Advancing health equity‐Agency for Healthcare Research and Quality research and action agenda

Health Services Research, Journal Year: 2023, Volume and Issue: 58(S3), P. 275 - 280

Published: Nov. 28, 2023

The United States continues to grapple with profound and persistent health inequities that harm its vitality. President Biden's Executive Order (EO) outlined the first-ever “whole of government” comprehensive approach advancing equity for all people. It defined as “the consistent systematic fair, just, impartial treatment individuals, including individuals who belong underserved communities have been denied such treatment, Black, Latino, Indigenous Native American persons, Asian Americans Pacific Islanders other persons color; members religious minorities; lesbian, gay, bisexual, transgender, queer (LGBTQ+) persons; disabilities; live in rural areas; otherwise adversely affected by poverty or inequality.”1 Agency Healthcare Research Quality (AHRQ) is acutely aware embedded US healthcare system stand way AHRQ has a long history funding disseminating research address advance equity. This focus demonstrated publication Special Emphasis Notice (SEN) highlight AHRQ's interest new innovative investigator-initiated grant applications focused on services Request Application (RFA) specifically aimed at building evidence regarding implementation effectiveness equity-focused evidence-based interventions disparities equitable care delivery systems.2 Over past 2 years, examined work, internal workplace culture, policies procedures administrating programs, opportunities center within our priorities. As part latter, establishing an Equity Agenda Action Plan, leveraging core capabilities research, practice improvement, data analytics, systems workforce training. hosted multistakeholder Health Summit invited five papers summarize state provide input this agenda action domains which AHRQ, well researchers, could drive more care: (1) Delivery System Structure, (2) Payment, (3) Social Determinants & Needs, (4) Implementation Science, (5) Access Care (Figure 1). commentary describes inclusive agenda-building process, presents Framework used participants explore through lens, highlights key cross-cutting themes emerged from domain can serve basis informing field broadly. To amplify voices, worked Langco + Partners3 ground principles equity-centered community design community-based participatory Summit. focuses historical current contexts systemic racial inequity rebuilding maintaining trust among stakeholder communities. In December 2021, convened planning meeting included than 50 diverse stakeholders users data, tools. Participants leaders, patient family advocates. group discussed scope, goals, strategies equity, diversity, anti-racism, inclusiveness, accessibility structure also provided feedback context mission illustrates domains: These support deliver care, reduce quality, safety, value. figure shows lens magnifying critical make impact. Notably, these undergirded competencies research; improvement (tools products speed translation into action); analytics (use inform program policy decisions); training (health workforce). domains. At far left, ecological four nested levels: individual; community; institutions/organizations; policy, systems, environment. crucial bidirectional, dynamic relationship must be considered simultaneously develop meaningful questions ensure results are actionable directly needs priorities populations they serve. teams author framework's conducted narrative reviews intersection their recommended agenda. was purposefully pragmatic meant stimulate innovation. Rather conducting formal reviews, encouraged each team tailor topic, literature, rapid project timeline so shared maximize opportunity go beyond literature incorporate voices experiences stakeholders. September 2022, 2-day established belonging, co-created related system, identified progress. goals developing understanding language describe vision mission; exploring about impact structural racism implications improving performance; empowering change agents. Full-group community-building sessions bridged smaller break-out sessions, one small-group received initial paper outline discussion before One professional facilitator co-led small session, groups utilized Jamboard, real-time, interactive, collaborative tool. processes prioritized empowered participation. They ensured contributions were captured later use updating papers. recordings breakout images Jamboards. Authors met discuss updates based resolve potential areas overlap. writing finalized papers, underwent peer review Services (HSR). articles special issue follow aim meet base “where it is,” reflect lived those often minoritized, where should while prioritizing importance, impact, Within vanquishing “ensuring communities,”1 commissioned HSR Framework: Care. input, expert opinion advances guiding feild reserach indicate partners play leading role inequities. Below, we conclusions important considerations system's primary goal improve patients integral parts process. remind us purpose high-quality everyone's health, not solely efficiency. Consistently, emphasizes importance authentic engagement participation expertise essential addressing effectively. However, diverse, solutions them, especially most minoritized. paper, Baumann et al. dissemination science solid promise accelerating progress toward equity.4 Not surprisingly, central principle overall pathway promote monitoring healthcare. Additionally, Jindal al., Levesque framework5 six dimensions access, which, respectively, emphasize