The AUA was excited to facilitate a conversation between Dr Larissa Bresler, professor of urology, obstetrics, and gynecology at the Loyola University Medical Center; Dr Randy Vince, director of minority men’s health at the Cutler Center for Men at University Hospitals, assistant professor of urology at Case Western Reserve University in Cleveland, Ohio, and the AUA’s 2023 Health Equity Fellow; and Dr Chuck Scales, associate dean for clinical research initiatives and associate professor at Duke University Health System, discussing HealthEMe, their new endeavor developing health outcome metrics for our minority patients.

Larissa Bresler: Greetings. Everyone, my name is Larissa Bresler. I am the chief diversity officer for the American Urological Association and a proud Veteran Affairs Hospital and Loyola urologist. Today we have a very special podcast and column because we have Dr Chuck Scales and Dr Randy Vince, who lead our novel collaborative AUA group we’re calling HealthEMe (Health Equity Metrics) group. This podcast is for you to learn about our wonderful group and to share the exciting science of it. I will ask each of my colleagues to tell me a bit more about themselves and how they got into this work.

Randy Vince: I’m a urologic oncologist by training and the director of minority men’s health at University Hospitals’ Cutler Center for Men. I always like to say, before any of the degrees, I’m a Black man who’s from West Baltimore. I’ve lived through a lot of struggles that you see in a lot of inner cities. And so, because of this viewpoint from growing up and then into adulthood, I’ve always had this passion to serve. When I noticed that things were not equal and equitable, I asked, “What can I do to make a difference?” That’s really the lens that I approach this work from. Also, it just so happened a personal experience brought me into the field of urology: the loss of my grandmother, who died from metastatic renal cell carcinoma. At the time of her initial diagnosis, instead of being offered a nephrectomy, which she should have had, she was started on a tyrosine kinase inhibitor, and the disease progressed. That sparked my interest in this field. I learned urologists were the people who would have done that surgery, and I wanted to learn how to do it and become really good at it, ultimately giving people more time with their family members. I think between that experience and then moving into urologic oncology, seeing the disparities within prostate cancer, and seeing how historically those in medicine have talked about race and used race as part of the clinical decision-making. None of this stuff made sense to me, so when you see something that doesn’t make sense or something that you feel is wrong, you could say something about it or just turn a blind eye to it. I’ve never been one of those people who turned a blind eye. That’s a little about myself and how I got interested in doing equity work.

Chuck Scales: Thanks so much, Larissa, and I’m really excited to be here. Randy, I just want to jump in first by saying what you said about the importance of seeing inequities or differences that you know shouldn’t exist, and jumping in to make a difference really resonated with me. I want to reflect on that as well, by way of a very brief introduction. I’m a clinical urologist at Duke University with a focus on mostly benign diseases, kidney stones, and benign prostatic hyperplasia, which is permanently in my area of practice. I’m also fortunate to be the associate dean for clinical research initiatives at the School of Medicine. I think one of the things that really motivated me to work in this area is the role of allyship and mentoring, which is the perspective that I bring to the table. Over the past decade, about two-thirds of my mentees have been from backgrounds that are underrepresented in urology, from either a racial or ethnic basis or as women that are also in urology and obviously as well underrepresented. So, listening carefully to those lived experiences has provided me with a lot of insight into what it’s like not to be a White male in the field. It inspired me to do what I can from my position and try to address those inequities. I’m really excited to bring that to the table for this. I’m really excited about the partnership with Randy and Larissa to address these key priorities for the American Urological Association.

Larissa Bresler: Thank you for that; I really appreciate you sharing it. And as I always say, we can’t walk in each other’s shoes, but we can attempt to understand the journey. I come from the world of being a refugee and immigrant with a green card, and now I am a very proud US citizen and generalist, so I treat everything and make a difference, leveraging science to help us do it. I love my data. In our generation, we’re all taught that opinions don’t matter; data do. That’s what our group will attempt to do: leverage data and science to reach for health equity.

How did this group come about? What was it like being asked to be a part of this?

Randy Vince: Two major recommendations spurred the development of this group. One recommendation was to develop metrics that identify disparities for underrepresented minority patients getting urologic care.

Chuck Scales: The second one is about how we support the urologic practice community in developing innovations that would increase equity essentially or decrease disparities.

Randy Vince: Those two recommendations were given by the Diversity, Equity, and Inclusion Task Force, which was the spearhead of our group’s development. Initially, I think when we saw these recommendations, we thought they were pretty broad recommendations. How do we take this broad recommendation and put it into something that’s actionable? That was my first thought, but then I got excited about it because this is something that we haven’t really approached in the field of urology. It gives us the opportunity to lay a good blueprint for how we approach this down the road. Additionally, it also made me think that we have the opportunity to be very comprehensive about how we do this. Historically, we’ve been, like, the data drive everything right; the data tell the story. But I give a little bit of a caveat when we say that it is because of how we collect the data. That is something that we need to be very intentional about. Second, when we talk about approaching equity, there needs to be a multidisciplinary approach to it. So that’s to say that somebody with an oncology background might have 1 lens, but then somebody who treats stones and general urology might have a different lens, or how we can approach different disease states. All these things made me excited because I think there’s a tremendous opportunity to really lay that blueprint on how we can approach this work and really push our field forward when we talk about health equity.

