Health Equity Research Lab



Patient Preferences and discrimination in the healthcare system (PCORI)

The Patient Centered Outcomes Research Institute (PCORI) supports research to inform healthcare decisions and improve healthcare delivery and outcomes through integrity and evidence-based information. The Lab was awarded a three year grant to develop an instrument to understand patients’ treatment preferences in their depression and diabetes care. Incorporating patient preferences into treatment plan requires an understanding of patients’ past experiences and preferences, including experiences of discrimination and the influence of peers, family and community members regarding treatment options. A mismatch between treatment and patient preferences worsens health outcomes via lower patient engagement, poorer adherence, and higher attrition. We have developed a survey that combines conjoint analysis with measurement of prior healthcare experiences and socio-cultural factors to describe the influence of preferences among race/ethnic minorities. The survey was sent nationally to more than 1500 patients with either depression, diabetes or both. To further understand treatment preferences and prior experiences, we conducted interviews with patients and providers in person and by phone. We are sharing these findings with providers and raising awareness of the importance of including preferences as part of treatment planning. These research efforts were developed using community-based participatory research in collaboration with the Primary Care Practice Improvement team and the Volunteer Health Advisers at Cambridge Health Alliance and the Transformation Center, a peer-support organization that seeks to transform policy and practice in communities through the participation of people with mental health diagnoses.

To learn more, visit the PCORI page
Collaborating partners: The Transformation Center
                                     The Cambridge Health Alliance Primary Care Practice Improvement 

PI: Benjamin Cook
Point Person at the Lab: Esther Lee
Team members:  Adam Carle, Ana Progovac, Benjamin Cook, Catherine Rodriguez Quinerly, Danny McCormick, Deborah Delman, Dharma Cortes, Jonathan Delman, Susan Busch, Tali Fleitman Soffer, Timothy Creedon, Sherry Hou, Valeria Chambers, Ziva Mann, Diedre Jordan, Selma Castro, Ruth Nabisee, Farah Shaikh, Afsaneh Moradi, Maria Jose Sanchez, Esther Lee, Michael Flores, Rajan Sonik, Heba Abolaban, Natasha Kaushal

Medicaid Payment Policy and Access to Care for Dual Eligible Individuals (nimhd r01)

Dr. Cook and Dr. Vicki Fung at Massachusetts General Hospital (MGH) were granted a NIMHD R01 grant for 5 years with the aim to assess the impact of recent Medicare policy changes on racial/ethnic disparities in mental health care. The Lab will assess the effects of policy changes on racial/ethnic minorities in medical care use, quality process measures, clinical events and total and component medical spending. Racial/ethnic minorities are less likely to receive mental health care than Whites and these Medicare policies have the potential for reducing these disparities. Data to be used are a 20% sample of fee-for-service beneficiaries linked to provider and area-level data implementing difference-in-difference and within-person statistical analysis.

PI: Benjamin Cook, Vicki Fung (MGH)
Point Person at the Lab: Benjamin Cook
Team members: Mike Flores, Esther Lee, Brian Mullin

Gender Minority Health and Healthcare Disparities Using Medicare Claims and Electronic Health Records (NIMHD R03)

In 2016, the National Institutes of Health (NIH) formally designated gender minorities (i.e., transgender or gender non-binary persons) as a health disparity population, reflecting mounting evidence that this population has unique unmet health needs and that more research is needed to answer the epidemiological and health services questions which may help reduce disparities for this group. We seek to understand access and utilization of health services by identifying gender minority patients in Medicare claims and in electronic health records. Dr. Progovac has been granted a Harvard Catalyst Award as well as an R03 NIMHD to proceed with the studies. Key outcomes of interest include adequate treatment for depression, treatment for chronic conditions, suicide behavior, victimization from domestic violence, avoidable hospitalizations. We have developed strong collaborations with advocates, policymakers and clinicians who are working closely with and for this population to improve gender minority well-being and health.

PI: Ana Progovac          
Point Person at the Lab: Fred Lu     
Team members: Benjamin Cook, Brian Mullin, Maria Jose Sanchez, Fred Lu, Alex McDowell.
Other collaborators: Sari Reisner, Marshall Forstein, Cindy Telingator, Emilia Dunham, Masson Dunn, Joanna Gattusso, Natalie Bird, Pei Chen, Joshua Saffer, Laura Hatfield, Mark Schuster.

