Project IMPACT aims for better healthcare for patients of color

It’s an effort to improve healthcare outcomes for all people, and it’s starting with the skin, but it goes much deeper.

Project IMPACT, which debuted just over a year ago, is aimed at reducing racial bias in healthcare outcomes. The effort is focusing on improving dermatology for patients of color, since some doctors aren’t proficient in treating patients with dark skin. (IMPACT is an acronym: Improving Medicine’s Power to Address Care and Treatment.)

Nada Elbuluk, director of clinical impact at VisualDX

VisualDx, a clinical decision support system, is behind Project IMPACT and is collaborating with the NEJM Group and the Skin of Color Society and other collaborators. In a short time, the project’s reach has extended to 1.5 million doctors.

Nada Elbuluk, director of clinical impact at VisualDx and a practicing dermatologist, said many textbooks and journal articles don’t depict images of dark skin. Because many doctors aren’t knowledgeable about how conditions appear on those with darker skin, patients can pay the price.

“It’s really essential for any dermatologist or primary care provider to feel comfortable diagnosing and evaluating different skin types,” she said in an interview with Chief Healthcare Executive.

Certain conditions look different on patients with darker or lighter skin. If the physician doesn’t have a trained eye, Elbuluk said, “They can easily miss the diagnosis.” Doctors can also undertreat, which can affect the patient’s quality of life.

• Related story: Talking about bias in electronic health records

Nearly half (47%) of dermatology residents said they have insufficient training on skin conditions with Black patients, according to Project IMPACT.

In addition, Black individuals with melanoma have lower survival rates than white patients, according to the U.S. Centers for Disease Control and Prevention. Delays in diagnosis could be contributing to the lower survival rate in Black patients, the CDC found.

Project IMPACT started with a webinar aimed at treating patients of color, and over 30,000 people registered. “We realized at that time to move the needle on health equity, our mission becomes stronger when we collaborate with other like-minded organizations,” Elbuluk said.

The coalition now includes eight groups, including the American Academy of Dermatology, the American Medical Women’s Association and the National Minority Health Organization.

Part of the coalition’s work will be improving diversity in medical textbooks and journals, she said. “For a long time, this has been an issue that’s overlooked,” she said. She said she’s starting to see greater representation on issues affecting patients of minority groups in journal articles, but textbooks remain a work in progress.

Elbuluk said she’s encouraged to see more medical conferences focusing on the importance of health equity.

Historically, doctors have shown differences in prescribing habits and undertreatment when it comes to patients in minority groups, Elbuluk said. “And it results unfortunately in increased morbidity and mortality in these populations,” she said.

Part of the problem is a lack of diversity in the physician workforce, which is an especially glaring issue in dermatology.

Only 3% of dermatologists are Black, and 4% of dermatologists are Hispanic, she said. Nationwide, about 5% of all physicians are Black, while another 5% are Hispanic, according to the Association of American Medical Colleges.

Elbuluk said cultural competence in dermatology - and medicine generally - is extremely important.

“Cultural competence is more than just having a knowledge base to effectively diagnose and treat. It’s having an understanding of that person’s background,” she said. “In order to really deliver effective care, it has to be done in a culturally competent way.”

It’s also critical to not only develop more doctors and nurses from minority groups, Elbuluk said. Healthcare organizations need to be looking to put them in leadership roles.

“When you look at leadership in healthcare as well as many other sectors in society, it’s not very diverse,” Elbuluk said. “It’s not enough to diversify our workforce. We have to make sure they feel included so they stay and can climb the ranks of the organization.”

• Related story: Why inclusion may be more important than diversity

Down the road, Project IMPACT may expand to other areas in healthcare, but the focus for now will be on dermatology, Elbuluk said. So far, the effort has been “a really wonderful experience,” she said.

In the near future, Project IMPACT aims to continue collaborating, with meetings and more teaching sites to help people learn more. More outreach efforts are planned, including social media, Elbuluk said.

“We’re working on delving deeper into what we’ve started,” she said.

“This is about community building and bringing people together.”