Mechanisms to enhance racial equity in health care: Developing a model to facilitate translation of the ACCURE intervention

Ida Griesemer; Sarah A Birken; Christine Rini; Suzanne Maman; Randall John; Kari Thatcher; Crystal Dixon; Christina Yongue; Stephanie Baker; Claire Bosire; Aditi Garikipati; Cleo A Ryals; Alexandra F Lightfoot

doi:10.1016/j.ssmqr.2022.100204

Mechanisms to enhance racial equity in health care: Developing a model to facilitate translation of the ACCURE intervention

SSM Qual Res Health. 2023 Jun:3:100204. doi: 10.1016/j.ssmqr.2022.100204. Epub 2022 Dec 2.

Authors

Ida Griesemer^{1

2}, Sarah A Birken³, Christine Rini⁴, Suzanne Maman⁵, Randall John⁶, Kari Thatcher², Crystal Dixon^{2

7}, Christina Yongue^{2

8}, Stephanie Baker^{2

9}, Claire Bosire², Aditi Garikipati², Cleo A Ryals^{2

6

10

11}, Alexandra F Lightfoot^{2

5

12}

Affiliations

¹ US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, 150 South Huntington Avenue (152M), Jamaica Plain Campus, Building 9, Boston, MA, 02130, USA.
² Greensboro Health Disparities Collaborative, 301 S. Elm Street, Suite 414, Greensboro, NC, 27401, USA.
³ Department of Implementation Science, Wake Forest School of Medicine, 300 Medical Center Blvd, Winston-Salem, NC, 27157, USA.
⁴ Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 420 E Superior St, Chicago, IL, 60611, USA.
⁵ Department of Health Behavior, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.
⁶ Department of Health Policy and Management, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.
⁷ Department of Health and Exercise Science, Wake Forest University, 1834 Wake Forest Rd., Winston-Salem, NC, 27109, USA.
⁸ Department of Public Health Education, University of North Carolina, 1408 Walker Ave # 437, Greensboro, NC, 27412, USA.
⁹ Department of Public Health Studies, Elon University, 100 Campus Drive, Elon, NC, 27244, USA.
¹⁰ Lineberger Comprehensive Cancer Center, University of North Carolina, 450 West Dr, Chapel Hill, NC, 27599, USA.
¹¹ Flatiron Health, 233 Spring St., New York, NY, 10013, USA.
¹² Center for Health Promotion and Disease Prevention, University of North Carolina, 1700 MLK Jr Blvd Ste 7426, Chapel Hill, NC, 27599, USA.

Abstract

Background: As medical and public health professional organizations call on researchers and policy makers to address structural racism in health care, guidance on evidence-based interventions to enhance health care equity is needed. The most promising organizational change interventions to reduce racial health disparities use multilevel approaches and are tailored to specific settings. This study examines the Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) intervention, which changed systems of care at two U.S. cancer centers and eliminated the Black-White racial disparity in treatment completion among patients with early-stage breast and lung cancer.

Purpose: We aimed to document key characteristics of ACCURE to facilitate translation of the intervention in other care settings.

Methods: We conducted semi-structured interviews with participants who were involved in the design and implementation of ACCURE and analyzed their responses to identify the intervention's mechanisms of change and key components.

Results: Study participants (n = 18) described transparency and accountability as mechanisms of change that were operationalized through ACCURE's key components. Intervention components were designed to enhance either institutional transparency (e.g., a data system that facilitated real-time reporting of quality metrics disaggregated by patient race) or accountability of the care system to community values and patient needs for minimally biased, tailored communication and support (e.g., nurse navigators with training in antiracism and proactive care protocols).

Conclusions: The antiracism principles transparency and accountability may be effective change mechanisms in equity-focused health services interventions. The model presented in this study can guide future research aiming to adapt ACCURE and evaluate the intervention's implementation and effectiveness in new settings and patient populations.

Keywords: Antiracism; Cancer care; Community-based participatory research; Intervention; Planned adaptation; Quality improvement.

Abstract

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