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Grants help HHC neuroscience teams explore more equitable, accessible care

August 16, 2024

Patients often face various barriers to quality healthcare, a concept that fueled researchers with three specialty programs at Hartford HealthCare’s Ayer Neuroscience Institute to tap grant monies and find ways to overcome obstacles so patients can get the care they deserve.

Equity-related research is underway at the Ayer Institute in the areas of stroke, spine and movement disorders. The work reflects efforts systemwide into unique, effective ways to reach all people needing care.

“Our mission at Hartford HealthCare is to improve the health and healing of all, which includes improving access and eliminating barriers to care. We are fortunate to have researchers who work diligently on innovative and compassionate approaches to fulfilling this mission,” says Sarah Lewis, vice president and chief equity officer at Hartford HealthCare. “We hope many of the projects they’re working on today will become standards of care for us and others in the future.”

The Ayer team, she continues, routinely demonstrates understanding of the unique needs of their patients and collaborate to imbed equity in their work. In addition to research, Ayer colleagues actively participate in the HHC’s Equity Integration Program, which brings together cross-disciplinary teams to design and test the effectiveness of novel health equity interventions.

“This has been helpful,” says Janine Phang of the Ayer work. Her father, Noel Phang, was added to one study after suffering an ischemic stroke in November 2023. “It’s nice to know you guys are calling and checking in on how he’s doing. Knowing he has a team there for him is reassuring.”
Current Ayer equity research includes:

Stroke care access

“Stroke and Equitable Access to Care – A Prospective Cohort Study.” Led by Kent Kilbourn, PA-C, supported by students from the University of Connecticut and Trinity College and fueled by a $15,000 grant from the Hartford HealthCare medical staff, the project examines how a volunteer health corps of students can address the way unmet social needs – transportation, healthcare illiteracy, inability to pay for medications, lack of access to healthy foods and language barriers – in stroke patients can impact outcomes like function, hospital readmission, recurrent stroke and death.

“We’re collecting data on these touchpoints to compare with historic data to see if addressing these needs can help prevent a second stroke,” Kilbourn says, noting stroke is the fifth leading cause of death nationally. “In the process, we’re learning about the various resources we have to help stroke patients, such as the Food4Health Clinic at Hartford Hospital which gives patients free access to healthy foods.”

Hartford HealthCare’s stroke patients, he adds, tend to include a higher percentage of people from marginalized communities because of the areas the Stroke Centers serve. The rate of stroke in the Black population is twice that in white people, and Hispanics experience 68.5 strokes per 100,000 in this area versus 50.1 for white people.

The Ayer study will create interventions that start in the hospital before patients are discharged and evolve into a schedule of regular touchpoints during their recovery. These could include helping patients access specialists, pick up prescriptions, schedule transportation for follow-up appointments and have the foods needed for a healthy diet.

The study goal is to intervene with almost 300 patients, half of whom will be from marginalized communities living in an urban setting, Kilbourn says.

Spine care equity

“The Effect of Patients’ Socioeconomic Status and Geographical Location of Spine Clinics on Spinal Intervention Outcomes in the Hartford HealthCare System.” Housed in HHC’s Fairfield Region under the direction of Vijay Yanamadala, MD, director of spine quality with Ayer’s Spine Program, and Nabil Matmati, PhD, and supported by a $15,000 grant from the Hartford HealthCare medical staff, this project seeks to eliminate the challenge a home address can pose for people struggling with back pain and spinal conditions.

“Poorer patients may present with worse symptoms that may require more urgent intervention,” Dr. Yanamadala notes. “Our goal is to identify potential solutions that reduce identified barriers and support care equality.”

First, the researchers will compare outcomes for patients living near the Spine Wellness Center in Westport with those living near its Bridgeport office.

“Our hypothesis is that patients in Bridgeport will have increased barriers to accessing care and, as a result, may also receive fewer interventions, have decreased quality of life and lower levels of satisfaction in their care,” Dr. Yanamadala says.

Identifying those barriers that limit access to care – transportation, language, insurance coverage and other factors – will enable the medical team to create and implement targeted solutions that advance health equity, he says.

Care for Spanish-speaking patients with Parkinson’s

“Improving the Health of Spanish-Speaking Patients with Parkinson’s Disease: A New Model of Care.” Spearheaded by Maria Moro-de-Casillas, MD, with J. Antonelle de Marcaida, MD, medical director of the Ayer Chase Family Movement Disorders Center as principal investigator, this project received a $100,000 grant from the Davis Phinney Foundation.

The Movement Disorders Center launched a dedicated Spanish clinic in Hartford in 2020, one of only three such programs in the country. This research is helping the team determine the needs and preferences of the population of Hispanic patients with Parkinson’s, the largest marginalized group with the disease.

“Initial assumptions regarding what resonates with this community proved inaccurate,” Dr. de Marcaida notes. “This strengthened our resolve to stop presuming that we know and to actually ask our Latinx patients about their unique preferences, challenges and needs.”

Early research findings revealed that:

• Almost all patients want to receive medical information directly from their physician or provider rather than online or from a brochure.
• Only one third of patients felt confident in their knowledge of Parkinson’s treatments when they first came to the clinic. Almost half did not feel very confident.
• More than half reported their major barrier to care was not transportation but access to Spanish-speaking clinicians.

“We will use the results of our survey to further enhance and tailor the services we provide and to develop our Spanish Movement Disorders Clinic as a national model of care for the Latinx population” Dr. de Marcaida says.