Although disparities in surgical care have been documented, few attempts have been made to systematically study and understand the complex determinants of these disparities. Moreover, few studies have evaluated interventions to eliminate disparities in surgical care. We need to develop, implement, and evaluate strategic changes in our health care systems, our patients, and ourselves to eliminate disparities in access to surgical services, as well as the outcomes of surgical care.

Given the complexity of these issues, this unique course provides an opportunity for a broad based coalition of clinicians, policy makers, advocates, and other stakeholders to put forward multi-pronged approaches to the elimination of surgical disparities. The focus of this symposium is to translate research to practice.

Because surgical disparities are not limited to populations in the United States, the global problem of disparities in surgery and its unique challenges will be addressed, including presentations of case studies from the developing world.

Constrained resources, systems of care, quality of surgical care, and surgical safety all impact the delivery of surgical care and often effect disparate outcomes. These facets will be explored in greater depth.

The role of academic medical centers in surgical delivery, issues of workforce development and human capital, the impact of health care reform with Massachusetts as a model, the importance of data collection of race/ethnicity and primary language, and community participatory interventions as they impact these disparities will also be addressed.

In this second symposium, we aim to build on the momentum and energy of the first meeting and continue to seek to understand the nature of disparities in surgical care and the factors that influence and mitigate them. To that end, this course is structured to have multiple opportunities for formal and informal interaction with faculty and will foster networking and collaboration.

Upon completion, participants of this course will be able to:

• Define disparities in surgical care
• Understand how systems of care, public policies, resource utilization, health care reform, surgical safety, and surgical workforce can affect surgical outcomes
• Discuss the local, national, and global impact of delivery of surgical services
• Identify areas to focus research and implement practical solutions in their own practice to mitigate surgical disparities

Objective

• Create public awareness of disparities in surgical care on local, national, and global levels
• Devise strategies to improve systems of care as a potential solution to mitigate disparities in surgery
• Present evidenced-based research and practical interventions and explore new approaches to eliminate disparities in surgical care
• Establish ongoing communications with existing health services researchers and potential new collaborators
• Generate and publish a summary of the symposium proceedings

Poster Session

You are invited to submit your work for consideration to participate in our poster session detailing work in disparities in surgery (descriptive, interventional, or clinical research/basic science) or global disparities (case studies, burden of surgical disease).

Poster session: Monday, October 27 from 5:00–6:30 P.M.
Submission Deadline: August 1, 2008
Acceptance Notification: August 16, 2008

Contact:
Tess P. Panizales, M.S.N., R.N. (mpanizales@partners.org)
Katherine A. Latson, B.A. (kalatson@partners.org)
Kathleen J. Lively, R.N. (klively@partners.org)
for additional information and guidelines, please refer to: www.brighamandwomens.org/centerforsurgeryandpublichealth link on poster session details or call (617) 525-7300

Program

Breakout Sessions

Session One:
Cardiovascular Surgical Outcomes – Race/ethnicity is not often reported in large randomized trials in vascular surgery, and when it is, the enrollment of minorities is lower than the prevalence of disease. Race and gender interactions are seen in patients with bypass for critical limb ischemia, even when care is standardized. This session will review two different approaches taken to understand the drivers of these disparities and explore potential actions that may address these findings and discuss follow up analyses that may help measure policy efficacy.

Session Two:
Colorectal Cancer Disparities: How Research Can Impact Practice – This session will focus on methods to improve the outcomes of colorectal cancer patients, including: Increasing Access to Care, Influences on the Delivery of Care, and Factors which Influence the Quality of Care Delivered. We will discuss methods of tracking and measuring health disparities, and the potential impact of public policy interventions (i.e., public reporting and pay for performance) on the care of colorectal cancer patients.

Session Three:
Measurement of Race/Ethnicity and Primary Language: Practical Approaches to Eliminate Health Care Disparities – This session will explore the intersection of health care organizations’ commitment to providing high-quality and timely access to care and the well-documented findings that some racial and ethnic groups often experience worse outcomes than others. Through the standardization of patient self-reported data, health care organizations are improving the accuracy of the data available and have an opportunity to identify racial and ethnic disparities in health outcomes and implement innovative approaches towards the elimination of these disparities.

