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Bridging Health Disparities: The Asian American Hepatitis Project

Collaborative research project focusing on hepatitis B and liver cancer disparities in Asian Americans through innovative interventions and stakeholder engagement.

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Bridging Health Disparities: The Asian American Hepatitis Project

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  1. Collaborative Patient-Centered Research to Reduce Health Disparities: The Health Within Reach Project Tung Nguyen, MD, Division of General Internal Medicine, UCSF Mandana Khalili, MD, Division of Gastroenterology and Hepatology, UCSF/SFGH Arcadi Kolchak, San Francisco Hep B Free February 2, 2016 Patient-Centered Research Outcomes Institute (PCORI) AD-12-11-4615 Asian American Research Center on Health (ARCH)

  2. Asian Americans • Asian Americans fastest growing racial group • 66% born outside the U.S, and 50% of foreign-born came after 1990 • 37% are limited English proficient: Chinese: 48%, Vietnamese: 55% • 1 out of 3 San Franciscans is Asian

  3. Scientific and Community Needs • Hep B infection among Asian Americans ~10-15% • 1/3 never had hep B screening test • Few studies on Asian Americans and hepatitis C • Liver cancer incidence much higher among Asian Americans compared to non-Hispanic Whites • Very few clinical interventions to improve quality of care among Asian Americans

  4. Health Within Reach Aims • Develop interactive patient education video (Video Doctor) and Provider Alert to increase screening of hepatitis B and C in Asian American patients • Evaluate the efficacy of the Video Doctor + Provider Alert intervention + Provider Panel Notification vs. Provider Panel Notification in 2 healthcare systems through provider randomized controlled trial

  5. Health Within Reach Team • Sites: UCSF General Medicine, SFGH General Medicine and Family Practice • Team: General Medicine (Nguyen, Walsh, Goldman), Hepatology (Khalili), Psychology (Tsoh), Community (SF Hep B Free Exec Director) • Stakeholders: Asian American Network for Cancer Awareness, Research, and Training (AANCART); Patient Advisory Councils, Vietnamese Community Advisory Board • Research Associates : Chinese-Vietnamese (Wong), • Chinese (Lau, Chow), Vietnamese (Lam, Bui)

  6. How/Why Was the Team Formed? • SF Hep B Free Perspective • SFGH Hepatology Perspective • UCSF General Medicine Perspective

  7. Why Was the Team Formed? • Passion for Asian American health and health disparities • Commitment to community-based and patient-centered work • Common focus on hepatitis B and liver cancer • Complementary expertise • Hep B Free: community mobilization, stakeholder engagement • SFGH/Hepatology: clinical research, underserved, specialty • UCSF/General Medicine: community-based participatory research, multi-lingual interventions, prevention

  8. How Was the Team Formed? • SFGH/Hepatology and Hep B Free • SFGH/Hepatology and UCSF/General Medicine • San Francisco AANCART • NCI Program Grant on Hepatitis B screening • Hep B Free and UCSF/General Medicine • UCSF: Vietnamese portion of Hep B Free Campaign • Hep B Free requested consultation through CTSI Community Engagement & Health Policy (CE&HP) Program • All 3: CE&HP Working Group---SF Hep B Quality Improvement Collaborative • Grant opportunities

  9. Benefits to the Project • Funding: Innovation, Collaboration, Capabilities, Stakeholder Engagement • Intervention Development: Scientific, Logistics, Culture/Language, Patient-Centered • Implementation: Instrument Development, Informed/Consent/Recruitment, Clinic/System Logistics • Dissemination

  10. Benefits: Application Algorithm

  11. Benefits: Mobile App and Provider Alert

  12. Benefits: Empowerment

  13. Benefits: Control Group

  14. Benefits: Usability

  15. Challenges of Collaboration • Different perspectives and approaches • Aligning expectations • Communication • Personnel and other changes

  16. Addressing Challenges • Budget • Logistics: regular team meeting with rotating sites, coordinators meetings, PI phone calls • Respectful communication • time for discussion so everyone’s viewpoints are heard • problem solving not finger pointing • consensus decision making • Stakeholder engagement: regular meetings on site with food, being open-minded, sense of humor

  17. Recommendations • Establish relationships early before thinking about writing a grant together • Be flexible and modify your approach as needed • Establish open communication • Understand that resolving challenges caused by intersection of different perspectives lead to innovation and generalizability

  18. Discussion • How to find stakeholders or collaborators? • How to be flexible? • How to deal with conflict?

  19. Tung.Nguyen@ucsf.edu Mandana.Khalili@ucsf.edu arcadi.kolchak@sfhepbfree.org www.asianarch.org

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