community-centric factors.6 access dimensions: approachability (e.g., trustworthiness; engagement, partnership, co-development), acceptability cultural tailoring, bias, identity concordance between clinician), availability geographic distribution services, in-person vs. virtual delivery, type member providing service), accommodation interpreter accessible space disabilities), affordability insurance coverage, out pocket costs, costs grappling barriers), appropriateness racial/ethnic bias algorithms; low-value given marginalized patients) operationalized therefore guide care. present-day intersectional oppression racism, sexism, homophophia (also Theme 2) largely missing frameworks thereby limiting findings disparities. Peek need SDOH social adapt specific sociocultural socially populations.7 Focusing examining heterogeneity effect intervention across people different identities, collaboration team, improves outcomes reduces (or worsens) Understanding factors deeply society's foundation vital creating anti-racist break cycle While fields studied tended interpersonal implicit bias. principles, explicitly call recognize approaches conceptualize settings.4 allows deeper transparent impacts turn practices directly.7 includes conceptualizing marginalization SDOH. This, note, lead development experience measures inequity, mitigate Chisolm assert any conceptualization prejudice outset, anchoring recommendations anti-discriminatory counter oppression.8 More specifically, proposals target multiple levels, dependencies, complexities yet cluster around opportunities, whether programs well-trained, evidence-based, culturally tailored testing models racially targeted disinvestments. may moved operationalizing only individual level institutional societal structures, acting together reinforce inequities, thus necessitating even wider understand relationships interactions. Eschliman define payment mechanism compensating providers service goods paying physician office visit) financing procuring available legislature passing Medicaid budget insurers charging enrollees premiums).”9 limitations value-based reforms, date, successfully promoted because emphasis savings (focused financial risk) lack innovation reforms financing. authors point gap range problems ripe action, differential resources communities, scarcity health-related integration no accountability whole-person outcomes. Potential adjust cost-sharing increase high-value design; defining high care), equity-related metrics, experience. Chisolm, Peek, colleagues driving equity.7, 8 innovation—looking partnership efforts continue align incentivize needs, food insecurity, housing instability, transportation barriers. consider benefits integrative whole-community approaches, notably features allow scalable sustainable improvements equity.8 Similarly, “Given shape complex patient-level alone sufficient achieve multi-level individual, clinical, community), multisector healthcare, housing, transportation, services), practice-based, needed populations.”4 neglected omitted significant levels sectors. reflecting failures entity accountable aspects wellbeing.9 Thus, will likely fail optimal all, if non-clinical factors, delegate others. underscore why fall short reaching remain fragmented siloed. Interventions, down walls sectors link Dissemination tool influence how scientific put practice, why, how, whom achieved not. illustrate power seeing lens.4 Their draw attention practitioners, leaders tangibly rate acceleration adoption Yet historically, explicit science. Each points gaps that, addressed, foster both de-implementation adaption prevent harm,6 build interventions,8 limits solutions, ways integrate care.7, What underlies contexts, populations, settings creation system. Moreover, note sense urgency, misuse existing exacerbate cause harm. Explicit step evidence-generation process design, implementation, evaluation critical. Embedding stage widespread accelerated effective all. Multiple perpetuate Several diversity inclusion leadership, structure, research. values particularly determine (perception being met).6 greater bi-directional greatest need. Both workforce's representativeness reflects leadership's broader beliefs values.6, Recruitment leadership integrating leaders' perspectives decision-making means dismantle long-standing “inclusive diversity” teams.7 designed implemented them. representation undermines widens measure intervene effects supporting sustain workforce, recruitment retention (i.e., ongoing tracking metrics) workforce. remains steadfast commitment year, diligently continued invest dovetail recommendations. For example, undertook work examine digital algorithms identify biases.10 We launched Learning Embedded Scientist Training Centers initiative train researchers scientists conduct system-focused enhance diversity.11 funded leverage test, refine, implement systems.12 issue, requirements partnerships, values, co-creation, co-learning systems. announced Enhancing Workforce Diversity announcement supplement projects recruit backgrounds, shown underrepresented research.13 Yet, ahead. prioritize plan informed insights contributed crosscutting foundational group. continually evaluating investments collective Dr. Chin contract subject matter consulting project. co-directs Robert Wood Johnson Foundation Advancing Equity: Leading Care, Systems Transformation National Program Office co-chairs Medicare Payment Network Advisory Team. Blue Cross Shield Panel Bristol-Myers Squibb Company Board. He co-directed Merck Bridging Gap: Reducing Disparities Diabetes Office.