Session Four:
Disparities in the Elderly – The population is expanding and aging. This breakout session will discuss disparities in the elderly undergoing surgery, issues with measurement, possible solutions, and realistic goals.We will discuss prior studies, identify gaps in knowledge, and set an agenda for future work.

Session Five:
Community Participatory Research – This session will feature a brief introduction into the paradigm of Community Based Participatory Research (CBPR) and how this research approach can be a useful model for studying disparities in surgical care as well as for developing interventions to reduce disparities in surgical care and outcomes.

Session Six:
Eliminating Racial Health Disparities: National and Global Nursing Perspectives – This session will examine racial/ethnic health disparities in the nursing profession focusing on national and global nursing perspectives. Challenges for health care systems related to a U.S. nursing workforce with few multicultural nurses and the emerging trends in global nurse migration will be explored.

Session Seven:
Academic Medical Centers in Global Surgical Delivery – Globally, access to surgical services to heal, cure, and comfort is a pressing public health problem. The world’s surgical, anesthesia, and nursing workforces are insufficient and maldistributed. This session will address the role that providers in the developed world can play in knowledge transfer, research, and service to resource-constrained settings. Topics will include access to surgery, impact of surgical intervention on the global burden of disease, surgical epidemiology, surgical education, surgical cost-effectiveness, and surgical delivery.

Session Eight:
Lung Cancer Disparities: How Research Can Impact Practice – This session will focus on underuse of surgery for non-small cell lung cancer among whites and African Americans.We will discuss ongoing efforts to uncover and address potential patient, physician, and health care system related factors underlying differences in treatment.

Session Nine:
Race and Surgical Outcomes: It’s Not All Black and White – This session will focus on the effect of race on perioperative outcomes. Previous work has suggested that African American race is an independent predictor of poor, postoperative outcomes. More recent studies, however, suggest that greater comorbidity and increased care at “low-volume” hospitals (not race) may explain these observations. The implications of these studies on the “volume-outcome debate” and potential interventions to optimize surgical outcomes among racial minorities will be discussed.

Accreditation

Physicians: Harvard Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Harvard Medical School designates this educational activity for a maximum of 12.75 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The American Medical Association has determined that physicians not licensed in the US who participate in the CME activity are eligible for AMA PRA Category 1 Credit(s)™.

Nursing contact hours pending.

Approved for 1 Risk Management Credit for Massachusetts.

Registration Information

Tuition Fee - $525 (USD)
Reduced Fee for Residents and Fellows in Training (with a letter of verification from Department Chair) - $395 (USD)
Allied Health Professionals - $395 (USD)

All foreign payments must be made by a draft on a United States bank or by Visa or Mastercard. If paying by check, make it payable to Harvard Medical School and mail with the completed registration form to: Harvard MED-CME, P.O. Box 825, Boston, MA 02117-0825. If paying by credit card, fax the completed registration form to (617) 384-8686, or mail it to the above address. Telephone registrations are not accepted. Inquiries should be directed to the above address, made by phone: (617) 384-8600, Monday - Friday, 10 a.m. to 4 p.m. (Eastern Time) or by e-mail: hms-cme@hms.harvard.edu. Upon receipt of registration a confirmation letter will be mailed to the address listed on the form.

Tuition Refund Policy

A handling fee of $60 is deducted for cancellation. Refund requests must be received by mail one week prior to the course. No refunds will be made thereafter.

Course Location

All sessions will be held at the Seaport World Trade Center, 200 Seaport Boulevard, Boston, MA.

Accomodations

Hotel rooms in Boston are limited. You are urged to make your reservations early. A limited number of rooms have been reserved at the Seaport Hotel (877-732-7678) until July 27, 2008. Please specify that you are enrolled in the Harvard/BWH CSPH Surgical Disparities Course to receive a reduced room rate of $279.00 Single/Double. All room rates are quoted exclusive of state and local taxes. A map of Boston listing local hotels will be sent with your confirmation of enrollment. For additional housing assistance call Boston Reservations at (617) 332-4199.

Travel

Please do not make non-refundable airline reservations until you have been confirmed into your course. You can make your airline reservation by calling: the HMS Travel Desk toll free 1-877-4HARVMD (1-877-442-7863) Monday - Friday 9 am - 8 pm (EST). From outside the U.S., Canada and Virgin Islands, please call 617-559-3764.

Faculty