Updated on Jun 18, 2024 | Diversity and Inclusion
Mount Sinai’s Digital and Technology Partners (DTP)-Digital Experience Team, with guidance from the Digital Equity and Accessibility (DEA) Committee, seeks to improve underrepresented patient cohorts’ access to Mount Sinai digital products. The team is taking a data-driven approach to address equity gaps by identifying patient cohorts with proportionally low digital engagement.
The usage of MyMountSinai is the current priority, as patients will benefit greatly from accessing a digital entry and patient portal. MyMountSinai is offered in seven languages, allowing patients to receive in-person and virtual care and to message providers.
Building relationships with our communities is a key health equity priority. DTP and Mount Sinai’s Office for Diversity and Inclusion (ODI) stakeholders partnered to prioritize Central Harlem as a starting point based on the strength of our existing Community-Based Organization (CBO) partnerships. They plan to collaborate with other CBOs to better reach and engage patients in Central Harlem and other marginalized communities. The Digital Experience Team seeks to understand the unique needs of these communities and build awareness of MyMountSinai’s usefulness in accessing care.
In the first quarter of 2024, they identified gaps in MyMountSinai usage. In the second quarter, they created an engagement plan and identified potential CBOs with which to partner. In the third quarter, they plan to connect with CBOs to discuss how to best build awareness and engagement around MyMountSinai. The goal is to increase Central Harlem Mount Sinai patients’ usage of MyMountSinai from 54 percent to 70 percent. Heading into 2025, as they make progress on this metric, they seek to increase adoption of MyMountSinai in other underrepresented neighborhoods.
This effort is led by Jordan Randall in partnership with Gary Gravesandy, Arianna Goldman, Huma Sohrwardy, Eric Kim, and other members of the Digital Equity and Accessibility committee. For more information, please contact Jordan Randall (jordan.randall@mountsinai.org) about this project, and Eric Kim (eric.kim@mountsinai.org) about the DEA Committee.
Updated on Jun 17, 2024 | Community, Diversity and Inclusion, Featured
At Mount Sinai, active collaboration with department stakeholders drives the efforts of the Health Equity Data Assessment (HEDA) team to advance health equity through data-driven initiatives.
Yvette Calderon, MD
Yvette Calderon, MD, Vice President and Dean for Equity in Clinical Care at the Icahn School of Medicine at Mount Sinai, recently discussed how the Emergency Department (ED) partnered with the HEDA team to apply an equity lens to evaluate Left Without Being Seen (LWBS) patients.
Together, they are reviewing data integrity in emergency medical records and applying an equity lens to effect meaningful change.
“This commitment underscores Mount Sinai’s ongoing dedication to fostering health equity through collaborative, data-informed strategies,” said Pamela Y. Abner, MPA, CPXP, Senior Vice President and Chief Diversity Operations Officer in the Office for Diversity and Inclusion, and Health Equity Officer for the Mount Sinai Health System.
LWBS is defined as a patient leaving the ED before completing a medical screening exam. When this metric is not met, it can represent quality and safety concerns, according to Lyndia Hayden, Senior Director, Data Integrity and Equity Analytics.
LWBS patients may also have an undiagnosed medical condition and may experience undesirable health outcomes outside of the hospital. Hospitals can also face penalties if they fail to meet certain quality metrics, like LWBS. The Centers for Medicare & Medicaid Services can reduce reimbursement rates for hospitals that do not meet these standards, having a direct impact on the hospital revenue stream.
On average, non-white patients tend to have a disproportionally higher rate of LWBS than white patients. As such, LWBS must be examined through an equity lens to ensure optimal patient outcomes for all patients.
Dr. Calderon emphasized the critical role of data integrity as a foundational step before delving into metrics analysis. With invaluable support from the HEAD Hub, the Department of Emergency Medicine at Icahn Mount Sinai implemented a comprehensive dashboard system, empowering ED service lines across the Mount Sinai Health System to closely monitor performance indicators, identify key drivers, and establish clear accountability measures.
