support Specialist
“The CDC most recently released new data findings that over 80 percent of maternal deaths were preventable — this staggering number only emphasizes the need for stable insurance access for women’s prenatal and postpartum care. However, insurance churn (moving from insurance plans or between insurance and uninsured) is incredibly high. One study found that ONE in FIVE women lost insurance coverage during this period. The health implications of this undoubtedly contribute to US’s poor maternal outcomes and death rates as moms have reduced access to screenings for complications, diagnostic tests, social support, and interventions. Standard postpartum Medicaid coverage supports mothers 60 days after delivery, after which the mothers face a loss in coverage if they do not meet their state’s Medicaid eligibility thresholds. However, most recently, states have adopted the Medicaid postpartum coverage plan (a part of the American Rescue Plan Act), which extends coverage for moms up to 12 months after delivery. This provides moms continuity of care during such a high-risk time period. Currently, 34 states have implemented or plan to implement this plan which has already been correlated with lower maternal mortality rates. Health insurance is a clear determinant of maternal health, but incentivizing states to adopt extended insurance coverage is the main barrier to a crucial step to improving maternal outcomes in the US.”
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Care Delivery Process Improvement and Operations Manager
“I’m interested to see how The White House Sync for Social Needs coalition will evaluate and pilot the integration of specific social screening tools in electronic medical record (EMR) systems to help identify, support, and more effectively treat patients. As The White House and others begin to integrate social determinants of health within EMRs, understanding how/if this helps prevent poor health outcomes will be so meaningful.”
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