Racial inequities in prevention, care, and outcomes for patients with sepsis are well-documented. Thus far, however, there have been no proposed interventions to address structural racism in sepsis care.
Sepsis is a life-threatening systemic reaction to an infection. It affects 1.7 million adults in the U.S. each year and is one of the leading causes of death. African American/Black and Latinx people with sepsis experience higher rates of complications and readmissions compared with the non-Hispanic white population.
In an attempt to address the problem, the Yale Global Health Leadership Initiative in November launched “Champions Advancing Racial Equity in Sepsis” (CARES), a national collaborative to address racial inequities in care and outcomes for patients with sepsis using a coalition-based leadership development intervention. A virtual launch forum Nov. 16 and 17 brought together the four participating health systems to discuss the ways in which structural racism influences patient care at their sites.
What we hope to generate is a roadmap or a set of approaches that could be used to tackle structural racism in all the ways that it shows up in health inequities.
Erika Linnander, Director, Yale Global Health Leadership Initiative
The CARES collaborative was made possible by a research grant awarded by the National Institute of General Medical Studies, a division of the National Institutes of Health.
“There are a lot of different paths that lead to sepsis, and it’s a good example of how structural racism acts,” said Erika Linnander, director of the Global Health Leadership Initiative and one of the principal investigators on the project. “If you chart a patient’s path all the way from primary prevention — which is how to keep from getting sepsis — through to longer term outcomes, such as hospital readmission and chronic health effects of having had sepsis, Black patients have worse outcomes at every step along that process compared to white patients.”
“It is a confluence of all of the ways that structural racism acts within our society. It’s everything from really big issues like housing and access to primary care and immunizations, all the way through to what happens in the hospital and the ways that Black patients are treated differently from white patients on a systems level, and then all the way through to access to resources afterward.”
For example, said Linnander, the way a Black patient describes symptoms of sepsis might not be taken as seriously as the way a white patient describes symptoms. Inequities in care in the hospital could also have to do with confounders like insurance status and whether a patient drives to the emergency department or is taken by ambulance.
The goal of the intervention is to build an organizational culture within each health system that addresses structural racism as it relates to sepsis care. Each site will have a “guiding coalition” of 15 to 20 people from a diverse range of roles and organizations, departments, and areas of expertise, such as emergency medicine, intensive care, quality improvement officers, people who are focused on health equity, and community-based organizations.
“The idea is you get a bunch of different disciplines together around the table,” said Linnander. “You look at the issue of racial inequity and sepsis from all those different perspectives. You say, okay, what are sepsis outcomes within our health system? How are we doing in terms of racial equity in those outcomes? And then, where's the opportunity for change? The aim is to come up with new insights into how to address it.”
The investigators will conduct workshops at each site and measure organizational culture over time. Every six months, they’ll come together virtually to share their progress and lessons learned, as well as any tools that they've found helpful.
In the next phase of the project, the investigators will examine the impact of changes in organizational culture on the reduction of racial inequities related to sepsis focusing on three outcomes: early identification and treatment, readmissions, and mortality.
Linnander believes that hospitals across the country are committed to addressing issues of health inequity, but there's not a lot of evidence on how to do it because the issues are so complex.
“What we hope to generate is a roadmap or a set of approaches that could be used to tackle structural racism in all the ways that it shows up in health inequities,” she said. “We're trying to take a pretty broad and important concept and distill it down so that hospitals have something that they can grab onto and start to make an impact.”