The researchers will assemble and analyze a formidable data set to examine the associations between the level of segregation and selected quality measures in order to craft a blueprint for reducing these disparities, which they will disseminate to other hospitals and health systems. They will also study the impact of Mount Sinai’s historic efforts to integrate clinical practices on quality of care and patient outcomes.
The study, known as DISRUPT, short for “DIsmantling Structural Racism Underlying the organization of ambulatory PracTices: an observational study of clinical desegregation,” will collect retrospective data for more than 15 million ambulatory patient visits from five academic medical centers across New York City to evaluate the current level of segregation in medical, pediatric, and OB/GYN practices and its impact on quality measures of preventive, procedural, and chronic disease management for Black, Latino, and Medicaid populations. The researchers will obtain the data from the INSIGHT Clinical Research Network.
“We are thrilled that the NIH has provided its support for our investigation into structural racism in the clinic setting,” says Principal Investigator Nina Bickell, MD, MPH, Professor of Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai. Dr. Bickell will co-lead the study with Carol Horowitz, MD, MPH, Professor of Medicine, and Population Health Science and Policy, and Dean for Gender Equity at Icahn Mount Sinai, and Lynne D. Richardson, MD, Mount Sinai Professor of Emergency Medicine and Health Equity Science at Icahn Mount Sinai. Drs. Horowitz and Richardson also serve as Director and Co-Director of IHER.
“It is remarkable to have access to detailed clinical data for 15 million patient visits. Our study will provide an unprecedented investigation that looks across New York City to gauge the degree to which clinics have achieved integration. With this data in hand, we will look at the relationship between integration, or separateness, and quality of care, relying on standard quality measures. For example, in general medicine clinics, we will assess quality by looking at metrics such as the proportion of patients with uncontrolled diabetes or hypertension, and the number of patients with coronary artery disease who are taking statins,” says Dr. Bickell.
The investigation, says Dr. Bickell, fulfills one of eleven strategies delineated by Mount Sinai’s Diversity and Equity Task Force, formed during the pandemic, in its Road Map for Action: “To unify and integrate clinical practices, where possible, while advocating for payment and regulatory reforms that would allow for the full integration and unification of clinical practices regardless of insurance status.”
The Institute for Health Equity Research (IHER), established in 2020, studies the effects of health issues on at-risk communities, including those that are non-white, low-income, immigrant, uninsured, and LGBTQ+ across all ages, genders, and abilities, collaborating with an extensive network of patients, providers, payers, policymakers, and industry leaders to produce discoveries that will translate into sustainable and scalable initiatives. “The DISRUPT study is a perfect example of the collaborative nature of our work; none of our work is done alone,” says Dr. Richardson.
Structural racism is the accumulation of prejudices that is reinforced by rules, policies, laws, practices, and norms. The most conspicuous example, says Dr. Richardson, is residential racism, the physical separation of races that discourages different racial groups from intermingling. “Segregation in health care is akin to residential racism; both are deeply embedded in our society. However, while residential segregation is obvious and apparent, the structural racism that underlies it is not as visible to the naked eye, even though it is right in front of us,” says Dr. Richardson.
“Even though practice segregation has existed in our health care system for centuries, and even though it is deeply intertwined in patient care and medical education, it remains poorly understood. What we do know is that a corrosive mindset is deeply baked into our society—that some people belong here, and some people go there. We want to address this through our investigation,” says Dr. Richardson.
“Long-term success will require that academic medical centers and hospitals across the country dig into this problem. And we will need legislative and regulatory change too. All of this will take time and collaboration,” says Dr. Richardson.
The DISRUPT study underpins a larger institutional investment by the Mount Sinai Health System in anti-racism and diversity measures, and a system-wide commitment to developing a racial equity culture. Mount Sinai has historically served all communities, having been founded as a hospital to serve Jews who were denied care at other hospitals. While its focus has been on those who are ignored, oppressed, or facing bias, the system amplified its efforts after a surge of support for the Black Lives Matter movement. Some of the organization’s diversity-promoting measures include a multi-institution effort to identify and implement new strategies to recruit faculty members from groups underrepresented in medicine funded by a five-year, $16 million grant awarded by the NIH. Similarly, Mount Sinai unveiled the Biomedical Laureates Program in 2020 to advance inclusivity and diversity in biomedical science and in its faculty pipeline and mentorship opportunities. In 2021, Icahn Mount Sinai announced a three-year project, Anti-Racism Transformation (ART) in Medical Education, to dismantle systemic racism in medical education by developing a community of practice with 11 partner medical schools across North America. This program, now in its second year, leverages components of Icahn Mount Sinai’s Racism and Bias Initiative (RBI), which is unique in its focus on change that is continuous and evolving. As noted above, the RBI has set forth a Roadmap for Action to address structural racism, including racism within the system itself.
About the Mount Sinai Health System
Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, over 400 outpatient practices, nearly 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.
Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 7,300 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report‘s Best Hospitals, receiving high “Honor Roll” status, and are highly ranked: No. 1 in Geriatrics and top 20 in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children’s Hospital among the country’s best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is one of three medical schools that have earned distinction by multiple indicators: It is consistently ranked in the top 20 by U.S. News & World Report‘s “Best Medical Schools,” aligned with a U.S. News & World Report “Honor Roll” Hospital, and top 20 in the nation for National Institutes of Health funding and top 5 in the nation for numerous basic and clinical research areas. Newsweek’s “World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York City and in the top five globally, and Mount Sinai Morningside in the top 30 globally; Newsweek also ranks The Mount Sinai Hospital highly in 11 specialties in “World’s Best Specialized Hospitals,” and in “America’s Best Physical Rehabilitation Centers.” For more information, visit https://www.mountsinai.org or find Mount Sinai on Facebook, Twitter, and YouTube.