Research Projects

Collecting and contributing scientific and epidemiological evidence to regional policy challenges faced by low and middle resource settings in the face of a global epidemic of chronic disease.

Dr. Nunez-Smith leads and is the sole PI on a multi-million dollar U24 cooperative agreement from the National Institutes of Health/National Institute on Minority Health and Health Disparities to establish the Eastern Caribbean Health Outcomes Research Network (ECHORN). Now in Year 3 of the initial 5-year study period, she created a de novo collaboration between Yale School of Medicine and academic health institutions across four Caribbean island sites to conduct original global health disparities research on chronic disease in the region.

This effort is one-of-a-kind in its design and Dr. Nunez-Smith is one of only a few researchers working in this region. ECHORN can be briefly described as the “Framingham of the Caribbean” and has established an infrastructure to support future intervention and epidemiologic research that can be expanded to other island sites within the region. She, and ECHORN, partner with the World Health Organization/Pan-American Health Organization (PAHO/PAHEF) and the Caribbean Community (CARICOM) as well as all site Ministries of Health or equivalent to promote translation of the collected data into policy.

Creating standardized patient-reported measurement approaches to assess healthcare quality and equity. These approaches are developed using state-of-the art methodological techniques for item development and advanced psychometric testing for validation.

Dr. Nunez-Smith is the sole PI on a National Institutes of Health/National Cancer Institute (NIH/NCI) R01 to develop and test the Patient-Reported Experiences of Discrimination in Care Tool (PreDict). This multi-state, multi-hospital collaborative, now in Year 2, is creating a first in patient measurement specific to healthcare equity. She is an inaugural member of the National Quality Forum’s (NQF) Health Disparities and Cultural Competency Standards Steering Committee, established in 2011 to identify disparities-sensitive and disparities-sentinel hospital performance measures.

The NQF is a nonprofit organization that seeks to improve the quality of American healthcare through endorsement of national consensus standards for measuring and publicly reporting on healthcare system performance. NQF endorsement is the standard precursor to performance measure adoption by payers such as the Centers for Medicare and Medicaid Services (CMS).

PreDict has the potential to emerge as a hospital-level performance measure, similar to other patient-reported measures currently endorsed by NQF. PreDict is being developed along inpatient internal medicine service lines and is poised for expansion to other inpatient service lines and other care delivery settings such as ambulatory practices and long-term care facilities. She was recently invited to serve on the Connecticut State Medical Society’s new Health Equity Committee. This Committee will make guideline recommendations for best practices relevant to providing care for historically vulnerable populations within the state.

PreDict began in 2006 when Dr. Nunez-Smith received a Yale Center for Clinical Investigation Scholar Award, which provided research support for her project on developing an instrument to measure discrimination in healthcare systems. That pilot project was subsequently funded by the NIH/NCI through an R21 and is now supported through the R01 described above. PreDict’s ultimate goal is to assess the patient-centeredness of the care experience, to compare and report on hospital-level performance, and to ultimately improve the quality and equity of the care experience within healthcare organizations.

Developing metrics for academic medical center internal and external assessment germane to the Liaison Committee on Medical Education (LCME) faculty diversity-related accreditation standards through the conduct of a series of secondary data analyses using Association of American Medical Colleges (AAMC) data.

Dr. Nunez-Smith has been the lead or senior author on numerous seminal papers in this field, most notably a research paper in the Annals of Internal Medicine on the professional experiences of physicians of African descent, one of her RWJF CSP fellow projects. She has subsequently received many awards and recognitions for her work in the area of healthcare workforce diversity such as the Association of American Medical College’s (AAMC) Nicken’s Faculty Fellowship, which recognizes a junior faculty member who leads efforts to remedy inequities in medical education and health care. She also submitted an invited editorial to the British Medical Journal.

She has also been the PI on several foundation awards to extend her original research. She is the PI on PaRoDiME, Promotion and Retention of Diversity in Medical Education, funded by the Josiah Macy Jr. Foundation. She has presented PaRoDiME findings as a plenary presenter at the National Institutes of Health and has published several research papers based upon these results. Her recent election by her peers as Yale’s junior faculty representative to the AAMC Council of Faculty and Academic Societies furthers her existing policy partnership with the AAMC on academic health center policy on healthcare workforce diversity and inclusion.