Characterizing Structural Racism in the Receipt of Palliative Care: A Novel Approach to Identifying Specialty Palliative Care Consultation
Racial/ethnic minority-group patients, specifically Black and Hispanic patients, may be disproportionately affected by limited palliative care resources due in part to structural racism. However, investigators cannot examine disparities in access to specialty palliative care nationally due to measurement challenges. The current standard for claims-based identification of specialty palliative care consultation has variable specificity (75.1-99.1%) and low sensitivity (49.8%).
The specific aims of my proposed project are to: (1) create a novel claims-based approach to identify receipt of specialty palliative care that has high sensitivity and specificity; (2) apply this approach to examine racial/ethnic disparities in the receipt of palliative care.
To address these aims, I have acquired novel datasets of Hospice and Palliative Medicine certified physicians and advanced practice registered nurses that have never been used for palliative medicine health services research. By combining these datasets with insurance claims from a large urban health system, our claims-based approach has the potential to transform measurement of specialty palliative care.
I am uniquely poised to carry out these projects given my clinical training in Hospice and Palliative Medicine, research training as part of a Master’s in Clinical Research, and support from Mount Sinai. I have strong relationships with my proposed mentorship/advisory committee, all of whom are highly accomplished researchers. In addition, I have developed career development objectives that will deepen my expertise in disparities research and reimbursement for specialty palliative care through coursework and independent study.
By developing a novel claims-based approach to identify specialty palliative care, I will lay the foundation for a K23 proposal, in which I will examine racial/ethnic disparities in access to specialty palliative care using national Medicare data. This work is a critical first step in improving access to palliative care for racial/ethnic minority-group patients by developing innovative care delivery models and policy initiatives.
Julia L. Frydman, MD, received her BA from Princeton University and her MD from Harvard Medical School. She completed her internal medicine residency at New York University and her Hospice & Palliative Medicine fellowship at the Icahn School of Medicine at Mount Sinai. She is currently an Assistant Professor in the Brookdale Department of Geriatrics and Palliative Medicine at Mount Sinai and completing a Master of Science in Clinical Research. Her research goal is to address racial/ethnic disparities in access to palliative care by identifying drivers of these disparities and developing novel care delivery models that promote equity. Her prior work has focused on identifying barriers to palliative care, including serious illness communication, and overcoming these barriers through clinician-directed training programs.