Mount Sinai’s Kirk Campbell, MD: Increased Data Collection, Education Driving Equitable Care Strategies

Inequities in health care outcomes and dellivery have long persisted within underserved communities across the United States. The complex interaction between biological, socioeconomic, and environmental factors, such as a person’s ZIP code, have substantial implications regarding an individual’s health status. However, there remains a paucity of data and research examining the true impact of these issues.

As health equity came to the forefront of national attention amid the COVID-19 pandemic,  Kirk Campbell, MD, FASN, who in 2017 became the vice chair for diversity, equity, and inclusion (DEI) in the Department of Medicine at Mount Sinai Health System in New York, noted how his organization started the Institute for Health Equity Research, which is driving improved efforts for demographic collection, educational research, and clinical initiatives that provide a data-driven approach to meet the care needs of vulnerable populations they serve.

Focusing on 3 pillars in their efforts to improve health equity—workforce, education, and clinical outcomes—Campbell speaks with The American Journal of Managed Care^® (AJMC^®) on Mount Sinai’s 11-point plan to tackle disparities, increased data collection on social determinants of health (SDOH) and other factors to proactively track clinical outcomes, and how his organzation is supporting and training frontline workers on equitable care delivery.

AJMC^®: ​​Can you speak on your goals and priorities in your role as vice chair for DEI in the Department of Medicine at Mount Sinai Health System in New York?

Campbell: I became the vice chair for DEI at Mount Sinai in January 2017, and I really have tried to focus on 3 pillars in our health equity initiatives: the workforce, education, and clinical outcomes.

From a workforce standpoint, we're mindful that we have a clear responsibility to support our faculty, residents, fellows in training, or medical students rotating on our services, as well as a lot of the nonclinical staff that work side by side with us in the department. So, we take a metric and data-driven approach to all our work, tracking demographics for faculty and health staff, comparing those to national standards, as well as local community representation from a demographic standpoint.

We take a very close lens to climate and wellness surveys. We oversee a number of facilitated discussions just to get a better sense of the day-to-day experiences of the folks working in the clinical and educational research settings. And creating dashboards for appointments, promotions, tenure for faculty, it's something that we're very mindful of.

We're very proud of a mentorship sponsor substructure that we have for trainees to enable them to get the most out of residency and fellowship training here at Mount Sinai—that's been very well received. We also have supported in the Department of Medicine a number of unconscious bias and undoing racism workshop training sessions that, again, have been well received, and we're in the process of assessing how effective those trainings are. That's a very hot topic, nationally, right now.

We're also expanding a number of initiatives to track clinical outcomes to make sure that we're not leaving any patients behind related to their demographic bases and characteristics and their socioeconomic status, health literacy. So, we're working closely with the hospital system to ensure that we have optimal clinical outcomes for all our patients.

AJMC^®: ​​You additionally are a director of the Nephrology fellowship program at Mount Sinai and serve on several editorial boards in kidney disease. What lessons have you gained from your work and research in nephrology, and how does this influence your work in your leadership role in DEI at Mount Sinai?

Campbell: I served for 7 years as a dellowship Director of nephrology, and nephrology is—of course, I'm biased—but I think it's an extremely fascinating specialty. On the one hand, it's very diverse. We have a very high percentage of international medical school graduates practicing in nephrology in the United States, and at the same time, it has traditionally had lower numbers of women and folks from underrepresented groups among the trainee, faculty, and attending workforce.

So, there are a lot of initiatives that have been expanded over the years to ensure that the workforce reflects the patient population that we serve, because patients who are Black, Latino, Native American, and those from lower socioeconomic backgrounds disproportionately are affected by kidney disease, and they're more likely to require dialysis when they do develop kidney disease. There are tremendous disparities with access to kidney transplants and home dialysis, so it's really provided me with a great perspective to tackle a lot of the workforce and clinical challenges in ensuring, again, that there's good representation and support in the workforce and providers for patients.

AJMC^®: ​​What notable initiatives has Mount Sinai implemented over the past few years to address health inequities and disparities for the populations it serves, and how are new resident doctors being educated/trained on these practices?

Campbell: Mount Sinai developed a roadmap to address racism and really empowered a task force that developed an 11-point plan that was quite ambitious to tackle disparities, again, from the workforce to the provider and patient. And key to this is, again, empowering leaders as well as folks within our hospital and medical school community to be fully engaged.