Language: Английский

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Barriers and facilitators of healthcare access for long COVID-19 patients in a universal healthcare system: Qualitative evidence from Austria

Research Square (Research Square), Journal Year: 2024, Volume and Issue: unknown

Published: July 19, 2024

Background: Long COVID-19 challenges health and social systems globally. International research finds major inequalities in prevalence healthcare utilization as patients describe difficulties with accessing care. In order to improve long-term outcomes it is vital understand any underlying access barriers, for which relevant evidence on long COVID-19 thus far lacking a universal system like Austria. This study aims comprehensively identify barriers facilitators faced by Austria explore potential socioeconomic demographic drivers care access. Methods: Applying an exploratory qualitative approach, we conducted semi-structured interviews 15 experts including medical professionals senior officials well focus groups 18 confirmed diagnosis reflecting varying participant characteristics (age, gender, urbanicity, occupation, education, insurance status) (July-Nov 2023). Data were analysed following thematic framework drawing comprehensive ‘access care’ model. Results: Based expert patient experiences, several emerged along all dimensions of the Main themes included scepticism stigma professionals, finding knowledgeable doctors, limited specialist capacities ambulatory sector, waiting times care, statutory coverage treatments resulting high out-of-pocket payments. Patients experienced constant self-organization their pathway stressful, emphasizing need multidisciplinary centralized coordination. Facilitators supportive environments, telemedicine, informal information provided nationwide patient-led support group. Differences experiences emerged, among others, women younger gender- age-based stigmatization. Complementary reduced financial strain, however, did not ease capacity constraints, particularly challenging those living rural areas. Conclusions: The findings this indicate call action situation empowering both providers via increased offerings, strengthened interdisciplinary treatment structures funding. Our insights potentially lay necessary foundation future quantitative inequality research.

Language: Английский

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Non-COVID Respiratory Infections Emergency Room Visits Among Autistic in the United States

American Journal of Preventive Medicine, Journal Year: 2024, Volume and Issue: 68(1), P. 46 - 55

Published: Aug. 23, 2024

Language: Английский

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Deprivation and Aspiration Strains as Function of Mental Health Among Chinese Adults: Study of a National Sample

International Journal of Environmental Research and Public Health, Journal Year: 2024, Volume and Issue: 21(12), P. 1598 - 1598

Published: Nov. 30, 2024

Background: China is in a period of rapid transformation economic and social development. The imbalance the distribution benefits, focusing on adjustment reorganization, has led to an increase relative deprivation. Studies have shown that deprivation leads decline personal mental health. Methods: We used national data Chinese General Social Survey (CGSS) collected 2015 (N = 10,702; male 46.89%) estimate relationship between aspiration strains Covariates included age, gender, education level, marital status. Results: results show mechanism how status affects health residents through strains. It was found are both negatively correlated with health, even when controlling for confounding variables. Conclusion: Mental can be improved, suicide rates may decreased by vigorously developing economy, promoting equity justice, strengthening psychological counseling general population.

Language: Английский

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The US health-care paradox: lifting the veil

The Lancet, Journal Year: 2024, Volume and Issue: 404(10469), P. 2244 - 2246

Published: Dec. 1, 2024

Language: Английский

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Advancing equity research in the quality of and access to health care in a post‐affirmative action era

Health Services Research, Journal Year: 2023, Volume and Issue: 58(S3), P. 281 - 283