For example, guided by these insights, each ED tailored interventions to their unique context, with initiatives such as Provider-in-Triage (PIT) protocols, mandatory unconscious bias training, and enhanced education for registration staff on demographic data collection emerging as effective strategies at Mount Sinai Beth Israel.
This work was presented to the Joint Commission during the Mount Sinai Downtown survey. It impressed the surveyors to see that Mount Sinai had already started integrating the new standard from the Joint Commission.
“The data integrity piece had to happen first before we could look at any of the metrics,” said Dr. Calderon. “Through diligent implementation, these interventions have proven instrumental in addressing pertinent issues within the emergency departments that identified a need.”
Jun 13, 2024 | Community, Diversity and Inclusion
Mount Sinai’s Heritage of Latinx Alliance (HOLA) employee resource group participated in the 67th Puerto Rican Day parade down Fifth Avenue in New York in a joyous display of dancing and interacting with the crowd. The event was held Sunday, June 9.
“Events like these hold great significance as they bring together individuals from diverse backgrounds, reflecting the strong foundation of diversity within the Mount Sinai Health System. Coming together for a shared purpose truly embodies our motto, We Find a Way,” said Shawn Lee, Director of Operations for the Central Billing Office and Co-Lead of the Heritage of Latinx Alliance. “During the parade, we found our way down Fifth Avenue, proudly representing Mount Sinai.”
“Marching in the parade demonstrates Mount Sinai’s diversity and inclusion efforts to our thousands of hard working employees, to the tens of thousands of Puerto Ricans in New York City, and to millions more New Yorkers,” said Frank Pabon, Director of Operations at the Central Billing Office and Co-Lead of Heritage of Latinx Alliance. “Our participation makes a statement to all who march in the parade and watch on television that Mount Sinai values the culture and history of Puerto Ricans.”
Participation in the parade was made possible by the Mount Sinai Health System Office for Diversity and Inclusion, Carlos A. Maceda, MBA, Chief Supply Officer, Sylvia Anavitate, Billing Coordinator, and the HOLA employee resource group.
“Thank you to everyone who joined us,” said Mr. Pabon. “We had an amazing time and look forward to having an even bigger presence at the parade next year.”
Updated on May 16, 2024 | Community, Diversity and Inclusion, Featured
Mount Sinai’s Post-Baccalaureate Research Education Program (PREP) helps prepare scholars who are interested in biomedical careers to apply successfully for doctoral programs. PREP scholars take graduate level courses, participate in career development activities, and receive personalized research mentorship. They spend one or two years in the program, with most of the experience taking place in laboratories conducting biomedical research.
Mount Sinai has a long, rich history with PREP, beginning 23 years ago when Terry Krulwich, PhD, received the first National Institute of General Medical Sciences funding for the program and directed it for 18 years, before leadership was transitioned to Eric Sobie, PhD.
Today, the program is led by Kirk Campbell, MD, Irene and Dr. Arthur Fishberg Professor of Medicine and Professor of Pharmacological Sciences at the Icahn School of Medicine at Mount Sinai and Inaugural Director of the Mount Sinai Center for Kidney Disease Innovation, and Jamilia Sly, PhD, Assistant Professor, Population Health Science and Policy, who recently renewed Mount Sinai’s grant. The PREP program focuses on growing a diverse research community and provides a launching pad for students pursuing their PhD or MD-PhD degrees.
More than a decade ago, Principal Investigators from Mount Sinai, Albert Einstein College of Medicine, and the University of Pennsylvania began an annual research symposium in May, with the programs rotating hosting duties. This year the schools participating expanded to include Cold Spring Harbor Laboratory and Weill Cornell Medical College.
Organizers say programs like PREP, which focus on developing a diverse pool of well-trained postbaccalaureates ready to engage in rigorous biomedical research-focused doctoral degree programs, have never been more important in today’s research landscape.
Mount Sinai’s Graduate School of Biomedical Sciences hosted the PREP Northeast Regional Symposium for 2024 on Monday and Tuesday, May 6-7.