Cambridge Health Alliance Health Integration Program Evaluation (HMS Kaplen fellowship)

The Health Integration Program at the Central Street Health Center at CHA is a Behavioral Health Home that offers recovery-oriented care to adults with serious mental illness, including schizophrenia and other psychotic disorders. The project consists of a “reverse integration” program where primary care services are provided in a mental health care setting. It involves the participation of a multidisciplinary team including healthcare providers, nurse practitioners, case managers and administrative personnel. The Lab provides short and long-term evaluation of the program, including barriers/facilitators, appropriateness, acceptability, feasibility, sustainability and replicability. A mixed methods approach from analysis of electronic health records and narratives from semi-structured interviews with providers and patients, has identified that through enhanced training and care coordination, patients have received more screening tests and monitoring of co-morbid chronic and acute medical conditions. Dr. Progovac has earned a Kaplen award to continue with the analysis of the implemented project and define upcoming priorities as well as potential expansion to other CHA sites.

PI: Ana Progovac
Point Person at the Lab: Ana Progovac
Team members: Benjamin Cook, Miriam Tepper, Stephen Leff, Dharma Cortes, Sandy Cohen, Fred Lu, Brian Mullin

Neighborhood- level Predictors of Opioid- Related Mortality (HMS zinberg fellowship)

In 2017, the Department of Health and Human Services declared the opioid epidemic a “public health emergency.” The Centers for Disease Control and Prevention estimated 63,632 overdose deaths occurred in 2016. Close to two-thirds (66%) of these overdose deaths involved an opioid, either prescribed or illicitly obtained. The specific aims of this project are to identify the neighborhood-level factors that predict opioid-related mortality among CHA patients, determine the clinical and individual factors that predict health service use among CHA patients with opioid use and comorbid mental illness, and examine the barriers and facilitators of addiction treatment planning at CHA.  

Point Person at the Lab: Mike Flores
Team Members: Benjamin Cook, Aparna Nathan

Improving Limited English Proficient Patient Safety through Patient Portal Accessibility (crico)

Language barriers a risk for poor clinical outcomes, medical errors, and liability across the spectrum of care. We have partnered with Dr. Robert Marlin, a strong advocate of vulnerable populations, to assess the effects of implementing a Spanish-language patient online portal that accurately sends messages to low English proficiency patients in their native language with the aim to improve communication with the care team and mitigate risks that result from miscommunication. The project has recently started, and we look forward to evaluating patient satisfaction and clinical outcomes.

PI: Robert Marlin, MD, PhD, MPH
Point Person at the Lab: Fred Lu
Team members: Benjamin Cook, Jorge Rodriguez, Michael Flores, Brian Mullin, Zhishao (Ken) Luo, Meredith Brown, Fernando Gargano

Safety Net Collaborative and CPD mental health/criminal justice initiatives (miller foundation and Department of justice)

Supported by a Department of Justice and the Miller Foundation, the Lab is partnering with the Cambridge Police Department (CPD) to conduct evaluation of their diversion program for youth with mental illness (Safety Net) and community policing efforts for adults. In the last 10 years, the CPD has transformed its community policing philosophy to focus more on prevention, intervention, and diversion. Because at least 70% of people in the criminal justice system are mentally ill, the city has been working to connect at risk individuals with mental health care prior to arrest and incarceration. An important part of this initiative is the CPD Community Services Unit, which includes officers and sworn personnel who are dedicated to addressing the needs of youth, the elderly, the homeless, and individuals with mental health issues by facilitating information sharing and coordination of care between CPD and partner organizations. We evaluate the current state of these programs, formalize partnerships, and develop toolkits to promote information sharing between law enforcement agencies looking to expand community policing services in their communities.

PI: Jamie Barrett
Point Person at the lab: Esther Lee
Team members: Dharma Cortes, Benjamin Cook, Esther Lee, and Fred Lu.

using the electronic health record to predict and prevent adolescent suicide

Natural Language Processing and Machine Learning are computerized processes that can be used to code and make predictions from both structured (e.g. ICD-9/10 codes) and unstructured (e.g. free text) data. The Lab is evaluating the utility of these approaches to predict suicide in adolescents and first episode of psychosis. Improved identification of at risk individuals has the potential to reduce the prevalence of suicide while reducing the duration of untreated psychosis is associated with improved outcomes.

