While health disparity data sit quietly in front of Ana Quiñones, Ph.D,, to her, their message is screaming: "We need to do more!"
In college, Quiñones started to see how the issues of health conditions and health status affect some members of society more than others. Little has changed since then, she says. Persistent health disparities, health inequities and their effects are all parts of a giant health care puzzle on which Quiñones ruminates.
"This is timely with what we are seeing in our country now," she said. "My goals are to improve care for people who really don't have much of a voice and are not as participatory in the political system. We also have a very fragmented health care system. I feel compelled to investigate, study and understand what disproportionately affects some people and how we can try to move the system."
Quiñones, associate professor in the OHSU-PSU School of Public Health and the Department of Family Medicine in the OHSU School of Medicine, is a gerontologist with a doctorate in health care management and policy; she has been with OHSU since 2010 and family medicine since 2017. Her research addresses four main areas: age-related changes in health; racial and ethnic disparities in health; co-existing chronic disease, called multimorbidity; and health care delivery changes to improve the management of chronic conditions for vulnerable older adults.
Connecting data points
Diabetes, cancer, heart disease and COVID-19 are just a few of the leading causes of death in the United States, and disproportionately affect people of color and those who have poorer social determinants of health. Quiñones' overarching goals work toward what she calls a hyperconnection in health care — a synchronous system that focuses on the roots of well-being and prevention, and weaves quality care tightly into social policy.
A source of inspiration for Quiñones was her father, a combat veteran whose health steadily declined due to managing multiple chronic diseases. He died in 2007.
"Our family saw how difficult it was to manage his health and resulting health cascades. That personal perspective is what drives my research focus," she said. "A future direction of my work is to partner with some of my amazing colleagues who use qualitative methods to bring in the patient voice to help us interpret what these models based on large data tell us."
The pandemic
The COVID-19 pandemic slowed the pace of some of her research, but Quiñones sees a bright spot: With new funding and new COVID-19 data sets, she will be able to understand more health disparities and care patterns. Questioning COVID-19's relationship to chronic diseases, aging and other factors will be a new venture for her team.
"We're just now preparing to do the COVID data pulls," she said. "We're seeing interesting patterns concerning mental health conditions and physical health conditions, cardiometabolic conditions — all the things that may have an impact on the severity of COVID and long-term consequences of COVID. There may be some associations, and we're going to be investigating that in a safety-net population."
Whole-person care
Meanwhile, her team is one of the few nationwide examining chronic disease patterns and multimorbidity patterns in community health clinics and safety-net populations. Some of their recent work on multimorbidity among mid-to-older people has appeared in the Journals of Gerontology and Journal of General Internal Medicine.
"With every step, we uncover, dig deeper, and find more interesting and compelling reasons to keep going and to continue the line of inquiry," Quiñones said. "It's kind of a weird thing to be proud that your work is never finished, but it's satisfying. We're working on a complex problem that cannot be solved by one person or one line of research. I'm really motivated and excited, and feel proud trying to chip away at these big problems in the collaborative setting at OHSU."