The event began with a welcome reception during which students and faculty from all five institutions shared their experiences with their PREP programs. At one point, the room filled with excitement when Kaya Adelzadeh, a PREP scholar at Mount Sinai, found out she had been accepted to the MD-PhD program at the University of California, Davis. Since August 2022, Ms. Adelzadeh, who earned a Bachelor of Science in Biomedical Engineering at Boston University College of Engineering, has been a post-baccalaureate research assistant in the orthopedic research laboratories of James Iatridis, PhD, and Woojin Jan, PhD. She was cheered on by her colleagues and by PREP leaders, a reminder of what the PREP scholars are working to accomplish.
Dr. Campbell and Dr. Sly, along with Marta Filizola, PhD, Dean for the Graduate School of Biomedical Sciences, and Talia Swartz, MD, PhD, Senior Associate Dean for MD-PhD Education, delivered opening remarks. They discussed the history of the symposium, welcomed new participants, and encouraged the PREP scholars to apply for the participating institution’s PhD and MD-PhD programs.
Scholars from the five institutions shared their oral presentations. The two scholars from Mount Sinai were Taelor Matos, who shared research she is conducting with Jessica Ables, MD, PhD; in her presentation “Axonal Plasticity in Learning”, and Tony Valencia, who shared research he is conducting under the mentorship of Benjamin Chen, MD, PhDs, in a presentation “Investigating Asymmetry of HIV-1 Envelope Protein and its Impact on Packaging.”
In her keynote address, Yasmin Hurd, PhD, Director of the Addiction Institute at Mount Sinai, discussed the neuroscience of addiction. She highlighted the role of the endocannabinoid system in neuronal development, differential psychological effects of cannabinoid components and provided insights into therapeutic utility of cannabidiol in opiate use disorder.
Dr. Hurd discussed her own career journey, noting data regarding the lack of diversity in the scientific workforce. She encouraged students not to let data about who is or isn’t a scientist determine the path for their academic training and career goals. She reminded students during the question and answer session that being a good scientist doesn’t mean knowing all the answers to scientific questions, rather that a good scientist asks a lot of questions about the things they do not know.
A PREP alumni panel featured former scholars from Mount Sinai and Albert Einstein College of Medicine. The panel was moderated by Tia Robinson, a current Mount Sinai PREP scholar, and included alumni Yoselin Paucar, Stephen Ruiz, Bryan Ticoche, and Jeury Veloz. Scholars from each institution had the chance to ask questions and inquire about the experiences of PREP alumni both during and after their programs.
Two rounds of poster presentations gave PREP scholars opportunities to share their research with peers from other schools and to practice their presentation skills. Mount Sinai had eight scholars participate in the poster sessions. This was followed by an awards ceremony recognizing the PREP scholars with the top oral and poster presentations. Alexandra Ramirez, University of Pennsylvania PREP, received an award for the Best Oral Presentation. She has been accepted to Icahn Mount Sinai’s PhD in Neuroscience program as a student starting this fall. Kendall Moore, Icahn School of Medicine PREP, won for Best Poster Presentation.
In closing remarks, Dr. Campbell and Dr. Sly reiterated why collaboration is so important between PREP programs, and they encouraged scholars to continue their great work and to look forward to next year’s symposium.
Learn more about our PREP program to see how it can guide your journey to joining a doctoral program in biomedical sciences.
May 8, 2024 | Diversity and Inclusion, Featured, Your Health
As the country celebrates the cultural diversity of Asian Americans, Native Hawaiians, and Pacific Islanders in May for Asian/Pacific American Heritage Month, it is time for a reminder for members of those communities to keep up with their cancer screenings. Specifically, experts at the Mount Sinai Health System are calling on Asian American and Pacific Islander (AAPI) people to be vigilant about breast and colorectal cancer screenings.
“Breast cancer is the leading cause of cancer death for women worldwide, and the second leading cause of cancer deaths for women in the United States,” says Desiree Chow, MD, Assistant Professor of Medicine (General Internal Medicine) at the Icahn School of Medicine at Mount Sinai. “However, for Asian Americans and Pacific Islanders, these groups have been found to consistently score lower than their non-Hispanic white counterparts for breast cancer screening.”