PI and Point Person at the Lab: Nick Carson
Team members: Benjamin Cook, Brian Mullin, Maria Jose Sanchez, Fred Lu

CMS Disparities (ACOs) by Race/ Ethnicity, Gender, and Gender Identity Status (cms office of Minority Health)

The Health Equity Research Lab was awarded one of the 5 Office of Minority Health seats with the CMS Virtual Research Data Center. This project studies the differences in ACO participation by race/ ethnicity, gender (including gender minority status), and mental health status beneficiaries. This project will also study disparities within ACO’s by dual eligibility status, race/ ethnicity and gender/gender identity in access, utilization, and quality of mental health services, and also compare access, utilization, and quality of disparities for beneficiaries treated within ACOs to those not treated in ACO’s by race/ethnicity and gender.

Comparative Effectiveness Research and Racial/Ethnic Health Care Equity (ahrq r01 completed)

We examine whether specific information in FDA warnings influenced disparity trends in psychotropic drug use and mental health care and to identify how provider characteristics and HMO enrollment act as mechanisms that underlie the differential diffusion of Comparative Effectiveness Research (CER) via health risk warnings. Identifying the influence of FDA risk warnings on trends in psychotropic drug use and related health care provides a platform to understand how CER will influence disparities and will help us to assess whether information regarding the risks and benefits of medications are being equitably disseminated. Our examination of how an increased reliance on CER will likely influence disparities in treatment after health care reform will provide policymakers with actionable information that might avert the negative equity consequences of incorporating CER into routine practice.

PI: Benjamin Cook           
Team members: Mike Flores, Ana Progovac, Nicholas Carson, Brian Mullin

The Impact of a Comprehensive Electronic Patient Portal on the Health Service Use of Patients Obtaining Services at Four Hospitals in Madrid: An Interrupted Time-series Analysis (completed)

The objective of this study is to determine the extent to which an electronic patient portal was associated with improvements in health service use. Using a quasi-experimental interrupted time-series approach to analyzing administrative hospital data, we assessed health service use before (April 2012-March 2015) and after (April 2015-December 2016) the implementation of a comprehensive electronic patient portal in four hospitals from the Madrid Health System (Madrid, Spain). Our primary health service use outcomes consisted of number of outpatient visits, any hospital use, any 30-day all-cause readmission, and any emergency department (ED) use.

Point Person at the Lab: Benjamin Cook
Team members: Mike Flores


Center for Mindfulness and Compassion

The Center for Mindfulness and Compassion (CMC) is an interdisciplinary center within Cambridge Health Alliance, CMC is an organization grounded in current scientific understanding of mindfulness and compassion, and the promotion of empirically supported theory and practice. CMC is committed to using mindfulness and compassion to foster an inclusive and caring community that ensures access on the basis of intersecting factors such as race, gender, sexuality, language, mental and physical ability, and economic status. The HER Lab is partnered with CMC on multiple projects that align both center’s focus on improving physical and mental health in diverse communities.  These projects include:

  • “Effect of Mindfulness Training on Opioid Use and Anxiety During Primary Care Buprenorphine Treatment.” This study will pilot test the Mindful Recovery OBOT Care Continuum model and demonstrate capacity for a multi-sites Randomized Control Trial (RCT) comparing Group-Based Opioid Treatment versus M-ROCC in primary care office-based opioid treatment (OBOT).

  • “Effects of Remote Motivational Enhancement and MySafeRx via Video on Post-Detox Engagement and Retention in Buprenorphine Treatment.” This study will both investigate the effects of starting remote motivational enhancement during inpatient detoxification on rates of engagement in during inpatient detoxification on rates of engagement in buprenorphine treatment and evaluate the impacts of MySafeRx, a mobile device application which integrates remote motivational coaching with daily observed dosing from secure electronic pill dispensers at home via video-conference on treatment retention and overdose prevention.

  • “Mindfulness Influences on Self-Regulation: Mental and Physical Health Implications, and Effects of Remote Motivational Enhancement.” This study seeks to understand the impact of mindfulness training on the underlying neural mechanisms of self-regulation for patients who are participating in mindful primary care at CHA.

Point Person at the Lab: Benjamin Cook
Center for Mindfulness and Compassion: