Increasing the Representation of Black Men in Medicine by Addressing Systems Factors.

In 2015, data released by the Association of American Medical Colleges (AAMC) showed that there were more Black men applying and matriculating to medical school in 1978 than 2014. The representation of Black men in medicine is a troubling workforce issue that was identified by the National Academies of Sciences, Engineering, and Medicine as a national crisis. While premedical pathway programs have contributed to increased workforce diversity, alone they are insufficient to accelerate change. In response, the AAMC and the National Medical Association launched a new initiative in August 2020, the Action Collaborative for Black Men in Medicine, to address the systems factors that influence the trajectory to medicine for Black men. The authors provide a brief overview of the educational experiences of Black boys and men in the United States and, as members of the Action Collaborative, describe their early work. Using research, data, and collective lived experiences, the Action Collaborative members identified premedical and academic medicine systems factors that represented opportunities for change. The premedical factors include financing and funding, information access, pre-health advisors, the Medical College Admission Test, support systems, foundational academics, and alternative career paths. The academic medicine factors include early identification, medical school recruitment and admissions, and leadership accountability. The authors offer several points of intervention along the medical education continuum, starting as early as elementary school through medical school matriculation, for institutional leaders to address these factors as part of their diversity strategy. The authors also present the Action Collaborative's process for leveraging collective impact to build an equity-minded action agenda focused on Black men. They describe their initial focus on pre-health advising and leadership accountability and next steps to develop an action agenda. Collective impact and coalition building will facilitate active, broad engagement of partners across sectors to advance long-term systems change.

Exploring the provider and organization level barriers to medication for opioid use disorder treatment for Black Americans: A study protocol.

Objectives: This study seeks to examine the provider and organizational factors that could be limiting the treatment of Opioid Use Disorder (OUD) for Black Americans in Texas. Formative research at the provider and organizational level will assist in understanding the current facilitators, potential barriers, and capacity for OUD treatment for Black Americans. Study design: Using the exploration phase of the Explore, Preparation, Implementation, Sustainment (EPIS) framework, the project will be a formative assessment of local factors that influence Medication for OUD (MOUD) treatment availability for Black Americans to guide the design of a culturally and locally relevant multi-level intervention strategy. Methods: and analysis: This project will utilize emergent mixed methods to identify and clarify the problems that are obstructing treatment for Black patients with OUD. First, the perspectives of individual providers in their openness and willingness to provide MOUD treatment to Black Americans diagnosed with OUD will be explored through in-depth interviews. The organizational capacity factors associated with increased availability to treatment for Black American OUD patients will be examined with the organizational leaders using an exploratory sequential mixed-methods design. Leader and program managers of organizations that provide MOUD will be invited to participate in an online survey, with the option to participate in a follow-up in-depth interview. All qualitative data from the provider and organization staff interviews will be analyzed with a thematic analysis approach. The analysis of the two different types of qualitative data will be analyzed together, as a form of triangulation. Conclusions: This project will assess the understandings of individual providers as well as the organizational-level awareness of the cultural contexts of MOUD intervention for Black Americans. This formative research seeks to highlight the current status of the opioid crisis in the Black community, and what additional supports are needed.

Hospital Length of Stay in Patients with and without Serious and Persistent Mental Illness: Evidence of Racial and Ethnic Differences.

BACKGROUND: Prior studies have documented racial and ethnic differences in mental healthcare utilization, and extensively in outpatient treatment and prescription medication usage for mental health disorders. However, limited studies have investigated racial and ethnic differences in length of inpatient stay (LOS) in patients with and without Serious and Persistent Mental Illness. Understanding racial and ethnic differences in LOS is necessary given that longer stays in hospital are associated with adverse health outcomes, which in turn contribute to health inequities. OBJECTIVE: To examine racial and ethnic differences in length of stay among patients with and without serious and persistent mental illness (SPMI) and how these differences vary in two age cohorts: patients aged 18 to 64 and patients aged 65+. METHODS: This study employed a retrospective cohort design to address the research objective, using the 2018 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample. After merging the 2018 National Inpatient Sample's Core and Hospital files, Generalized Linear Model (GLM), adjusting for covariates, was applied to examine associations between race and ethnicity, and length of stay for patients with and without SPMI. RESULTS: Overall, patients from racialized groups were likely to stay longer than White patients regardless of severe mental health status. Of all races and ethnicities examined, Asian patients had the most extended stays in both age cohorts: 8.69 days for patients with SPMI and 5.73 days for patients without SPMI in patients aged 18 to 64 years and 8.89 days for patients with SPMI and 6.05 days for patients without SPMI in the 65+ cohort. For individuals aged 18 to 64, differences in length of stay were significantly pronounced in Asian patients (1.6 days), Black patients (0.27 days), and Native American patients/patients from other races (0.76 days) if they had SPMI. For individuals aged 65 and older, Asian patients (1.09 days) and Native American patients/patients from other races (0.45 days) had longer inpatient stays if they had SPMI. CONCLUSION: Racial and ethnic differences in inpatient length of stay were most pronounced in Asian patients with and without SPMI. Further studies are needed to understand the mechanism(s) for these differences.

