UCSF

TRANSPERS Program on Health Disparities: Equity and Access of Precision Medicine

The TRANSPERS Center is committed to promoting health equity and access to precision medicine health care services through multidisciplinary and collaborative research into the root causes of health disparities. In the past, precision medicine research has largely been euro-centric. To advance health for all, we must ensure equitable access to precision medicine. To that end, we are engaging diverse perspectives to understand the interactions and effects of health insurance or lack thereof, health policies, socioeconomic status, and access of underserved or underrepresented populations to precision medicine.

We bring our unique expertise in payer coverage, stakeholder decision-making, and quantifying value to examine a range of policy issues that drive inequities and unequal access to precision medicine.

We use a systematic and interdisciplinary approach:

  • Develop robust qualitative, approaches, including in-depth interviews with multilevel stakeholders (e.g., physicians, patients, policymakers, experts, etc.) and population-based survey research design
  • Analyze and linkage of large population-based secondary data (e.g., all-payer claims data, national cancer registries, census data, etc.)
  • Document and coverage policy analysis
  • Engage multiple stakeholders and build consensus

PDF icon Printable Summary: Health Disparities (PDF)

Accomplishments

Our publications have included studies on disparities in cancer screening, including gene expression profiling, and cost of access for individuals by race/ethnicity and socioeconomic status. We are continuing our work with a particular focus on equitable access to precision medicine focusing on novel genomic technologies as they emerge. Our publication in the Journal of Community Genetics, we highlighted challenges and solutions in the Latinx community for hereditary cancer panel testing. Similarly, in our publication in Journal of Genetic Counseling, we addressed payer coverage and out-of-pocket costs for hereditary cancer panel testing in diverse settings. Additional publications include:

  1. Douglas MP, Lin GA, Trosman JR, Phillips KA. Hereditary cancer panel testing challenges and solutions for the latinx community: costs, access, and variants. J Community Genet. 2022;13(1):75-80. https://pubmed.ncbi.nlm.nih.gov/34743282/
  2. Lin GA, Trosman JR, Douglas MP, Weldon CB, Scheuner MT, Kurian A, Phillips KA. Influence of payer coverage and out-of-pocket costs on ordering of NGS panel tests for hereditary cancer in diverse settings. J Genet Couns. 2022; 31:130–139. https://pubmed.ncbi.nlm.nih.gov/34231930/
  3. Jansen JP, Trikalinos TA, Phillips KA. Assessments of the Value of New Interventions Should Include Health Equity Impact. Pharmacoeconomics. 2022 Mar 3:1–7. Epub ahead of print. https://pubmed.ncbi.nlm.nih.gov/35237944/
  4. Jansen JP, Linthicum M, Chapman RH. Value Assessment And Decision Making In The Face Of Uncertainty. Health Affairs Forefront. January 26, 2022. https://www.healthaffairs.org/do/10.1377/forefront.20220124.894580
  5. Phillips KA, Jansen JP, Weyant CF. Value and Affordability in Precision Medicine. Science. 2021;371(6529): 564-569. https://pubmed.ncbi.nlm.nih.gov/33542123/
  6. Phillips KA and Subhashini Chandrasekharan. At The Prospect Of Delivering A Child With A Genetic Disorder, Poorer Women May Have Less Information and Fewer Choices. Health Affairs Blog. 12/19/2017. https://www.healthaffairs.org/do/10.1377/forefront.20171215.457066/full/
  7. Ponce, N. A., J. Tsui, S. J. Knight, A. Afable-Munsuz, U. Ladabaum, R. A. Hiatt and J. S. Haas (2012). "Disparities in cancer screening in individuals with a family history of breast or colorectal cancer." Cancer 118(6): 1656-1663. PMCID: 3262934. http://www.ncbi.nlm.nih.gov/pubmed/22009719
  8. Odierna, D. H., A. Afable-Munsuz, O. Ikediobi, M. Beattie, S. Knight, M. Ko, A. Wilson and N. A. Ponce (2011). "Early developments in gene-expression profiling of breast tumors: potential for increasing black-white patient disparities in breast cancer outcomes?" Per Med 8(6): 669-679. PMCID: 3242007. http://www.ncbi.nlm.nih.gov/pubmed/22190978
  9. Afable-Munsuz, A., S. Y. Liang, N. A. Ponce and J. M. Walsh (2009). "Acculturation and colorectal cancer screening among older Latino adults: differential associations by national origin." J Gen Intern Med 24(8): 963-970. PMCID: 2710471. http://www.ncbi.nlm.nih.gov/pubmed/19472016