Letters to the Editor

Readers respond about tackling bias and avoiding turf.

Tackling bias

Mollie Durkin's article “Fighting the subconscious biases that lead to health care disparities” (January 2016 ACP Hospitalist) highlights important efforts addressing the impact of clinician bias, such as the “Breaking the Bias Habit” workshops at the University of Wisconsin-Madison and the integration of the “Project Implicit” implicit association test into physician education and training at the Mayo Clinic in Rochester, Minn. Clinician-led efforts are commendable and reflect a growing awareness of clinician accountability and contribution to racial disparities. Our community-led efforts in Colorado also offer a unique perspective on innovative approaches to tackling racial discrimination in health care.

The C-STAHR Project (Community-Students Together Against Healthcare Racism) was founded in 2010 by University of Colorado medical students and minority community members. The project uses CBPR (community-based participatory research) models longitudinally to promote community-developed interventions to curb the negative effects of discrimination. C-STAHR's vision is “for students and community to work together to better understand perceived discrimination and design feasible interventions to better equip future healthcare providers and community members to reduce its effects.” In pursuit of this vision, this group recruited African-American and Latino community members and interdisciplinary health professions students to serve in the self-named “CAN” (Communiversity Action Network). Community members repeatedly expressed prior feelings of being treated as an experimental subject rather than a partner in health research and promotion. To overcome this challenge, C-STAHR prioritizes relationship building, trust, and sustainability—all power and decision-making are shared equally between community and academic partners.

Using principles of CBPR, C-STAHR conducted focus groups with minority community members residing in Denver-area neighborhoods. On the basis of the resulting qualitative data, C-STAHR used a community-initiated root-cause analysis to develop a “problem tree” mapping contributing factors to discrimination in health care settings. C-STAHR uses the “problem tree” as a guide to developing focused interventions addressing specific factors. Potential clinic-based interventions are vetted by focus groups consisting of clinic physicians.

For example, implicit bias was found to be one of many factors leading to poor clinician-patient communication, a key cause of perceived discrimination. To address this issue, a combination of community, student, and clinician input led to the selection of a communication/self-advocacy form and exit survey as a primary intervention to improve patient-clinician communication and mitigate the negative effects of implicit bias. Currently, C-STAHR's patient empowerment and communication tool is being implemented at 3 clinical sites.

To date, C-STAHR has presented at numerous academic conferences and community forums, garnering over $60,000 in funding and receiving recognition including in-Training magazine's Primary Care Innovation Award (2015) and the University of Colorado's President's Diversity Award (2015). By facilitating community dialogue and developing various innovative interventions, C-STAHR provides a unique example of how sustainable partnerships can be created between academia and community to bring meaningful change.

The C-STAHR Project
Student representative: Romany Redman
Community representative: Owetta McNeil

Avoid turf

I was disappointed to read the article title “Will ICUs become hospitalists' turf?” (February 2016 ACP Hospitalist). Some of the major dysfunctions in medicine currently are the services functioning in “silos” and the conflicts over “turf.” The article itself actually addressed working together to improve patient care and efficiency, not who would “own” the unit. Having worked as both a hospitalist and an intensivist, I am very aware of the need to communicate well between services and share responsibilities. I would have appreciated it if the article title had more closely reflected that concept.

Ronald G. Snyder, MD, ACP Member
Billings, Mont.

A fan

I look forward to receiving my monthly issue of ACP Hospitalist. The articles are well organized, pertinent, and eminently enjoyable. The February 2016 issue was no different. The article “Apophenia” was as entertaining as it was informative. The reference to statistical type I and type II errors was beautiful.

Chakrapani Prakash, MD, FACP
St. Petersburg, Fla.