LaQuandra Nesbitt, MD, MPH

LaQuandra Nesbitt, MD, MPH

2006-2007

Director, Washington DC Department of Health Associate Professor, School of Public Health and Information Sciences, University of Louisville

Dr. LaQuandra S. Nesbitt is a board-certified family physician who is the Director of the Louisville Metro Department of Public Health and Wellness in Louisville, KY.  The Louisville Metro Department of Public Health and Wellness (LMPHW) is responsible for the approximately 750,000 residents in Louisville, KY.  As an independent health department, the LMPHW provides programs and services primarily through three divisions: Clinical Services, Community Health, and Environmental Health and Preparedness.  In addition, the department is home to the Center for Health Equity which aims to achieve equity in the social determinants of health throughout Metro Louisville using a "health in all policies" approach.  Dr. Nesbitt also serves as an Assistant Professor in the Department of Health Management and Systems Science at the University of Louisville School of Public Health and Information Sciences. Prior to her current role at LMPHW, Dr. Nesbitt served separate terms as Senior Deputy Director for the Community Health Administration and Senior Deputy Director for the Center for Policy, Planning, and Evaluation at the District of Columbia Department of Health. Prior to joining the District of Columbia Department of Health Dr. Nesbitt was Assistant Professor in the Department of Family and Community Medicine and the Senior Coordinator for Health Disparities and Policy Research Initiatives in the Office of Policy & Planning at the University of Maryland School of Medicine. Her responsibilities encompassed providing primary care services to patients in inner-city Baltimore including adolescent health services, preventive medicine services, and chronic disease management with an emphasis on hypertension and diabetes care. Her academic interests include racial and ethnic disparities in health outcomes and health care services, workforce diversity, and improving access to care for the uninsured and underinsured through policy and health services research. 

Dr. Nesbitt received her Bachelor of Science degree in Biochemistry from the University of Michigan-Ann Arbor, her medical degree from Wayne State University School of Medicine, and a Master of Public Health in Health Care Management and Policy from the Harvard School of Public Health. Dr. Nesbitt completed an internship in family medicine at the University Hospitals of Cleveland/Case Western Reserve University. Dr. Nesbitt completed her family medicine residency in the University of Maryland’s Department of Family Medicine where she served as chief resident. Dr. Nesbitt completed her fellowship training with the Commonwealth Fund Harvard University Fellowship in Minority Health Policy.

2009

2006

Access to Quality Cancer Care: Creating an Agenda for Action

Background:

Access to health care is a major national concern.  Additionally, there exists an imperative to focus on assuring not only access to basic health care but also high quality and affordable health care, especially for the most underserved communities. Given the increasing national, state and local focus on health care disparities, the lack of access to quality and affordable health care has been identified as a major contributor to health disparities in general and cancer disparities in particular.

Objective:

To gain a better understanding of the factors that impact access to care, the study will:

  •     Examine demographic profiles of eight states and districts in the South Atlantic Region of the United States
  •     Identify factors that impact access to care in those states and the United States
  •     Identify key components of quality cancer care
  •     Review healthcare access policies, legislation, and regulation as well as cancer care plans in the region
  •     Develop an agenda for action for policymakers and cancer care organizations and associations to improve access to affordable quality cancer care

Methods and Data Sources:

A variety of data sources were utilized in this report including the American Cancer Society Cancer Facts and Figures; the National Cancer Institute Surveillance, Epidemiology and End Results (SEER) and other data sources; Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System; U.S. Census Bureau; Kaiser State Health Facts; U.S. Department of Education; American College of Surgeons Commission on Cancer (CoC) and Comprehensive Adult Student Assessment System (CASAS).  Available data were analyzed nationally and for each of the SAD states and the District of Columbia. Where data were available, comparisons to United States data are also provided. Frequency reports and proportions for a variety of health care access and cancer rate variables were reviewed.

A brief questionnaire was developed and administered to state cancer control plan staff within each area in the study.  The purpose of this questionnaire was to determine responses to a set of key questions on access and cancer care and to determine whether policies, laws or regulations specific to cancer care existed in these states and whether plans were in progress to pursue additional legislation this year. Responses were received from all states. The responses were provided via email or telephone.

Results:

All of the states/districts analyzed in this study—Delaware, the District of Columbia, Georgia, Maryland, North Carolina, South Carolina, Virginia, and West Virginia—have age-adjusted cancer death rates that exceed the U.S. rate of 195.7 deaths per 100,000 population per year.  All of the states/districts rank in the top half of the states with the highest cancer death rates; West Virginia ranks fifth and the District of Columbia ranks first in the nation.  Within the South Atlantic Region, variations in cancer screening, incidence rates, and death rates exist.  There are also vast differences between the states in racial/ethnic composition, insurance rates, health care facilities, educational attainment, unemployment rates, income, household resources, geographic profiles, legislation, and cancer care plans.

Conclusion:

Cancer screening practices, insurance rates, health care facilities, educational attainment, unemployment rates, income, household resources, and geographic profiles are important for the understanding of health care access and quality cancer care issues. Additionally, the evident differences in variables reported have a role in cancer disparities.  Therefore we conclude that,

  •     Factors associated with access to health care are complex and are viewed as encompassing more than health insurance status.
  •     Multiple factors may be associated with decisions regarding type of treatment offered by the clinician and accepted by the patient.
  •     There is a need for a definition of quality cancer care which encompasses multiple components and domains of care.
  •     There is a need to develop the best methods to achieve quality care which may be achieved by standardizing treatment guidelines.
  •     Developing policies that create uniformity in cancer data reporting among all cancer agencies or registries may aid in the elimination of cancer disparities.

Preceptors:

Claudia Baquet MD, MPH, Associate Dean for Policy and Planning, Professor of Medicine, and Professor of Epidemiology & Preventive Medicine, University of Maryland School of Medicine