Tawakalitu Omosalewa (Salewa) Oseni, MD is an assistant professor in surgery at Massachusetts General Hospital, Boston, MA. Dr. Oseni is committed to eliminating healthcare disparities, especially in surgery through engagement with using health systems as a primary vehicle to drive change. She has developed extensive leadership experience through military service, achieving the rank of Commander. During her 15 year career in the U.S. Navy, Dr. Oseni received a Naval Achievement Medal as well as Naval Commendation Medals. She was elected Treasurer of the Association of Women Surgeons and she serves as Associate Director for the diversity, equity and inclusion committee in the Department of Surgery at MGH. Dr. Oseni received her medical degree from Case Western Reserve University in Cleveland, OH in 2001. She completed her residency in general surgery at National Naval Medical Center in Bethesda, MD in 2006, and a fellowship in surgical oncology at Fox Chase Cancer Center in Philadelphia, PA in 2009.
Tawakalitu Omosalewa (Salewa) Oseni, MD, MPH
Assistant Professor of Surgery, Mass General Hospital, Boston, MA
Developing a Health Equity Metric for Surgical Care in Cancer
Background: Racial disparities in surgical outcomes have been well documented and are influenced by patient, provider and system level factors. Despite the increased focus on quality, disparities in the rates of surgical intervention among minorities have not been eliminated even after controlling for socioeconomic factors and insurance. As the largest cancer‐specific accreditor of hospital quality in the United States, the Commission on Cancer (CoC) has been instrumental in ensuring quality standards among hospitals. Majority of cancer care in the US is delivered at CoC accredited hospitals. Studies evaluating compliance with CoC Quality of Care measures have focused on patient level outcomes with a trend towards improved patient outcomes. A recent study using the National Cancer Database (NCDB) found that hospital level compliance with CoC quality measures was not consistently associated with improved patient survival. Together these studies demonstrate that while compliance with CoC measures is important to patient outcomes, in its current version it is an inaccurate tool for assessment of hospital level performance. A direct focus on health equity may be required to address in disparities in surgical access. An initial step towards this goal would be developing a health equity metric of surgical care that is relevant to CoC hospitals. The primary goal of this project is to develop a hospital level health equity measure of surgical access with quantitative analysis from the NCDB
Objectives
- To provide general patient demographic information and surgical trends in breast cancer treatment between Black and White women.
- Using the National Cancer Database, perform quantitative analysis to assess disparities in surgical treatment between Black and White breast cancer patients.
- Quantify difference in time to surgery (from diagnosis) as a hospital level health equity metric to assess surgical access.
Methods
- Developed a research protocol to study the above questions. Protocol submitted and approved by MGH institutional review board and the Commission on Cancer review board.
- Using the National Cancer Database, analyzed this large dataset using Stata and identified salient trends.
- Reported treatment trends and the feasibility of using Time to surgery as a health equity metric of surgical access
Overall, time to surgery for ALL breast cancer patients has increased in the past decade at CoC hospitals which represent 80% of hospitals delivering cancer care. Overall, Black women were 40% less likely to have surgery within 90 days of diagnosis. This lack disparity in time to surgery is worse among academic hospitals, metropolitan region and in the Northeast.
Future directions:
- Evaluate whether CoC hospitals use or will use this metric to address disparities in time to surgery among breast cancer patients
- Collaborating with the American College of Surgeons and CoC in advocating for routine reporting of this as a health equity metric nationwide.
Preceptor: Heidi Nelson, MD, David Chang PhD, MPH