A similar theme echoes in colorectal cancer, notes Sanghyun (Alex) Kim, MD, Chief of Colon and Rectal Surgery at Mount Sinai Beth Israel, Mount Sinai-Union Square, and Mount Sinai Morningside. “Not only are we seeing lower screen rates for AAPI communities in colon cancer, but over the last 20 years, we’ve seen a twelvefold increase in colon cancer rates in these populations,” says Dr. Kim. “This is why it’s very important for physicians who see AAPI patients to be proactive in reminding them to be screened regularly.”
Left: Desiree Chow, MD. Right: Sanghyun (Alex) Kim, MD.
What are the disparities in cancer screening rates among different races/ethnicities?
While breast and colorectal cancer screening rates have steadily grown over the years, Asian American and Pacific Islander (AAPI) populations screen at a lower rate than the non-Hispanic white population. Here’s a snapshot of how each group screens for those cancers from 2008 to 2018, according to a report from the Centers for Disease Control and Prevention (CDC).
Source: Health, 2019, National Center for Health Statistics, CDC
As the COVID-19 pandemic hit, screening rates declined in 2020—by as much as 97 percent for breast cancer for AAPI communities compared with the previous five-year average, according to an April 2023 memo from the CDC. To address the decline in screening among certain populations, the agency is partnering with health care providers to resume timely use of preventive tests for early detection of breast, cervical, colorectal, and lung cancers.
Drs. Chow and Kim share their thoughts on the importance of being up to date with breast and colorectal cancer screenings, respectively.
Why are we calling for our AAPI communities to be vigilant about breast and colorectal cancer screening?
Dr. Chow: In general, Asian American women tend to have dense breasts, which is an independent risk factor for breast cancer and it decreases the ability for mammograms to detect small lesions. So in addition to the higher risk, Asian Americans having lower rates of screening, which is concerning and needs to be addressed.
Dr. Kim: Some 20 years ago when I went into colorectal surgery, the number of surgeries for colorectal cancer for Asian Americans was lower than for their white, Hispanic, or Black counterparts. Since then, that number has increased 12 times—not 12 percent—in America. On top of that, AAPI individuals are known to be less up to date on colorectal screening. Part of it could be a greater focus on other kinds of cancers—such as stomach and liver—instead, and part of it could be attributed to a tendency to play down illnesses and not be very good at following up with doctors.
Who should be thinking about screening? How often should it be done?
Dr. Chow: The United States Preventive Services Task Force (USPSTF), the body that sets guidelines for screening in the country, has recently updated their recommendation for women to start screening for breast cancer at the age of 40, every two years. However, there are other factors that could push one to start screening earlier or screen more frequently, and that is a conversation to have with a health care provider. These could include having a family history of breast cancer or having a genetic predisposition to breast cancer, such as a BRCA gene mutation.
Dr. Kim: The USPSTF recommends screening for colon cancer as early as the age of 45. Colonoscopies are the gold standard and would only have to be done every five to ten years. There are stool-based tests, which would have to be done every one to three years to provide comprehensive detection. This recommendation is the same for both men and women, although men have a higher prevalence of colon cancer. If a patient has a family history of cancer—could be of various types, including pancreas, stomach, liver, breast, endometrial or bladder—that person should consider early screening as well. A simple guideline would be: whatever age the family member had the cancer, the patient’s screening should be done at an age 10 years below that—thus for a patient whose family member had pancreatic cancer at age 50, the patient should get a colonoscopy at age 40.
What is involved in breast and colorectal cancer screenings? Is it painful/time-consuming?
Dr. Chow: The mammogram is the only screening method that has been shown to decrease mortality related to breast cancer. The best way to get a mammogram would be to get a referral from your primary care provider, or your OB/GYN. Under the Affordable Care Act (ACA), public and private insurance must provide preventive women’s health screening with no cost sharing. For those who do not have health insurance, there are ways to obtain low- or no-cost mammograms, as New York City and New York State have programs, such as free mammogram buses, that provide such screening.
