# DiSRUPT: Dismantling Structural Racism Underlying the Organization of Ambulatory PracTices: an observational study of clinical desegregation

> **NIH NIH R01** · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · 2022 · $844,995

## Abstract

PROJECT SUMMARY
Structural racism is not simply an accumulation of individually held prejudices, but rather, it is the embodiment
of racism in rules, policies, laws, practices, and norms. The most conspicuous example of structural racism is
residential segregation, the degree to which social groups live separately from one another within a specified
geographic area. Segregation is a multi-dimensional, complex construct that has contributed to racial disparities
across many domains. Segregated facilities and organizations persist throughout society, including in healthcare,
where for example, teaching services in academic medical centers are often located in areas with large numbers
of medically underserved groups; and discriminatory insurance programs perpetuate the maintenance of
separate outpatient practices for indigent patients. There is, however, surprisingly little research on segregation
in healthcare or its direct (disparate quality and access) and indirect (perceived discrimination, mistrust) impacts
on the delivery of care or health outcomes. To eliminate structural racism and discrimination from healthcare
systems, we must identify, quantify, and address these factors. The DiSRUPT study will use retrospective
ambulatory visit data for 12 million patients from five academic medical centers across New York City (NYC)
obtained from the INSIGHT Clinical Research Network (CRN) to assess the level of segregation of ambulatory
practices and its impact on processes of care and care outcomes. We will use detailed concurrent and
prospective data regarding clinical structures, processes, and policies at the Mount Sinai Health System (Sinai)
to characterize the multiple domains within which structural racism and discrimination operate and to evaluate
the impact of current and planned equity interventions. Sinai is undertaking a transformational set of equity
initiatives to dismantle structural racism system-wide, including the unification (desegregation) of ambulatory
practices, creating a “natural experiment”. We aim to: 1) use CRN data to describe the level of segregation,
(using Dissimilarity Index and Isolation Index), in hospital-based and faculty practice ambulatory sites in NYC
and its association with selected quality measures of preventive care (pediatrics), procedural care (obstetrics),
and chronic disease management (general and family medicine) for Black, Latinx, and Medicaid populations; 2)
identify structural differences between more and less unified practices in a large NYC academic medical center
and their association both with quality measures and with patient, staff, provider and trainee perceptions of
racism; and 3) observe effects of equity interventions over time on level of segregation, quality measures, and
perceived racism and, using microsimulation techniques, estimate the potential societal impact of widespread
desegregation on selected cardiometabolic outcomes. We will use our findings to build a blueprint that other
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## Key facts

- **NIH application ID:** 10474861
- **Project number:** 1R01MD017508-01
- **Recipient organization:** ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
- **Principal Investigator:** Nina A. Bickell
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $844,995
- **Award type:** 1
- **Project period:** 2022-06-19 → 2027-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10474861

## Citation

> US National Institutes of Health, RePORTER application 10474861, DiSRUPT: Dismantling Structural Racism Underlying the Organization of Ambulatory PracTices: an observational study of clinical desegregation (1R01MD017508-01). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10474861. Licensed CC0.

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