MGH seeks to bridge healthcare's racial gap

Massachusetts General Hospital executives will announce today the creation of a center designed to address one of the most stubbornly chronic conditions in healthcare: the deep division that exists in medical status between racial and ethnic groups.

The hospital and Partners HealthCare System are pledging a total of $3 million to found the Disparities Solutions Center, where researchers will hunt for answers to end disparities in patients' medical treatment and improve their health.

Mass. General leaders envision working with health plans and other medical centers from across the state and around the nation to identify unequal treatment at their facilities by collecting data detailing which patients get what kind of care. That information will then be used to figure out why disparities in care exist and to eliminate those differences.

The emergence of the center solidifies Boston's position at the vanguard of efforts to end disparities in care that result in African-Americans and Hispanics suffering higher rates of heart disease, diabetes, and HIV than whites.

Doctors involved with the drafting of a scathing, landmark national examination of disparities in 2002 by the Institute of Medicine said in interviews that they believe Mass. General is the first hospital in the United States to make such a sweeping commitment to solving the disparities across all specialties.

The $3 million investment over five years will be used to bring together a team of healthcare specialists devoted to studying disparities and finding ways to bridge the chasm. Additionally, the money will establish an institute to train medical professionals on issues of healthcare inequity and to underwrite a fellowship program for doctors-in-training.

Dr. Thomas Inui, chief executive of a medical research institute in Indianapolis and former chairman of ambulatory care and prevention at Harvard Medical School, hailed the center for moving beyond the mere documentation of the healthcare divide.

''I'm not aware of another system that said, 'We're going to go out and fix these problems and show others how to do it,' " said Inui, president of the Regenstrief Institute for Health Care and a member of the panel that prepared the Institute of Medicine's ''Unequal Treatment" report. ''We're really finished with the time in which we need more studies showing disparities exist. Now, we need to show how to close the gaps, how to repair or at least reduce the disparities."

The MGH-Partners initiative is the latest example of the growing urgency in Boston to address healthcare inequality. It is a movement being driven in the city by an unusual combination of political muscle, physician determination, and economic imperative, with hospitals recognizing that in an increasingly multicultural city and nation, ending unequal care is smart business as well as ethically correct.

''People are saying it's not enough to accept any longer that this is the way things are," said John Auerbach, executive director of the Boston Public Health Commission.

The founding of the Mass. General disparities center comes just a month after Boston Mayor Thomas M. Menino announced his own initiative to fix what he and his advisers regard as the city's most pressing health issue.

As part of the mayor's $1 million effort, the city will help pay for hospitals to begin detailed tracking of racial and ethnic differences in the care patients receive, and it will underwrite training designed to make physicians more culturally sensitive.

Another member of the Partners system, Brigham and Women's Hospital, had made disparities research a keystone in a new center devoted to examining the intersection between surgery and public health.

''When I sat down with my colleagues, we shared a common sentiment, which was, if we don't do it, who will?" said Dr. Selwyn Rogers Jr., director of the Brigham's Center for Surgery and Public Health. ''We're in a position to do this in a way that a single practitioner in Western Massachusetts can't, in a way that a single practitioner in Alabama can't do."

The gap in health status between racial and ethnic groups has long bedeviled medical associations, patient advocates, and health plans. Earlier this year, Dr. David Satcher, the former US surgeon general, wrote in the Health Affairs medical journal that 84,000 African-Americans die needlessly each year because of healthcare disparities.

In Boston, black men die on average five years sooner than white men. And a recently released study indicated that even infants born to black women with college degrees are substantially more likely to die before their first birthdays than babies born to white women with comparable levels of education.

An expanding body of research evidence indicates that blacks are substantially less likely than whites to get state-of-the-art medication to treat heart disease or to undergo bypass surgery. And blacks on dialysis are not as likely to receive kidney transplants.

The director of the new center at Mass. General, Dr. Joseph R. Betancourt, said he views the effort as a ''living laboratory" that will involve front-line doctors, academic researchers, and patients in the quest to find what will work -- and what will not -- to address disparities.

''We want to evolve from a model that points fingers to a model that says there's no one suspect, there's no one solution," said Betancourt, who also sat on the panel that drafted the disparities report for the Institute of Medicine, an independent agency that advises the federal government on health matters. ''It is a complex problem."

Specialists said the disparities are sparked by a tinderbox of social and economic factors: poverty, racism, hopelessness.

''We can't solve all of the issues that lead to disparities," said Dr. Peter L. Slavin, president of Mass. General. ''But we still have a responsibility to address the issues that reside within the healthcare community."

MGH executives said that, after their initial five-year investment, they hope that the center will be sustained by grants from foundations as well as contracts from other hospitals seeking help with disparities projects.

The center's architects hope it will serve as a clearinghouse for sharing information about healthcare inequity and lessons for remedying it. Dr. Alan R. Nelson, one of the leaders of the Institute of Medicine review of disparities, counseled patience as efforts to fix a problem decades in the making begin in earnest.

''The situation didn't occur overnight, and it's not going to be corrected overnight," said Nelson, special adviser to the chief executive officer of the American College of Physicians and a former president of the American Medical Association. ''But I think substantial progress is going to be made."

Stephen Smith can be reached at stsmith@globe.com.