Placement: Dana-Faber Cancer Institute
Mentor: Deborah Schrag, M.D., M.P.H., Chief, Division of Population Sciences, Department of Medical Oncology, Senior Physician and Professor of Medicine, Harvard Medical School
Project: Investigating the Potential for Provider Level Policies, Practices, and Cultures to Mitigate Income-Related Disparities in Cancer Outcomes
John Withington, M.A., M.D.(Res), FRCS, is a 2019–20 U.K. Harkness Fellow in Health Care Policy and Practice. Just prior to completion of his postgraduate training in urological surgery within the London Deanery, Withington was seconded as a National Medical Director’s Clinical Fellow, where he covered a diverse portfolio of work, including quality improvement and cultural development at the interface between primary and specialty care services, preparation for the U.K.’s exit from the European Union, and the rapid evidence evaluation of new cancer diagnostic technologies. Withington previously led a team of researchers working in England (King’s College London), Germany (Göttingen), and the U.S. (Harvard University), comparing testicular cancer survival across the three health care systems, developing a strong skill set in international comparative outcomes research. His doctoral thesis, completed between King’s College London and the Royal College of Surgeons’ Clinical Effectiveness Unit, investigated methods for measuring outcomes from percutaneous renal surgery in the English NHS. Findings from this research influenced, in real-time, the development of a national audit tool, which in turn has influenced continuous outcome measurement internationally. Withington earned his M.B.B.S. from King's College London, M.A. in medical sciences from the University of Cambridge, and M.D. (Research) from King's College London.
Project Overview: The U.S. is large, diverse, and profoundly unequal. This inequality manifests in socioeconomic health disparities, which are starkly exemplified by cancer outcomes. Whereas surviving cancer is dependent on reliable access to well-coordinated, efficient health care, evidence that health system reform mitigates underlying socioeconomic disparities in cancer outcomes is equivocal. Meanwhile, fundamental structural differences between the U.S. and U.K. health care systems belie striking similarities in health care disparities. The impact that policy, strategy, and practice can have in mitigating such disparities is, therefore, of significant interest across the two countries.
Using a mixed methods design, this project seeks to identify which health care providers in the U.S. are most effectively mitigating the socioeconomic disparities in cancer outcomes, and how they are achieving this success. Part one will involve quantitative analysis of a sample of integrated care providers across the U.S. to identify positive outliers. Part two will use qualitative methods, specifically semi-structured interviews with leading executives, clinicians, and patients, with the goal of understanding aspects of policy, strategy, practice, and underlying contextual factors that have enabled some degree of mitigation of inequality with respect to key cancer outcomes.