COVID-19, Structural Racism, and Mental Health Inequities: Policy Implications for an Emerging Syndemic.

The complex interactions between the 2019 coronavirus disease (COVID-19) pandemic, structural racism, and mental health inequities have led to devastating health, economic, and social consequences. The intersection of these three conditions, which meets criteria for a syndemic (synergistic epidemics), presents numerous policy challenges-and opportunities. Addressing these issues in a unified manner, using a syndemic theory approach, can lead to significant progress and effective solutions for otherwise intransigent problems in society. This article proposes steps that can be taken to protect "essential workers" and other "vulnerable" populations; engage and empower communities; optimize community-led crisis response interventions; improve data collection about the intersection of COVID-19, structural racism, and mental health inequities; support school-based interventions; expand financial supports for mental health service delivery; expand health care insurance coverage to increase access and lower out-of-pocket costs; and promote workforce diversity. Emphasis on local, state, and federal policy interventions that prioritize equity and justice and focus on collective health and well-being will ultimately lead us on a more sustainable and equitable path.

Shifting the Policy Paradigm to Achieve Equity.

This article offers a brief history of mental health policies that have shaped current inequities in health care financing and service delivery. Mental health has a unique position within the health care system given the pervasive nature of stigma associated with illness; race and ethnicity often amplify this burden. The acknowledgment of disparities in mental health and the development of policies that address the needs of minority groups are relatively recent phenomena. Highlighted are legislative actions that have influenced reforms of the health care landscape. This text outlines opportunities to advance a targeted, community-based approach to mental health policy development.

Validation of the MEDSAIL Tool to Screen for Capacity for Safe and Independent Living Among Nursing Home Residents.

OBJECTIVES: Capacity for safe and independent living (SAIL) refers to an individual's ability to solve problems associated with everyday life and perform activities necessary for living independently. Little guidance exists on the assessment of capacity for SAIL among nursing home residents. As a result, capacity for SAIL is not fully considered in the development of discharge plans to ensure safety and independence in the community. We reasoned that this problem could be addressed with the Making and Executing Decisions for Safe and Independent Living (MEDSAIL) tool, developed to screen for capacity for SAIL among community-dwelling older adults. In this report, we describe findings on the validity of the MEDSAIL when used with nursing home residents. DESIGN: Prospective cross-sectional pilot study. SETTING AND PARTICIPANTS: Twenty-four residents of a Veterans Health Affairs Community Living Center (CLC; nursing home); exclusion criteria were cognitive impairment too severe to complete the protocol, diagnosis of serious mental illness or developmental disability, inability to hear, or inability to communicate verbally. METHODS: Participants completed 2 assessments: the MEDSAIL interview administered by a research assistant and the criterion standard capacity interview administered by a geriatric psychiatrist. We examined internal consistency, divergent validity, and criterion-based validity. RESULTS: Five of 7 MEDSAIL scenarios approximated acceptable levels of internal consistency (α >0.70). MEDSAIL scores were highly positively correlated with criterion standard capacity determination (0.88, P = .001), and the Wilcoxon rank-sum test statistic for the 2 assessments was also statistically significant (P = .001). CONCLUSIONS AND IMPLICATIONS: MEDSAIL has promise as a user-friendly brief screening tool for use by nursing home staff to understand resident capacity for SAIL. This information can be used in the development of discharge plans to keep the resident safe and independent in the community. In addition, tailoring the MEDSAIL scenarios specifically to the nursing home setting may further enhance the tool's validity and utility in this new application.