Advancing Health Information Technology To Improve Care for Underserved Populations

Urmimala Sarkar

Professor, Division of General Internal Medicine

University of California, San Francisco (UCSF)

“With support from AHRQ, I have leveraged innovative health information technology approaches to advance the study of health equity. This research is helping to improve healthcare delivery and health outcomes for low-income and underserved patients.”

As a primary care physician working with low-income patients, Urmimala Sarkar, M.D., M.P.H., is committed to health equity—ensuring that everyone has the opportunity to attain their highest level of health regardless of income, geography, race, or ethnicity. With AHRQ funding, Dr. Sarkar, a professor in the Division of General Internal Medicine at the University of California, San Francisco (UCSF), is achieving this goal by using innovative health information technology (IT) to improve patient safety and care delivery for diverse patients.

Dr. Sarkar’s aims align with AHRQ’s mission to remove barriers to care and make healthcare safer for all patients. “Digital and internet-based tools for patient-provider communication are becoming a standard of care, but not all patients benefit from these tools due to language barriers or technology literacy limitations,” according to Dr. Sarkar.

In 2008, Dr. Sarkar established a foundation for her health IT research through a career development award from AHRQ. Under this grant, Dr. Sarkar’s team analyzed how well diabetes patients who used an interactive, online patient portal to refill their medication adhered to their medication plans. The research provided an early example of how digital approaches can benefit vulnerable patient populations. “Through this study, we learned that when patients engage with self-management tools between visits, we can detect and act on safety concerns,” noted Dr. Sarkar.

While her first grant analyzed the use and benefits of health IT at the patient level, Dr. Sarkar’s next project, which began in 2012, targeted care in safety-net hospitals that serve a proportionately higher number of under- or uninsured populations. In the United States, nearly 884 million healthcare visits were conducted in ambulatory care settings, where lack of information and fragmentation of care may worsen safety problems among patients. These issues are exacerbated in underresourced settings

, where low-income and racial and ethnic minority patients disproportionately receive their care.

With support from AHRQ, Dr. Sarkar evaluated patient safety issues such as adverse drug events, missed and delayed diagnoses, and failed treatment monitoring that are challenges for safety-net health systems. Building on this work, Dr. Sarkar was awarded a 5-year AHRQ-funded Patient Safety Learning Laboratory grant. Her learning laboratory projects explore the epidemiology of outpatient adverse events and use human factors engineering methods to iteratively develop and test patient safety solutions using technology and teams.

Dr. Sarkar’s recently completed AHRQ-funded project, Investigating Failures of Notification and Monitoring in Outpatient Care: Safety Promotion Action Research and Knowledge (SPARK) Network, represented the first collaborative effort to measure and report ambulatory safety metrics. The network consisted of five safety-net hospital systems in California.

Dr. Sarkar’s work has highlighted persistent safety gaps and significant data and reporting challenges in operationalizing ambulatory safety measurement. For example, she and her team published a 2018 study that found that followup for a colon cancer screening test was just 49 percent after 1 year; she hopes the findings will enable participating hospital systems to address the issues identified and will also contribute to researchers’ knowledge of safety gaps.

Dr. Sarkar is the Associate Director of the Center for Vulnerable Populations at UCSF. She also mentors young investigators as Director of UCSF's Primary Care Research Fellowship, curricular director for UCSF's Fellowship Advancement and Skills Training in Clinical Research, and co-director of the AHRQ-funded Learning Health Systems Early Career Acceleration Program for junior faculty involved in learning health systems research. She is a member of the American Medical Informatics Association, American Public Health Association, and Society for General Internal Medicine.

Principal Investigator: Urmimala Sarkar, M.D., M.P.H.
Institution: University of California, San Francisco
Grantee Since: 2008
Type of Grant: Various