Current events around the globe have vividly demonstrated that the human need to be included is a powerful and motive force. In healthcare, inclusion is the cornerstone on which we can build the framework to achieve a more robust and productive delivery system for the diversity of patients we serve. The concept of added value inclusion and diversity presents us with tremendous imperatives for training the next generation of clinicians, the business of healthcare delivery, and research.
I would like to share some recent experiences that exemplify the principles of diversity in action. By way of background, the National Center on Minority Health and Health Disparities has a 3-pronged approach in hopes of achieving the national research agenda that increases diversity and inclusiveness in clinical trials:
1. Conduct and support intensive research on the factors underlying health disparities.
2. Expand and enhance research capacity to create a culturally sensitive and culturally competent workforce.
3. Engage in aggressive, proactive, community outreach, information dissemination, and public health education.
As a past board member of the National Center for Medical Rehabilitation Research (NCMRR) at the NIH, I learned firsthand that the NCMRR is committed to adding value through diversity by applying our research findings to all of our patients. I currently serve as the board chairperson for a fascinating project entitled the "Lifestyle Redesign for Pressure Ulcer Prevention in Spinal Cord Injury" (LRD-PUPS), which is the subject of this month's continuing education article on page 275. I've recently concluded a site visit to the Division of Occupational Science and Occupational Therapy (OS/OT) at the University of Southern California (USC), Los Angeles, under the Leadership of Florence Clark, PhD, OTR/L, professor, associate dean, and chair. The program and the people that compose the LRD-PUPS study exemplify the core principles of diversity and inclusion. Researchers in the Division of OS/OT at USC and Rancho Los Amigos National Rehabilitation Center (Rancho) are in collaboration in an ongoing research program designed to (1) document the lifestyle precursors of pressure ulcers (PrUs), (2) develop a Lifestyle Redesign preventive intervention, and (3) conduct a randomized clinical trial of the efficacy and cost-effectiveness of the intervention. The long-term objective of this project is to identify an intervention option that can enhance the health and life quality of the population of adults with spinal cord injury (SCI) while simultaneously diminishing the heavy healthcare burden that results from the problem of SCI-related PrUs.
Diversity in Action
Although the aforementioned study is unique in its own right, the organizational structure and function of the program serve a distinct population of significantly diverse patients including African Americans, Hispanics, and others; the nonwhite study group is estimated to be approximately 40%. From a socioeconomic perspective, a significant number of study participants came from underserved, uninsured, immigrants or first-generation American citizens.
Increasing the Pipeline in the Health Professions
I was able to interact with 4 young professionals involved in the PUPS trial, whose parents had immigrated to the United States to give them a better life and opportunity for education. And educated they were! They were first in their families to go to college, let alone graduate school and obtaining doctorates in healthcare. During our discussions, the students, staff, and young minority faculty enthusiastically attributed their success in achieving higher education against all odds, to their families who wanted a better life for their children, to the leadership of USC and the Division of OS/OT, and to the all-encompassing nature of Dr Clark, who has provided nurturing and inclusiveness in her department and NIH research programs. I know that these individuals and others like them will enhance diversity and bring with them the cultural humility we all need to effectively communicate with our diverse patient populations. This program brings great credit to itself, the wound care profession, NIH, NCMRR, and USC.
Richard "Sal" Salcido, MD
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