(COLUMBUS, Ohio) – In the United States, health care inequities based on racial and ethnic sociodemographics are pervasive and persistent. Research has shown the systems that deliver health care have both contributed to and maintain these disparities.
Quality improvement programs and health policy innovations have led to modest improvements in equity, but research on which approaches work best and how to scale promising programs is limited.
“Health systems can help improve health but sometimes they also make things worse. Research can help us understand how to improve their quality and equity. This also helps us learn how to avoid potential negative outcomes related to health systems,” says Deena Chisolm, PhD, director of the Center for Child Health Equity and Outcomes Research at Nationwide Children’s Hospital.
Dr. Chisolm recently led a group of experts from across the country to publish a study in Health Services Research outlining priorities for such research. Their study was conducted as part of the Agency for Healthcare Research and Quality (AHRQ) stakeholder-engaged process to develop an Equity Agenda and Action Plan to guide the agency’s priorities for new research in the field. The result is consensus recommendations informed by stakeholder experts from academia, health care organizations, industry and government.
The new study identifies six priority themes with substantial research gaps:
- Institutional leadership, culture and workforce: Learning from how “cultures of safety” have improved health care quality and safety, consider exploring “cultures of equity.”
- Data-drive, culturally tailored care: This care meets the specific barriers and preferences of culturally defined groups and communities. Such care requires routine collection of data to enable disaggregated tracking to understand and meet patients’ needs.
- Health equity targeted performance incentives: Current incentives through value-based purchasing do not necessarily promote the reduction of health inequities. New performance metrics and incentives that are equity-based could help move the needle toward more equitable care.
- Health equity-informed approaches to health system consolidation and access: Maldistribution of health care delivery systems has led to care deserts that affect one-third of the U.S. population.
- Whole person care: Social conditions impact population health and must be addressed to improve health equity.
- Whole community investment: Health care delivery systems impact not only individual patients but the whole community they serve.
Each theme is supported by a recommended research agenda and action plan, summarized in Table 1 of the publication. The team also presents cross-cutting research recommendations, noting that two potential roadblocks to the success of research in these key areas are time and people. Expanding the research workforce and providing funding opportunities at all levels will help meet the needs of this field. Additionally, health equity research demands long-term investment to understand changing needs and create lasting change. As such, the authors recommend the development of funding mechanisms that go beyond the traditional R01 5-year awards.
“The Agency for Healthcare Research and Quality is the leading federal funder for health services research,” says Dr. Chisolm, who was the lead author of the publication. “This paper informs the type of work they should be funding in the years to come. Research in these areas will inform best practices for making health care systems part of the solution to eliminate long-standing health inequities.”
Citation:
Chisolm DJ, Dugan JA, Figueroa JF, Lane-Fall MB, Roby DH, Rodriguez HP, Ortega AN. Improving health equity through health care systems research. Health Services Research. 2023;1-11. DOI: 10.1111/1475-6773.14192
About The Abigail Wexner Research Institute at Nationwide Children's Hospital
Named to the Top 10 Honor Roll on U.S. News & World Report’s 2023-24 list of “Best Children’s Hospitals,” Nationwide Children’s Hospital is one of America’s largest not-for-profit free-standing pediatric health care systems providing unique expertise in pediatric population health, behavioral health, genomics and health equity as the next frontiers in pediatric medicine, leading to best outcomes for the health of the whole child. Integrated clinical and research programs are part of what allows Nationwide Children’s to advance its unique model of care. As home to the Department of Pediatrics of The Ohio State University College of Medicine, Nationwide Children’s faculty train the next generation of pediatricians, scientists and pediatric specialists. The Abigail Wexner Research Institute at Nationwide Children’s Hospital is one of the Top 10 National Institutes of Health-funded free-standing pediatric research facilities in the U.S., supporting basic, clinical, translational, behavioral and population health research. The AWRI is comprised of multidisciplinary Centers of Emphasis paired with advanced infrastructure supporting capabilities such as technology commercialization for discoveries; gene- and cell-based therapies; and genome sequencing and analysis. More information is available at NationwideChildrens.org/Research.