How can health care systems research improve health equity?

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, Ph.D., 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. 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."