Ana Quiñones is a gerontologist with a doctorate degree in health care management and policy. She's been with OHSU since 2010 and Family Medicine since 2017. Here are some of the things she's working on, and why she chose Family Medicine for her work.
What are you studying now?
We have an existing project that was funded several years ago on changes in multimorbidity — trying to understand and examine changes in patterns of multiple chronic conditions for middle aged and older Americans. Specifically, what we're interested in are the disparities that exist between race/ethnic groups and how they accumulate and progress in their chronic condition burden as they age. This means examining their chronic disease profiles over time, the different combinations of disease that they have, and the consequences of those combinations to their health-related quality of life.
In the last couple of years we've had two new projects funded, and I'm also involved in a national dementia collaboratory, the NIA IMPACT Collaboratory. This is an infrastructure grant for understanding how to conduct real-world, pragmatic trials for people living with dementia and their caregivers. I'm charged with leading the health equity team, which involves thinking about issues of diversity and inclusion in pragmatic dementia trials, and developing a repository of information, resources, and best practices on how to conduct those dementia trials in real-world conditions.
Most clinical trials are conducted under strict experimental conditions — with strict criteria for inclusion and exclusion of subjects. None of these are implemented in health care systems or clinics or nursing homes as part of the regular clinical workflow, and with patients who have multiple chronic conditions. We don't really have very strong evidence of what works and what doesn't work under more realistic, real-world conditions.
As I mentioned, I am also busy with my own investigator-led program of research. I have three R1s: the first (as I’ve already stated) involves changes in multimorbidity over time, so looking at the measurement and epidemiology of multimorbidity for racial/ethnically diverse older adults. The latest two — on the implications of coexisting conditions and multimorbidity with dementia (MEMORABLE), and in partnership with OCHIN, a project investigating multimorbidity patterns among the safety-net population (ACHES — Aging and Community Health Clinics). Several folks in Family Medicine are working with me on ACHES: Nathalie Huguet, Miguel Marino, and John Heintzman.
I'm really excited about it because we're one of the few projects around the country that is really looking at these chronic disease patterns and multimorbidity patterns in community health clinics, in safety-net populations.
A lot of my field is really focusing in on older adults with multimorbidity patterns. How does it develop and evolve differently for people from different racial/ethnic backgrounds? There’s real potential here for better understanding how the compounding of multiple kinds of disadvantaged groups is borne out by low socioeconomic status, race/ethnicity, and potentially immigrant populations — and understanding how that translates into premature aging. We are grappling with questions like, how does developing these chronic conditions or these chronic patterns earlier in life either compound over one’s lifespan, or result in premature mortality and premature disability? It will be interesting to see what these patterns are for our safety-net population.
How did you get involved in this work?
I've always been interested in issues of health care and health care access from a policy perspective, since high school. I'm interested in the ideas of policy and governance, and appropriate allocation of resources that can help people move forward, and help us lead healthy, productive lives.
In college I started to see how issues of health conditions and health status seemed to affect some groups more than others. This is very, very timely with what we are seeing in our country now. We're seeing these issues with systemic racism. We're seeing these issues of people being systematically excluded from systems of labor participation, from income streams, and it severely disadvantages groups of people, mainly people of color in this country, over an entire lifespan, and across multiple generations.
From a personal standpoint, my father passed away from diabetes in 2007, and he didn't just have diabetes. I saw, and my family saw, the difficult time that clinicians had in trying to manage his care, trying to manage his multiple chronic conditions. What do we do to keep his diabetes under control? What do we do to keep his congestive heart failure under control? He's exhibiting some symptoms dementia. What do we do to try to manage that and try to help the family manage that? It became kind of a puzzle for me and my whole family.
This is a really a terrible situation for families, but also kind of an interesting one from a research standpoint: What can clinicians do? Clinicians can be so siloed into their specialties. Sometimes they talk to each other, sometimes there are systems or programs in place (like care management) to share information on diagnoses, treatments, and medications that are prescribed, but really, we're a system of multiple systems. It's very, very difficult for whole-person care to happen.
That's what really launched me into focusing on health care policy and epidemiology — my academic career — and zeroing in on the problem of having multiple chronic conditions. Focusing on how health care systems — and communities, community programs, and other services that are available outside of hospitals, or outside of the four walls of a clinic — should be designed to support our wellbeing and enable living with high quality of life.
Why did you choose OHSU Family Medicine?
This really is the one place to be if you're in any kind of a health care, health policy, or public health field, which are all of my interests and orientation.
There's a lot of flexibility in our ability to do great work. The university does a good job of attracting talent and of giving us freedom in pursuing whatever kind of research program we're interested in pursuing.
Family Medicine is just a really great beacon within OHSU: the work that's done, the passion, the care for patients. There's a real sense of purpose and mission in providing care for patients, and the group of people in Family Medicine was really a big draw for me. I'm here because of what I saw the department doing for its patients, and for its faculty researchers.