Improving health equity through health care systems research

Deena J Chisolm; Jerome A Dugan; Jose F Figueroa; Meghan B Lane-Fall; Dylan H Roby; Hector P Rodriguez; Alexander N Ortega

doi:10.1111/1475-6773.14192

Improving health equity through health care systems research

Health Serv Res. 2023 Dec;58 Suppl 3(Suppl 3):289-299. doi: 10.1111/1475-6773.14192.

Authors

Deena J Chisolm¹, Jerome A Dugan², Jose F Figueroa³, Meghan B Lane-Fall⁴, Dylan H Roby⁵, Hector P Rodriguez⁶, Alexander N Ortega⁷

Affiliations

¹ Abigail Wexner Research Institute, Nationwide Children's Hospital, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA.
² Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA.
³ Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, Cambridge, Massachusetts, USA.
⁴ Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁵ Department of Health, Society, and Behavior, Program in Public Health, University of California, Irvine, Irvine, California, USA.
⁶ Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, California, USA.
⁷ Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA.

Abstract

Objective: To describe health equity research priorities for health care delivery systems and delineate a research and action agenda that generates evidence-based solutions to persistent racial and ethnic inequities in health outcomes.

Data sources and study setting: This project was conducted as a component of the Agency for Healthcare Research and Quality's (AHRQ) stakeholder engaged process to develop an Equity Agenda and Action Plan to guide priority setting to advance health equity. Recommendations were developed and refined based on expert input, evidence review, and stakeholder engagement. Participating stakeholders included experts from academia, health care organizations, industry, and government.

Study design: Expert group consensus, informed by stakeholder engagement and targeted evidence review.

Data collection/extraction methods: Priority themes were derived iteratively through (1) brainstorming and idea reduction, (2) targeted evidence review of candidate themes, (3) determination of preliminary themes; (4) input on preliminary themes from stakeholders attending AHRQ's 2022 Health Equity Summit; and (5) and refinement of themes based on that input. The final set of research and action recommendations was determined by authors' consensus.

Principal findings: Health care delivery systems have contributed to racial and ethnic disparities in health care. High quality research is needed to inform health care delivery systems approaches to undo systemic barriers and inequities. We identified six priority themes for research; (1) institutional leadership, culture, and workforce; (2) data-driven, culturally tailored care; (3) health equity targeted performance incentives; (4) health equity-informed approaches to health system consolidation and access; (5) whole person care; (6) and whole community investment. We also suggest cross-cutting themes regarding research workforce and research timelines.

Conclusions: As the nation's primary health services research agency, AHRQ can advance equitable delivery of health care by funding research and disseminating evidence to help transform the organization and delivery of health care.

Keywords: health care delivery systems; health disparities; health equity; health services research; social determinants of health.

MeSH terms

Delivery of Health Care
Government Programs
Health Equity*
Health Services Research
Humans
Racial Groups