Published: Nov. 28, 2023

It is much more important to know what sort of a patient has disease, than disease has. Despite powerful narratives echoing purported existence meritocracy in our society, major racial and ethnic disparities health healthcare have persisted for hundreds years. Yet clear understanding structural societal inequities not innate group differences underlying the was articulated nearly 200 years ago by Dr. James McCune.1 His position reified findings from “The Philadelphia Negro,” an elegant sociological epidemiological study W.E.B. Du Bois late 1800s.2 However, their voices were largely ignored because Native Black Americans been devalued America maintain myth inferiority. until 1985 Report Secretary's Task Force on Minority Health, led Margaret Heckler, that nation could accept such as problem worthy consideration. Soon thereafter, 2003 Institute Medicine report entitled “Unequal Treatment: Confronting Racial Ethnic Disparities Health Care” sought only codify outcomes, but emphasized these due how people treated attributes. also identified this mistreatment quality access care. The emerging focus care at turn 21st century embraced Agency Healthcare Research Quality (AHRQ) who started formally track delivery it relates socioeconomic factors priority populations. This formal tracking played critical role developing evidence base systems improve advance ability provide best all us. Spurred Coronavirus 2019 (COVID-19) pandemic 2020 murder George Floyd, US system faced social equity justice movement. movement racism inequitable distribution determinants (SDoH), broad set forces shaping conditions daily life, driving root causes In 2022, AHRQ sponsored Equity Summit bring together multiple working groups 2021 Agenda Action Plan created help guide priorities equity. commentary addresses two interrelated articles, written Chisholm et al.3 Jindal al.4 describe AHRQ's 2022 highlight stages key action steps future equitable delivery. six research themes promote population health, while strengthening care: (1) institutional leadership, culture, workforce; (2) data-driven, culturally tailored care; (3) equity-targeted performance incentives; (4) equity-informed approaches consolidation access; (5) whole-person (6) whole community investment. They propose complementary plans follows: publish white papers toolkits evidence-informed support policies require race ethnicity language data collection providers payers; develop assist organizations integrate metrics into management well publicly available equity-focused evidence-based indicators; development geographic information changes access, quality, arising and/or policy changes; accelerate outcomes linked needs; new funding models with allocated directly partnership universities or using Small Business Innovation model. last theme meaningful engagement, investment, partnerships local communities serve many ways greatest potential transform begin truly addressing more.5 need leverage other federal agencies public–private pursuit undoing systemic barriers inequities, describes five dimensions agenda focuses improving approachability, acceptability, availability accommodation, affordability, appropriateness. Complementary actions include: collaboratively evaluate trustworthy anti-racism toolkit systems; champion use tools racism; fund collaborative identify burnout lens intersectionality mistreatment; examine costs maintaining flexibility state Medicaid programs, coverage improvements Affordable Care Act, find eliminate discriminatory accessing insurance; patient-centered decision-making de-implementation low-value elimination individual-level race-based algorithms. note, “progress will be made when there common acceptance arise process rooted experience infrastructure rather DNA”. Together, articles reflect importance must done consideration intersectionality, emphasize high-quality inform These recommendations optimally address care, once again perpetuated legal decisions during time limits we achieve SDoH pathway through which works given implications Supreme Court rulings, can consider “an applicant's discussion affected his her discrimination, inspiration, otherwise.”6, 7 words, cannot used criterion admission alone, yet, applicant discuss they may impacted (or racism). A similar approach undertaken if extrapolation university care.11 prescient its timing, preceded landmark events landscape—the recent rulings (Students Fair Admissions, Inc. v. President Fellows Harvard College Students University North Carolina; 303 Creative LLC Elenis), ended affirmative college admissions yet allowed discrimination based free expression despite public accommodation laws. do mean identity-based no longer exist, particularly regard health. limit those focused workforce composition regulations requiring equal provision service. We collectively innovate ensure appropriate implement requisite solutions reduce why explicitly critical, driver necessary innovation priorities. Some argued are equipped take allocation (SDoH).8 Many patients interfacing suffering systematic indifference life-affirming resources. inability approve resources creates dilemma ultimately afford ignore SDoH, continue long-term effects utilization costs. Indeed, Laviest al. estimated direct indirect economic burden exceed $400 billion year.9 As noted both lead way determine partnering service more, private–public partnerships. reverse longstanding issues underpin partner closely communities.3, 4, 10 Direct buy-in needed investigator teams successful work conducting communities, subsequently allow success agenda. slowly beginning occur broadly universities, hospitals large, organization become “Anchor Institutions” commit financial, human intellectual challenges, inextricably outside walls.11 Ensuring us receive systems, especially components affect Implementation proposed infuse would toward achieving Ong receives relevant (K12 HS026407) Department Veteran Affairs Services & Development (CIN 13-417). Norris National Institutes (P50MD017366, P30AG021684, UL1TR000124).

Language: Английский

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