Chuck Scales: I would say that I had very similar reactions to Randy. If I were to summarize it in 2 words, I would say, “really excited and overwhelmed.” Maybe that was 3 words, but excited and overwhelmed. I think I was really excited because, over the past 9 years, I’ve taught a course here at Duke called Data Information and Healthcare Transformation. As you can kind of imagine, that’s exactly what we’re trying to do, which is really to leverage the data that we can gather around health inequities in urologic diseases. We want to provide that information back to the community and figure out how we, as a group of practicing urologists, really transform care and outcomes for our patients. That was the part that was really exciting, but at the same time, having some experience in health services research and trying to measure things. It’s a big task, right? If we think about all the urologic conditions and all the various groups that may have inequities in their treatment and outcomes. I think we’ve been thinking a lot, really carefully, about where we start and how we start, and we should make sure that we don’t try to “boil the ocean,” as they say. We want to try to figure out where we can make a difference, to begin with, figure out how the process works, and then really, over time, make a real impact across all the urology conditions for all our patients.

Larissa Bresler: I completely agree with both of you. I’m coming from both sides because how we collect the data and what we collect is very important, and quite often, we don’t feel comfortable even asking about social determinants of health. Many of us use EPIC. Click on some EPIC parameters, and you will see how many patients that data are even entered. The AUA has a wonderful database, AQUA, and we are partnering with leaders from QIPS to leverage our understanding of data and the AQUA database, how we gather our information, and also how we use this information. I tend to try to lead in rewarding good behavior and good practices rather than preaching to people. Nobody likes that, so can we reward good clinical practices in health, developing health, equity, and metrics, sharing this knowledge and addressing it for urological diseases, and collaborating with other medical groups so that none of us are reinventing the wheel?

What are our long- and short-term goals? What was your understanding of this group?

Chuck Scales: I’m really incredibly excited about our group. We have so many great leaders within the group, and they bring really valuable perspectives. We have folks who have been working in this space for a long time, and we have people who are real experts in not only measurement but also how we intervene and how we actually do what’s called implementation science. How do we start thinking about our measurement but use our longer-term goal of innovating and changing care to make sure that we set ourselves up from the implementation-science perspective? I think the wide variety of clinical expertise and methodology expertise on the team is one of the things that I think I’m most excited about. I think it really sets us up for success in the long term.

Randy Vince: I completely agree with that. I think that’s probably one of the things I’m most excited about as well: the group of people we get to work with as a part of this team. We have people who are very experienced researchers, specifically disparities researchers, who all approach it from a different angle. Getting a chance to get that feedback and actually learn from them at times is extremely exciting. I think we’re just scratching the surface of this work. There are a lot of good things to come.

Larissa Bresler: I’d like to add that our group is also very diverse. It’s geographic, age, perceived race, and reported race; many of us are bilingual, and some are trilingual, urban, suburban, VA. We are all over the place because we all bring different perspectives to the table and work well together. We’re all very excited about it because this is a trailblazing endeavor. How do we help our patients? How do we help our colleagues? How do we reach for health equity? And how do we leverage data to help us in this endeavor and disseminate this knowledge?

What do you think would be the short-term goals?

Randy Vince: Our short-term goals are to focus on the urologic conditions with the biggest disparities and outcomes and highlight them. Then, working as a team, we will review different ways to develop specific metrics or assess disparities. I would say those are probably the two goals that, in the short term, I think we can be very productive of.

Chuck Scales: I would agree with that absolutely. I think we’ve reached a good consensus that we need to figure out our early win to build confidence in what we’re doing and show value immediately. I think there’s already a lot of work that’s been done out there about measuring inequities and disparities and how we incorporate what’s already been done. We want to think about what metrics and quality and health care quality already exist and how we can understand those through the lens of equity and start at that point. Then, we want to identify what else we need to create or build from the metric perspective. Then, ultimately, as Randy and Larissa said, how do we actually create longer-term change through implementation science?

Larissa Bresler: That’s very well put. I’d like to add that everything we’re doing is also congruent with current Accreditation Council for Graduate Medical Education education for urology residents. The health faculty and health disparity in education are paramount and are included in one of the required parts of urological residency education. It was also one of the Diversity, Equity, and Inclusion Task Force recommendations to develop more educational avenues and programming for education on health disparities. I think we’re addressing 3 different recommendations and collaborating with a number of subspecialty societies so that we can take advice from leaders from various fields. We all understand the prostate cancer health inequity, we all understand incontinence for women of color, and I think we all understand disparities in bladder cancer, and gender and LGBTQIA+ approach to prostate cancer for trans women. I can go on and on and on, but these are just the things that we hear about. We will also take recommendations from specialty societies again to understand which disease entities we can gather information on. Perhaps we can alter how we gather this information and collaborate with and reward clinical practices.

Is there anything else you’d like to add?

Randy Vince: No, not from my standpoint. I think you did a great job of summarizing everything we’re aiming to do.

Chuck Scales: I would agree. That was an incredible summary, Larissa. I think that I would just like to echo how excited Randy and I are to be part of this and the honor of being asked to help shepherd the group, as it were, along with you, Larissa, and really the team from the AUA! There’s the support from Karen Johnson, and her team has been really incredible so far, and they’re going to be a key ingredient for the success. Kudos also to the AUA for engaging with us on this!

Larissa Bresler: I would like to thank both of you. I’m very honored to be in a group with you and learn from each group member, but also from you. It’s a learning experience and a growing experience, and I would like to add profound gratitude to the board of directors who have supported this. We presented this to the board, and they allocated time, resources, budget; we are leveraging AUA resources and walking the walk, not just talking the talk. It’s not that we’re just publishing DEI task force recommendations; we are actually taking concrete steps to accomplish it. It’s a team effort, and I’m very thankful to everyone who’s been a part of it. And for our AUA partners from the administrative side, it’s exciting. It’s exciting that we’re all working together on this, and I am very lucky to have worked with you both.