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February 05, 2019; 92 (6) Views & Reviews

Reducing neurodisparity

Recommendations of the 2017 AAN Diversity Leadership Program

Erika T. Marulanda-Londoño, Michelle W. Bell, Omotola A. Hope, Rodney O. Leacock, Cumara B. O'Carroll, Jose Posas, Natividad P. Stover, Richard Young, Roy Hamilton
First published January 18, 2019, DOI: https://doi.org/10.1212/WNL.0000000000006874
Erika T. Marulanda-Londoño
From the Department of Neurology (E.T.M.-L.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.W.B.), Columbia University Medical Center, New York, NY; Department of Neurology (O.A.H.), University of Texas, Houston; Palmetto Health (R.O.L.), University of South Carolina, Columbia; Department of Neurology (C.B.O.), Mayo Clinic College of Medicine, Phoenix, AZ; Department of Neurology (J.P.), Ochsner Health System, New Orleans, LA; Department of Neurology (N.P.S.), University of Alabama at Birmingham; Department of Neurology (R.Y.), University of Connecticut School of Medicine, Farmington; and Department of Neurology (R.H.), University of Pennsylvania, Philadelphia.
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Michelle W. Bell
From the Department of Neurology (E.T.M.-L.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.W.B.), Columbia University Medical Center, New York, NY; Department of Neurology (O.A.H.), University of Texas, Houston; Palmetto Health (R.O.L.), University of South Carolina, Columbia; Department of Neurology (C.B.O.), Mayo Clinic College of Medicine, Phoenix, AZ; Department of Neurology (J.P.), Ochsner Health System, New Orleans, LA; Department of Neurology (N.P.S.), University of Alabama at Birmingham; Department of Neurology (R.Y.), University of Connecticut School of Medicine, Farmington; and Department of Neurology (R.H.), University of Pennsylvania, Philadelphia.
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Omotola A. Hope
From the Department of Neurology (E.T.M.-L.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.W.B.), Columbia University Medical Center, New York, NY; Department of Neurology (O.A.H.), University of Texas, Houston; Palmetto Health (R.O.L.), University of South Carolina, Columbia; Department of Neurology (C.B.O.), Mayo Clinic College of Medicine, Phoenix, AZ; Department of Neurology (J.P.), Ochsner Health System, New Orleans, LA; Department of Neurology (N.P.S.), University of Alabama at Birmingham; Department of Neurology (R.Y.), University of Connecticut School of Medicine, Farmington; and Department of Neurology (R.H.), University of Pennsylvania, Philadelphia.
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Rodney O. Leacock
From the Department of Neurology (E.T.M.-L.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.W.B.), Columbia University Medical Center, New York, NY; Department of Neurology (O.A.H.), University of Texas, Houston; Palmetto Health (R.O.L.), University of South Carolina, Columbia; Department of Neurology (C.B.O.), Mayo Clinic College of Medicine, Phoenix, AZ; Department of Neurology (J.P.), Ochsner Health System, New Orleans, LA; Department of Neurology (N.P.S.), University of Alabama at Birmingham; Department of Neurology (R.Y.), University of Connecticut School of Medicine, Farmington; and Department of Neurology (R.H.), University of Pennsylvania, Philadelphia.
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Cumara B. O'Carroll
From the Department of Neurology (E.T.M.-L.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.W.B.), Columbia University Medical Center, New York, NY; Department of Neurology (O.A.H.), University of Texas, Houston; Palmetto Health (R.O.L.), University of South Carolina, Columbia; Department of Neurology (C.B.O.), Mayo Clinic College of Medicine, Phoenix, AZ; Department of Neurology (J.P.), Ochsner Health System, New Orleans, LA; Department of Neurology (N.P.S.), University of Alabama at Birmingham; Department of Neurology (R.Y.), University of Connecticut School of Medicine, Farmington; and Department of Neurology (R.H.), University of Pennsylvania, Philadelphia.
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Jose Posas
From the Department of Neurology (E.T.M.-L.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.W.B.), Columbia University Medical Center, New York, NY; Department of Neurology (O.A.H.), University of Texas, Houston; Palmetto Health (R.O.L.), University of South Carolina, Columbia; Department of Neurology (C.B.O.), Mayo Clinic College of Medicine, Phoenix, AZ; Department of Neurology (J.P.), Ochsner Health System, New Orleans, LA; Department of Neurology (N.P.S.), University of Alabama at Birmingham; Department of Neurology (R.Y.), University of Connecticut School of Medicine, Farmington; and Department of Neurology (R.H.), University of Pennsylvania, Philadelphia.
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Natividad P. Stover
From the Department of Neurology (E.T.M.-L.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.W.B.), Columbia University Medical Center, New York, NY; Department of Neurology (O.A.H.), University of Texas, Houston; Palmetto Health (R.O.L.), University of South Carolina, Columbia; Department of Neurology (C.B.O.), Mayo Clinic College of Medicine, Phoenix, AZ; Department of Neurology (J.P.), Ochsner Health System, New Orleans, LA; Department of Neurology (N.P.S.), University of Alabama at Birmingham; Department of Neurology (R.Y.), University of Connecticut School of Medicine, Farmington; and Department of Neurology (R.H.), University of Pennsylvania, Philadelphia.
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Richard Young
From the Department of Neurology (E.T.M.-L.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.W.B.), Columbia University Medical Center, New York, NY; Department of Neurology (O.A.H.), University of Texas, Houston; Palmetto Health (R.O.L.), University of South Carolina, Columbia; Department of Neurology (C.B.O.), Mayo Clinic College of Medicine, Phoenix, AZ; Department of Neurology (J.P.), Ochsner Health System, New Orleans, LA; Department of Neurology (N.P.S.), University of Alabama at Birmingham; Department of Neurology (R.Y.), University of Connecticut School of Medicine, Farmington; and Department of Neurology (R.H.), University of Pennsylvania, Philadelphia.
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Roy Hamilton
From the Department of Neurology (E.T.M.-L.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.W.B.), Columbia University Medical Center, New York, NY; Department of Neurology (O.A.H.), University of Texas, Houston; Palmetto Health (R.O.L.), University of South Carolina, Columbia; Department of Neurology (C.B.O.), Mayo Clinic College of Medicine, Phoenix, AZ; Department of Neurology (J.P.), Ochsner Health System, New Orleans, LA; Department of Neurology (N.P.S.), University of Alabama at Birmingham; Department of Neurology (R.Y.), University of Connecticut School of Medicine, Farmington; and Department of Neurology (R.H.), University of Pennsylvania, Philadelphia.
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Citation
Reducing neurodisparity
Erika T. Marulanda-Londoño, Michelle W. Bell, Omotola A. Hope, Rodney O. Leacock, Cumara B. O'Carroll, Jose Posas, Natividad P. Stover, Richard Young, Roy Hamilton
Neurology Feb 2019, 92 (6) 274-280; DOI: 10.1212/WNL.0000000000006874

