Understanding Disparities in the Search for Equity
George Rust, M.D., M.P.H.
Professor of Behavioral Sciences and Social Medicine
Florida State University College of Medicine
“AHRQ has always excelled at applying rigorous scientific methodologies to the complexities of the real world.”
Working in medically underserved communities revealed to George Rust, M.D., M.P.H., that care processes developed in tightly controlled research settings don’t always work in what he calls “the messiness of the real world.” This realization led Dr. Rust to devote his career to understanding disparities and making health equity a reality for minority and disadvantaged populations.
Dr. Rust, a professor of behavioral sciences and social medicine at Florida State University College of Medicine in Tallahassee, has used AHRQ funding to gain a deeper knowledge of disparities related to race, ethnicity, and economics, with a goal of improving safety for patients in underserved communities. As a primary care physician and a self-described clinician-teacher turned researcher, Dr. Rust has turned a traditional method of quality improvement—developing interventions at academic medical centers, then translating them to real-world settings—on its head. “I always had the notion that it was easier to translate innovations from the ‘muddy boots’ setting to the academic medical environment than vice versa,” he says.
With funding from AHRQ in 2000, Dr. Rust and his colleagues created the Southeast Regional Clinicians’ Network (SERCN), a Practice-Based Research Network (PBRN) focused on community health centers that serve medically underserved communities in the Southeastern United States. PBRNs are groups of primary care clinicians and practices working together to answer community-based healthcare questions and translate research findings into practice. Today, the SERCN includes more than 200 health centers with more than 1,700 clinical sites serving more than 4 million patients.
In 2003, Dr. Rust received AHRQ funding to strengthen the health services research (HSR) capacity at the Morehouse School of Medicine (MSM), where he was then a faculty member. MSM is one of a handful of medical schools affiliated with the Nation’s approximately 100 historically Black colleges and universities. Under his direction, MSM used AHRQ funding to help launch the careers of junior faculty as independent health services researchers. “Historically there was and still is a profound lack of racial diversity in the research field, including HSR. We needed people who could bring voice from lived experience to the problems we were trying to solve,” Dr. Rust says.
He then successfully competed for AHRQ large conference grants—in 2004 and again in 2010—to fund primary care and prevention conferences through MSM and its National Center for Primary Care, of which he was the founding director. Dr. Rust ensured that these annual meetings featured sessions on health disparities and were relevant to underserved community providers by partnering with other organizations such as the Migrant Clinicians Network, National Healthcare for the Homeless Council, and Association of Clinicians for the Underserved. “Oftentimes medical conferences are one-way communication, where the people putting on the conference are the knowledge source, and they’re delivering that knowledge to the front lines,” he says. “We had a different view, and AHRQ funding allowed us to build out the conferences so we could have researchers listening to clinicians from the front lines.”
Also, in 2010, Dr. Rust received AHRQ funding to build a Medicaid database to support projects that would benefit diverse patients using comparative effectiveness research, in which existing healthcare interventions are compared with each other to determine which work best for which patients under which conditions. Using that database, Dr. Rust analyzed disparities in several aspects of care, including asthma prevalence and emergency department (ED) use among children; ED utilization patterns for schizophrenia and diabetes patients; complex mental health and medical comorbidities, and HIV/AIDS treatment.
As his career developed, Dr. Rust found that while he understood the front-line aspect of care and he intuitively understood many aspects of research, his lack of formal training in research methodologies hindered him. “I was self-taught; and sometimes I felt like I was barely a step ahead of the people I was trying to mentor and teach, and sometimes I was behind them,” he says. So, in 2013, Dr. Rust pursued a Research Career Enhancement Award for Established Investigators in Patient-Centered Outcomes Research, which funded his transition from executive leadership to intellectual leadership. Dr. Rust applied his experience with computer modeling and Medicaid data to study outcome disparities among low-income, Medicaid-enrolled children. Results of this specific line of AHRQ-funded research were published in the March 2015 issue of the American Journal of Managed Care and in AIMS Medical Science in 2017.
Dr. Rust has published over 120 peer-reviewed articles with those whom he has mentored. He now directs the Florida State University College of Medicine’s Center for Medicine and Public Health. He is a fellow of the American Academy of Family Physicians and the American College of Preventive Medicine. Dr. Rust served as a senior scientific advisor to AHRQ from 2015-2016.
Principal Investigator: George Rust, M.D., M.P.H.
Institution: Florida State University College of Medicine
Grantee Since: 2000
Type of Grant: Various
Consistent with its mission, AHRQ provides a broad range of extramural research grants and contracts, research training, conference grants, and intramural research activities. AHRQ is committed to fostering the next generation of health services researchers who can focus on some of the most important challenges facing our Nation's health care system.
To learn more about AHRQ's Research Education and Training Programs, please visit https://www.ahrq.gov/training.