There's an equity scorecard, for example, that will guide a lot of these efforts going forward. There’s a strategy around integrating the clinical practices to make sure that we're delivering the same quality and standard of care across different practice sites throughout the health system. It’s a strong component of community engagement, and Mount Sinai has had a great track record of including community board members in a lot of policymaking that clearly are reflected in the point of care of clinical delivery.

Some of the financial and business strategies, and the partners who provide support services for the health system, that's been reformed and continues to be reformed over time. And of course, educational environments for medical students, graduate students, and trainees has been a big part of the strategy. Medical students and health staff are often a lot more enlightened than senior faculty in considering health disparities or health equity as a priority.

But we want to ensure and have implemented a number of cross-cultural communication activities and formal workshops during residency training. We want to make sure that our providers are avoiding the use of stigmatizing language, for example, and that's really important in the era of transparency where patients have full access now to their medical records, as part of the 21st Century Cures Act. And importantly, Mount Sinai in 2020 started an Institute for Health Equity Research, which is really driving a lot of the educational research and clinical initiatives, again, from that data-driven perspective going forward.

AJMC^®: ​​As health equity initiatives overall are largely in their infancy and the impact of these actions likely won’t be felt for generations to come, what quality metrics are being used by Mount Sinai to measure outcomes of diverse populations both short and long term?

Campbell: It's very important to have metrics that will guide any initiative that you begin—you have to track progress in a logical manner over time. As it specifically pertains to health equity, we realized several years ago that we didn't have very good demographic data, for example, and it's very difficult to determine whether or not you're providing equal access to care and similar outcomes, which is highly desirable on the clinical side for all our patients, if you don't have great demographic data to begin with.

So, a very exhaustive process was undertaken in 2020 to ramp up that data collection from a patient standpoint. The dashboard that's available now incorporates SDOH, by identifying patients who may have housing instability, food insecurity, or transportation concerns. These factors are very important for optimal care delivery, along with also identifying care gaps and promoting preventive medicine. Are patients getting their routine screenings, vaccinations, colonoscopy? Are patients with diabetes getting eye exams and foot exams?

These are now part of the dashboard, so whenever a patient's chart opens, we can see if patients are really meeting those crucially important quality metrics. And so, it really starts again, gathering great data, tracking that data exhaustedly and updating it constantly, and optimizing those features that you can to effectively use to deliver great care.

AJMC^®: ​​What research gaps are currently being investigated as they pertain to health equity at Mount Sinai?

Campbell: There are a lot of research gaps that are being investigated. I think our experience with the COVID-19 pandemic really brought this into full focus. The medical community, and Mount Sinai in particular, really had a sense of urgency to better understand this complex interaction between biological, socioeconomic, environmental factors, the neighborhood's that folks live in—the connection between those factors and health outcomes for communicable and noncommunicable diseases.

The answer may be different for each clinical diagnosis, but there are a lot of studies ongoing now that are trying to understand how a person's innate genetic background, diet, and daily exposures could impact the widely disparate rates of heart disease, lung disease, kidney disease, for example. There's definitely a sense of urgency, because this has been put front and center for us.

So, high-quality datasets are being built. There's great input from patients and community partners. And hopefully, we can come up with a lot of public health and preventive medicine interventions that would really complement some of the standard medical treatment options that we have been accustomed to for the past several decades. But I think we have an opportunity to really address some of the SDOH and public health factors—really caring for patients where they live in a manner that they can control with respect to diet and other exposures, for example.

AJMC^®: ​​Nurse staffing shortages have been a major issue nationwide, exacerbated by the recent strikes in New York City. How is Mount Sinai addressing any gaps in care that arise from this issue, particularly through a health equity lens?

Campbell: Multiple sectors across American society suffered a tremendous workforce challenge, and medicine hasn't been spared. In fact, for frontline health care providers like nurses, the problem has been even more acute.

The approach has really been 2-fold. First and foremost, supporting the nurses, understanding the tremendously important and difficult job and responsibilities that they have, and developing ways to recruit and retain the best nurses and supporting them to have a great work-life balance is crucially important. And also the partnership and training to ensure that equitable care is delivered by nurses, doctors, trainees, students, is also important.

But at the same time, really developing and maintaining those rigorous quality metrics to ensure that, again, the most vulnerable patients aren't left behind or not getting care that's inferior in any way. In fact, seeing that we are able to direct the resources, oftentimes more resources to patients who need them the most, who may have a higher burden of chronic disease. That's something that we constantly work with in partnership with our nurses, which we truly value.