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Abstract

Many advances in prevention, diagnosis, and treatment of neurologic disease have emerged in the last few decades, resulting in reduced mortality and decreased disability. However, these advances have not benefitted all populations equally. A growing body of evidence indicates that barriers to care fall along racial and ethnic lines, with persons from minority groups frequently having lower rates of evaluation, diagnosis, and intervention, and consequently experiencing worse neurologic outcomes than their white counterparts. The American Academy of Neurology (AAN) challenged its 2017 Diversity Leadership Program cohort to determine what the AAN can do to improve quality of care for racially and ethnically diverse patients with neurologic disorders. Developing a fuller understanding of the effect of disparities in neurologic care (neurodisparity) on patients is an important prerequisite for creating meaningful change. Clear insight into how bias and trust affect the doctor–patient relationship is also crucial to grasp the complexity of this issue. We propose that the AAN take a vital step toward achieving equity in neurologic care by enhancing health literacy, patient education, and shared decision-making with a focus on internet and social media. Moreover, by further strengthening its focus on health disparities research and training, the AAN can continue to inform the field and aid in the development of current and future leaders who will address neurodisparity. Ultimately, the goal of tackling neurodisparity is perfectly aligned with the mission of the AAN: to promote the highest-quality patient-centered neurologic care and enhance member career satisfaction.

Glossary

AAN=
American Academy of Neurology;
CME=
continuing medical education;
ED=
emergency department;
IAT=
Implicit Association Test;
TBI=
traumatic brain injury;
VA=
Veterans Affairs

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Editorial page 257

  • Podcast: NPub.org/acslf7

  • Received March 21, 2018.
  • Accepted in final form December 6, 2018.
  • © 2019 American Academy of Neurology
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  • Breaking the glass ceiling
    • Nitin K. Sethi, Associate Professor of Neurology, New York-Presbyterian Hospital, Weill Cornell Medical Center (New York, NY)
    Published February 09, 2019
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    • Strategies for enhancing health literacy and patient-centered education in the digital age
    • Promoting research and education in neurodisparity
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