Advancing Healthcare Equity: Insights from Environmental Scans, Clinical Experiences, and Program Analyses
As we reflect on the class of 2023's achievements, we want to highlight the exemplary practicum work of students willing to share. Our students never fail to impress us with the diverse skills and knowledge they bring to Dartmouth, especially within their practicum experience. From global challenges to personal experiences, the work our students set out to do will make a difference in the lives of many.
The entire graduating class of 2023 truly impressed us with their practicum work. Keep scrolling to explore three students who chose to speak on their projects in more depth. Congratulations to the class of 2023. Excellence awaits you!
To read the individual stories, click on the student's photo or name.
Health Equity Measurement in Hospitals and Health Systems: An Environmental Scan.
New regulations in 2023 from the Centers for Medicare and Medicaid Services (CMS) and The Joint Commission require that hospitals in the United States engage in measuring health equity. However, current guidance on health equity measurement is limited and fragmented. For her practicum project, Health Equity Measurement in Hospitals and Health Systems, Laura Galster utilized an environmental scan of available health equity analytics literature as well as interviews with health system analytics leaders. This informed her development of a summary document that included available resources and recommendations for hospitals on how to systematically and meaningfully approach health equity measurement.
Laura’s investigation was timely in responding to the quickly changing regulatory environment. Her ILE (Integrative Learning Experience) has since been shared with other organizations to inform their approach and led her to establish a Health Equity Committee at Rutland Regional Medical Center, where she currently works as the Senior Director of Strategy and Data Analytics, leading the development of health equity analyses.
"Dartmouth's Hybrid MPH was the perfect option for me as a working professional. The ability to immediately apply what we learned to my work was invaluable."
Clinician and Care Team Member Experiences in the Serious Illness Conversation Model of Care Implementation.
Serious illness conversations (SIC) are patient/clinician discussions that elicit the values and priorities of seriously ill patients to guide future care and existing literature suggests that SIC improves the quality of care for patients facing advanced cancer. In this qualitative study, Karen Guo explored oncology team members' experiences of an ongoing SIC quality improvement initiative at an outpatient academic cancer center focused on increasing the uptake of serious illness conversations among clinical oncology teams.
"The most profound takeaway from my practicum work was recognizing the compassion, empathy, and resilience of the oncology and palliative care providers at Dartmouth Cancer Center. I am so grateful to have heard the providers' stories and collated them into overarching themes in the context of qualitative research."
The oncology team members who participated in the SIC Model of Care Implementation at the Dartmouth Cancer Center were eligible for enrollment, and interviewees were recruited to participate in a 30–45-minute, semi-structured interview. Among twenty-two eligible participants, twelve participants were enrolled from five oncology teams and five primary disease sites. From a review of the collected data, prominent themes emerged, such as limited time and staff resources curtailing serious illness conversation uptake; oncology team members upholding patient autonomy with regard to the timing of SIC, and oncology team members find the inherent value of SIC to patients and caregivers.
"I was inspired by the dedication of each of the providers with whom I had the pleasure of interviewing; I hope this research can highlight the resources and needs of oncology and palliative care providers to better serve their patients facing advanced cancer."
Barriers and Facilitators to Uptake of Pre-Exposure Prophylaxis (PrEP) Among Black Men Who Have Sex With Men (BMSM) at an Infectious Disease Clinic in Delaware County, Pennsylvania.
Human Immunodeficiency Virus (HIV) remains a significant public health threat in the United States, particularly among Black men who have sex with men (Black MSM). However, uptake and persistence of Pre-Exposure Prophylaxis (PrEP) among Black MSM is suboptimal. While studies have examined barriers to PrEP uptake nationally, few studies have examined clinical-level PrEP programs and interventions designed to improve PrEP uptake among Black MSM. In his practicum work, Strauss highlighted structural-level factors that impact PrEP update and persistence in a clinical setting.
“It was interesting to see how poverty, stigma, marketing, etc., all contribute to the overall success of PrEP uptake and adherence (which is a key component of the national strategy to end the HIV epidemic). HIV is still a genuine problem in the US. While on a national level, indicators are improving, in certain populations (Black Men Who Have Sex With Men, particularly in the Southern US), HIV is getting much worse.”
Strauss evaluated barriers to the uptake and persistence of PrEP through a program analysis of an existing PrEP program at a community-based infectious disease clinic, AIDS Care Group. Both qualitative topics (processes, challenges, barriers) and quantitative topics (demographics, HIV risk, persistence) were examined. The literature review focused on PrEP and HIV among Black MSM. Change ideas were developed using the Model for Improvement. As the Executive Director of AIDS Care Group, Strauss reflects,
“Dartmouth was instrumental in equipping me with the tools needed to understand and synthesize the academic thinking on HIV and PrEP. In addition, my training allowed me to take that information and apply it locally, focusing on improvement methods to increase the success of a PrEP program at my organization.”
Stories written by Mia Pennekamp Soucy