Although most institutions strive for high-quality care, value-based care can look different from population to population. Patients are born into and live under conditions that affect their ability to be healthy, such as access to healthy food, reliable transportation, education and safe living conditions. In turn, these determinants can foster health disparities and inequities.1
The Vanderbilt University Medical Center (VUMC) Department of Radiology believes radiology is in a unique position to improve health equity. In 2020, VUMC Radiology established a health equity program committed to reducing barriers to imaging care, led by Lucy B. Spalluto MD, MPH, inaugural vice chair of health equity. The program aims to increase awareness of health equity principles, generate interest in health equity among trainees and foster research that addresses health equity.
Although VUMC Radiology Health Equity collaborates closely with VUMC Radiology’s Office of Diversity and Inclusion, the health equity program is a separate initiative with discrete infrastructure and resources. “We recognized there was a real need to focus our efforts on health disparities,” Spalutto says. “Specifically, we realized we needed to provide infrastructure and support for ongoing and future health equity efforts beyond diversity and inclusion in the medical workforce in order to drive real change.”
The department’s annual lectureship in health equity is an important avenue to support discussion of topics important to the surrounding community that affect community health. This annual lectureship is named after the late Matthew Walker III, PhD, professor of radiology and radiological sciences and professor of the practice of biomedical engineering at Vanderbilt University. Walker, who was a member of the health equity team, championed bringing affordable healthcare to marginalized populations as well as opening the pipeline for underrepresented minorities in medicine.
Helping communities at large requires the work of many hands. To that end, one of VUMC Radiology’s main strategies is to empower individuals throughout the geographic area to develop partnerships and collaborate with others working to improve healthcare. “To drive change, we have to get out into our communities and understand their needs — we can’t stay in the bubble of academic medicine,” Spalluto says.
In 2022, VUMC Radiology Health Equity offered the first Vanderbilt Radiology Health Equity Community Partnership Grants. Funded by the department’s Diversity, Equity and Inclusion Endowment, the grants offer up to $2,000 for the awardees to develop trust, capacity and understanding between VUMC Radiology and the surrounding community, Spalluto says. The awards are open to VUMC Radiology faculty, staff, residents and fellows, as well as medical students from Vanderbilt University and Meharry Medical College, a historically Black medical school in Nashville.
The three inaugural awardees from 2022 have already been making strides in the greater Nashville community. Kai Wang, MD, a resident at VUMC Radiology, is working on a project focused on breast cancer screening in the transgender patient population.
“Transgender patients have historically faced many barriers to healthcare, in part due to discrimination and trauma in healthcare settings,” Wang says. “Breast cancer screening is also rarely talked about once a patient has completed gender-affirming therapy, and the recommendations for breast cancer screening for transgender patients are different from those for cisgender patients.2,3 For example, although transgender men may have had breast tissue removed, they do not receive a total mastectomy, meaning they should still be screened.”
To help address this population’s needs, Wang is partnering with local lesbian, gay, bisexual, transgender, and queer (LGBTQIA+) organizations to engage with Nashville’s transgender population. Wang and his team are conducting a survey to gain better understanding of the transgender community’s sentiments toward breast cancer screening. The team will use those results to retool mammography experiences and aim to make the visits more inclusive for all patients. Wang and VUMC Radiology will also work with their community partners to host breast health seminars for transgender patients to increase understanding of current recommendations and who needs to be screened.
The other 2022 awardees — Heather A. Cole, MD, a resident at VUMC Radiology, and Angelina Cords, MD, a former resident at VUMC — worked with Shade Tree Clinic, a nonprofit clinic for uninsured people run by VUMC medical students who provide care at no cost to patients. People seen at Shade Tree Clinic are sent to VUMC if they need imaging care, with the cost of imaging covered by the institution.
However, receiving offsite care can be difficult for patients who have limited transportation access or who may have to ask for additional time off or incur extra childcare expenses. To alleviate some of that difficulty, Cole and Cords worked with Shade Tree leadership to create an on-site ultrasound clinic and have been coordinating volunteer sonographers to perform examinations and volunteer radiologists to interpret images and discuss findings with patients.
“Everyone has been enthusiastic to be a part of this project, with many of the radiologist attendings graciously volunteering their time,” Cole says. “Amazingly, the majority of our volunteer slots at Shade Tree are already filled for the year.” Cole is setting up an elective program that will allow radiology residents to participate in and learn from the clinic.
Both Cole and Wang credit part of their projects’ success to the community grants. “These grants empower us to make larger connections in our community — I had an idea I was passionate about, and they helped make it happen,” Cole says.
Making connections is also key to improving community care, Wang adds. “Getting out there really helps us understand the needs and perspectives of our patients and develop the trust that is so necessary for their care.”
VUMC Radiology also has implemented concerted efforts in breast and lung cancer screening. Nashville faces similar at-risk patient populations to those of any major city: historically marginalized residents, people experiencing poverty and homelessness, and LGBTQIA+ patients, just to name a few, according to Katie M. Davis, DO, assistant professor of radiology and section chief of breast imaging at VUMC. “We’re also surrounded by a rural population that must travel at least an hour to reach healthcare,” she says.
To help make mammography more accessible, VUMC Radiology meets patients in their own communities by visiting their workplaces or doctors’ offices and conducting screenings outside of traditional business hours, Davis says. Three times a year, VUMC Radiology partners with Metro Nashville Public Schools to offer Saturday screenings. VUMC also offers mammography sites throughout Nashville and its suburbs as well as locations in rural middle Tennessee.
Additionally, VUMC Radiology is the principal site of the Coordinate a Lung Screening with Mammography or CALM study. Research team members check mammography appointment schedules for patients who are also eligible for lung screening. The screening program clinical coordinator then contacts patients’ primary care physicians to let them know that those individuals can undergo both screenings on the same day at the same facility.
“I noticed that many women who were diagnosed with lung cancer had not enrolled in lung screening but had often received years’ worth of mammograms,” says Kim L. Sandler, MD, co-director of the Vanderbilt Lung Screening Program. “I realized these patients were engaged in the healthcare system and knew the benefits of breast screening but had perhaps not been presented the opportunity for lung screening.”
VUMC Radiology is hard at work on these initiatives and many more, including health equity lectures, resident electives and research opportunities. The organization is also hoping to inspire more radiologists to become involved in health equity efforts.
“As radiologists interact with patients more, the things we’re doing are impacting patients more than before,” says Andrea A. Birch, MD, FACR, associate director of health equity at VUMC Radiology. “Working in health equity allows radiology to impact some of the policies and some of the changes and initiatives that need to occur to level the playing field.”
That impact is only expected to grow as radiology continues to advance, Spalluto says. “Health equity is the responsibility of each and every one of us,” she says. “It’s going to take commitment from all levels to really create change.”