The procedure itself is pretty simple, and a technician helps the patient position their breast in a machine that takes images of the breast tissue. Most women do not report significant pain—perhaps some discomfort as they might have to hold certain positions for imaging. But from start to finish, a patient could be in and out of the clinic in about 30 minutes.
Patient service representative Monet Douglas at the Mount Sinai Mammogram Screening Unit Truck
Dr. Kim: For stool-based tests, such as Cologuard®, a patient sends a stool sample to a lab, where it’ll be studied to see if it contains blood products and/or polyp components. However, such tests might miss some polyps, hence a need to do them more frequently. A colonoscopy, in which a tube with a camera is put into the rectum and colon, can not only discover polyps and cancerous tumors, but also treat and remove them. Under the ACA, colorectal cancer screening must be covered by public and private insurance without cost-sharing.
A colonoscopy does involve some preparation. The patient is instructed not to eat for about half a day, and to take a concoction that would rinse out the bowels. For the actual procedure, the patient is put to sleep and the doctor would examine the colon and rectum for polyps or signs of cancer. If polyps are removed, or cancer tumors are biopsied, there might be some pain or bleeding afterwards, but for most patients, colonoscopies are very well tolerated. The actual procedure itself takes about 30 minutes, although a patient might take an hour to recover after the exam.
What might be the consequences for not being vigilant about breast and colorectal cancer screening?
Dr. Chow: Missed breast cancer is the biggest consequence. By the time women feel a lump in their breast, the cancer is at a later stage, is harder to treat, and may have already spread to other parts of the body. The point of screening is to detect these cancers at an early stage, when they are still easily treatable and even curable. At an early stage, a patient is more likely to be offered breast conserving surgery, where only a portion of the breast is removed, rather than a mastectomy, where the entire breast is removed.
Dr. Kim: The thing about colon cancer is that it is a preventable cancer. If you can screen and detect signs before it presents as colon cancer, you can avoid more intensive treatment. When the cancer has penetrated into deeper layers of the colon, the surgery needed means you’ll lose more length of colon. If the cancer has advanced even more and spreads out of the colon, you will need not only surgery, but chemotherapy and radiation, and these are very intense on the body. For patients who get rectal cancer—that risk is higher for smokers—if not picked up early, there’s a chance to lose the anus, and that could mean needing a colostomy bag—a pouch in which stool comes out of the abdominal wall.
Any other advice for our AAPI communities to stay on top of their cancer screening?
Dr. Chow: I’ve noticed that some segments of the AAPI population might be less willing, or less able, to access health care. They should still try to form a close relationship with a primary care doctor, so that the doctor is aware of their risk factors and can advise them accordingly. For Asian Americans specifically, there’s a misconception that Asian women don’t get breast cancer as frequently. That’s not so true anymore, as the incidence of breast cancer has been steadily rising since 2000. And lastly, there’s a misconception that if a patient leads a healthy lifestyle, with no family history of breast cancer, they won’t get it. That’s great in that they’re at lower risk, but the majority of breast cancer cases are de novo, meaning the mutation happens for reasons we don’t know. If you meet the guidelines for breast cancer screening and have not done it, do seek it out as soon as you can.
Dr. Kim: I’ve noticed among my Asian patients that the cultural tendency of not wanting to speak up about pain or discomfort is actually working against them for their health. Keeping concerns to yourself hinders proper care. Another thing I’ve noticed is that some—usually older, immigrant individuals—trust their doctors too much and expect their doctors to know and handle everything, while others—sometimes younger, American-born individuals—don’t trust their doctors enough, might have a distrust of the system, or believe they know their body better than the doctor does. Either extreme is not good. The solution to break through to both is patient education and building trust. First, getting information out there about why cancer screening is important helps patients understand the risks. Then, the primary care doctor needs to build a close relationship with the patient, so that the patient actually goes to the screening, but just as importantly, trusts the doctor enough to come back for any follow-ups.
Richard Silvera, MD, MPH, CPH (he, him)
Josiane Hickson, EdD, RN, NE-BC, NPD-BC (she, her)
Alex Escaja-Heiss (he/they/el/elle)
Leila Jeanpierre, MPH (they/them)
Derek Chen (he/they) 