# Improving Chronic Disease Outcomes Across the Lifespan by Addressing Structural Racism

> **NIH NIH R01** · UNIV OF MASSACHUSETTS MED SCH WORCESTER · 2024 · $803,618

## Abstract

PROJECT SUMMARY
Structural racism is embedded in societal structures that limit opportunities and resources for racialized
groups. This manifest as social determinants of health (SDOH)—the social circumstances in which people are
born, live, and age—and as racial/ethnic health disparities. Professional medical organizations and insurers
recommend screening for—and addressing—adverse SDOH within healthcare delivery. As a result, healthcare
systems especially those serving low-income patients are implementing SDOH screening. Despite this rapid
uptake, critical knowledge gaps remain regarding the equitable implementation and effectiveness of SDOH
screening/referral systems on improving disease outcomes. Our team’s work on the WE CARE SDOH system,
which leverages extant clinical staff and workflows to address families’ social needs, has demonstrated its
effectiveness on increasing referrals to social services and receipt of resources among low-income families;
WE CARE has been cited as an evidence-based SDOH intervention by the American Academy of Pediatrics.
However, our recently completed hybrid effectiveness-implementation RCT found significantly more caregivers
of color (compared to white caregivers) experiencing higher rates of double loss whereby their unmet needs
were not addressed despite being disclosed. These results are likely due to suboptimal implementation related
to multiple levels of discrimination that caregivers of color face in the healthcare and social service systems.
With an interdisciplinary team of SDOH, implementation, antiracism, and practice-based researchers, we will
apply an antiracism lens to WE CARE and develop an implementation toolkit aimed at mitigating
unequal treatment for patients of color. We will conduct a hybrid effectiveness-implementation study with a
stepped wedge cluster RCT design in four large family medicine (FM) clinics that serve racially/ethnically
diverse low-income families from Worcester, Massachusetts. Our specific aims are to: (1) Refine the WE
CARE implementation protocol using an antiracism lens and community engagement approach to: (a)
conduct key informant interviews with families to identify racism-related barriers to SDOH screening/referral;
(b) present these barriers to systems-level stakeholders to elicit input on strategies to address patient
concerns; and create an antiracist-informed toolkit for the implementation of SDOH screening/referral systems;
(2) Implement WE CARE by deploying the refined protocol in FM practices and assess implementation
outcomes including equity, appropriateness, and patient-centeredness; (3) Evaluate the effectiveness of WE
CARE on prevalent pediatric and adult chronic diseases outcomes. This proposal has the potential to create
novel community- and patient-engaged strategies for implementing SDOH screening and referral systems into
healthcare and social service systems with the potential to reduce racial/ethnic health inequities. It is aligned
with the NIMHD...

## Key facts

- **NIH application ID:** 10872179
- **Project number:** 5R01NR020752-03
- **Recipient organization:** UNIV OF MASSACHUSETTS MED SCH WORCESTER
- **Principal Investigator:** Arvin Garg
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $803,618
- **Award type:** 5
- **Project period:** 2022-09-23 → 2027-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10872179

## Citation

> US National Institutes of Health, RePORTER application 10872179, Improving Chronic Disease Outcomes Across the Lifespan by Addressing Structural Racism (5R01NR020752-03). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10872179. Licensed CC0.

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