Despite two decades of work on cutting-edge health care technology, I paid little attention to public health until I won the HHS Healthy People App Challenge in 2011. Shortly thereafter, I lost a very close relative to liver cancer, which was caused by chronic Hepatitis B infection. I was shocked when I learned that 70% of viral Hepatitis carriers are not getting recommended care. That means many patients do nothing about the infection for years until it becomes too late.
After these key events in my life, I became involved in the NPA, and I now serve as a co-chair coordinating health equity activities across Arizona, California, Nevada, Hawaii, and the Pacific Islands for the Region IX Health Equity Council. After joining the NPA, I began reviewing literature to learn more about gaps in the health care system, and became shocked by the fact that tens of thousands of people die every year because they miss key preventive services. The Institute of Medicine’s famous report “Crossing the Quality Chasm” revealed the gap in preventive care, which has been recently confirmed again by CDC studies (see graph below). Percentage of American adults who are receiving selected clinical preventive services. On average, adoption of recommended preventive services is as low as 50%. Source: CDC report: Conclusions and Future Directions for Periodic Reporting on the Use of Selected Adult Clinical Preventive Services - United States.
Disparities in preventive care are particularly pronounced among racial and ethnic minority groups. For example, 1 in 10 Asians have chronic hepatitis B, compared to 1 in 1000 in the general population. Approximately 1 in 4 of these individuals will die from liver cancer or liver failure without monitoring or care.
I learned that it all boils down to inadequacies in the implementation of medical guidelines for prevention throughout the care delivery system. Pilot studies have demonstrated that eliminating disparities for specific conditions, such as cardiovascular disease, is possible when the medical guidelines are embedded in clinical workflow at individual health facilities. The challenge is that most solutions cannot be scaled up across all clinics, hospitals, community health centers and physician offices.
In addition to scaling up such interventions, it is critical to address the language barriers experienced by the 22 million Limited English Proficient (LEP) residents in this country when they attempt to access health services. Both language barriers and low adoption of clinical preventive services can contribute to health disparities among the LEP population.
Based on my work both in the technology field and on the NPA, I have initiated discussion about developing an online platform that may help to eliminate the preventive care disparities that racial and ethnic groups – specifically LEP populations - encounter. This online platform is intended to use cutting-edge technology to engage both patients and doctors in accessing evidence-based medical guidelines for the complete list of over 60 preventive services covered under the ACA. These guidelines will be customized for each patient. I believe that we can scale this approach to many medical facilities as a multilingual patient engagement component that is included in the routine clinical workflow.
By making prevention recommendations transparent to both patients and physicians, as well as engaging patients, missed opportunities to utilize preventive services can be avoided and resultant disparities reduced.
I am currently working under the umbrella of the NPA to operationalize this approach. In future blog posts, I will provide additional insights and updates.
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of RHEC IX
AJ Chen, Ph.D., is the
Founder and President of Activ3p Inc. and two-time winner of HHS developer
challenges. Serving on Federal Advisory Committee's Consumer Technology Workgroup
and as a Co-Chair for the Region IX Health Equity Council, AJ advocates for
disruptive technologies to eliminate health care disparities, particularly
multilingual patient engagement approaches.