DOCTORS’ Notes
Left Behind
Sepsis care can be worse for minority
patients, study finds. BY MOLLIE RAPPE
Revolution
in Alzheimer’s
Research
Brown will help lead a nationwide collaboration to
improve dementia care. BY BRIAN E. CLARK
B
rown University and Boston-based Hebrew SeniorLife will
lead a national effort to improve health care and quality of life
for people living with Alzheimer’s disease and related
dementias, as well as their caregivers. The National Institute
on Aging is funding the project with up to $53.4 million over five years.
Together, the institutions will create a massive collaborative research
incubator to develop trials aimed at evaluating treatments for Alzheimer’s
or Alzheimer’s-related dementia.
“This grant will revolutionize the national infrastructure for research
into how care is delivered to people living with dementia and their
caregivers,” says Vincent Mor, PhD, co-leader of the collaboration and a
professor of health services, policy, and practice at Brown’s School of
Public Health.
The first objective of the project is to fund and provide expert
assistance to up to 40 pilot trials across the country that will test
non-drug, care-based therapies for people living with dementia. The
second objective is to develop best practices for implementing and
evaluating therapies and share them with the research community
at large.
The 40 year-long pilot projects will be run in health care systems
across the country and generate the necessary data to inform larger,
definitive trials supported with federal funding, the researchers say.
Mor says the size of the grant reflects the urgent need to better care for
the millions of families who face Alzheimer’s and related dementias.
More than 5 million Americans live with Alzheimer’s or a related
condition, according to the Alzheimer’s Association; that number is
expected to double by 2050. The annual cost of dementia care exceeds
$226 million a year in the US alone.
8 HEALTH DISCOVERIES l WINTER 2020
S
epsis is a life-threatening condition that
occurs when the body’s extreme response to
an infection triggers a chain reaction.
“Even with the best care, the mortality rate
is between 15 and 25 percent,” says Mitchell Levy, MD, a
professor of medicine at the Warren Alpert Medical
School.
Early identification and treatment of sepsis is
essential for saving lives (see Health Discoveries, Winter
2018). When New York launched an initiative to improve
care and survival, more patients received the recom-
mended treatment and mortality rates decreased,
according to a study that Levy co-authored.
However, the researchers found a difference in sepsis
care between black and white patients. During the first
27 months of the initiative, black patients experienced
an increase of only 5.3 percentage points in the
completion of the best-practice protocol, while white
patients saw an increase of 14 percentage points.
They also found that hospitals that serve higher
proportions of black patients had smaller improvements
in protocol completion. Within the same hospital, white
and black patients received similar care, in terms of
protocol completion rates, according to Amal Trivedi,
MD, MPH, a professor of medicine and the paper’s
senior author.
Prior research found that minority-serving hospitals
tend to have more financial stress, fewer resources, and
less infrastructure for quality improvement measures,
he says. These hospitals also tend to treat more
uninsured patients and those on Medicaid.
“Racial and ethnic minority groups can get left
behind,” says co-author Keith Corl, MD, an assistant
professor of medicine. “Knowing this, it is our job to
better design and monitor these programs to ensure
racial and ethnic minority patients realize the same
benefits as white patients.”