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Baumann AA, Shelton RC, Kumanyika S, Haire‐Joshu D. Advancing healthcare equity through dissemination and implementation science. Health Serv Res 2023; 58 Suppl 3:327-344. [PMID: 37219339 PMCID: PMC10684051 DOI: 10.1111/1475-6773.14175] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVE To provide guiding principles and recommendations for how approaches from the field of dissemination and implementation (D&I) science can advance healthcare equity. DATA SOURCES AND STUDY SETTING This article, part of a special issue sponsored by the Agency for Healthcare Research and Quality (AHRQ), is based on an outline drafted to support proceedings of the 2022 AHRQ Health Equity Summit and further revised to reflect input from Summit attendees. STUDY DESIGN This is a narrative review of the current and potential applications of D&I approaches for understanding and advancing healthcare equity, followed by discussion and feedback with Summit attendees. DATA COLLECTION/EXTRACTION METHODS We identified major themes in narrative and systematic reviews related to D&I science, healthcare equity, and their intersections. Based on our expertise, and supported by synthesis of published studies, we propose recommendations for how D&I science is relevant for advancing healthcare equity. We used iterative discussions internally and at the Summit to refine preliminary findings and recommendations. PRINCIPAL FINDINGS We identified four guiding principles and three D&I science domains with strong promise for accelerating progress toward healthcare equity. We present eight recommendations and more than 60 opportunities for action by practitioners, healthcare leaders, policy makers, and researchers. CONCLUSIONS Promising areas for D&I science to impact healthcare equity include the following: attention to equity in the development and delivery of evidence-based interventions; the science of adaptation; de-implementation of low-value care; monitoring equity markers; organizational policies for healthcare equity; improving the economic evaluation of implementation; policy and dissemination research; and capacity building.
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Affiliation(s)
- Ana A. Baumann
- Division of Public Health Sciences, Department of SurgeryWashington University School of MedicineSt. LouisMissouriUSA
| | - Rachel C. Shelton
- Department of Sociomedical SciencesColumbia University, Mailman School of Public HealthNew YorkNew YorkUSA
| | - Shiriki Kumanyika
- Drexel Dornsife School of Public HealthDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Debra Haire‐Joshu
- Brown School of Public Health and School of MedicineWashington University in St. LouisSt. LouisMissouriUSA
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Curt A, Khidir H, Ciccolo G, Camargo CA, Samuels-Kalow M. Geographically Indexed Referral Databases to Address Social Needs in the Emergency Department. West J Emerg Med 2021; 22:218-224. [PMID: 33856303 PMCID: PMC7972357 DOI: 10.5811/westjem.2020.11.49250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/23/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Unmet health-related social needs (HRSN) are among the drivers of disparities in morbidity and mortality during public health emergencies such as the novel coronavirus 2019 (Covid-19) pandemic. Although emergency departments (ED) see a high volume of patients with HRSN, ED providers have limited time to complete detailed assessments of patients’ HRSN and are not always able to provide up-to-date and comprehensive information to patients on available community resources. Electronic, geographically indexed resource database systems have the potential to provide an efficient way for emergency physicians to rapidly identify community resources in settings where immediate social work consultation is not accessible. Methods We conducted a systematic review of papers examining the use of geographically indexed resource database systems in healthcare to better understand how these services can be used in emergency care. We then conducted simulated, standardized searches using two nationally available databases (211 and Aunt Bertha), applied to a single metropolitan area (Boston). Results Our systematic review found that most public health and screening interventions using nationally available databases have focused on chronic care needs. A small subset of publications demonstrated that these databases were mobilized during disasters to successfully aid vulnerable populations during Hurricanes Katrina and Rita. A total of 408 standardized searches were conducted to identify community resources related to four domains of social needs (food, transportation, housing, and utilities). Although 99% of the resources identified by both databases were relevant to the search domains queried, a significant proportion of the resources identified by each database were restricted to a specific demographic (eg, veterans). Conclusion Our findings demonstrate that geographically indexed referral databases may be an effective tool to help ED providers connect patients to nearby community resources during public health emergencies. We recommend that EDs select a referral database based on the greatest number of resources that are not demographically restricted.
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Affiliation(s)
- Alexa Curt
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Hazar Khidir
- Harvard Affiliated Emergency Medicine Residency, Boston, Massachusetts
| | - Gia Ciccolo
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Carlos A Camargo
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
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Meurer WJ, Dome M, Brown D, Delemos D, Oska S, Gorom V, Skolarus L. Feasibility of Emergency Department-initiated, Mobile Health Blood Pressure Intervention: An Exploratory, Randomized Clinical Trial. Acad Emerg Med 2019; 26:517-527. [PMID: 30659702 DOI: 10.1111/acem.13691] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/21/2018] [Accepted: 12/22/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES We aimed to assess the feasibility of a text messaging intervention by determining the proportion of emergency department (ED) patients who responded to prompted home blood pressure (BP) self-monitoring and had persistent hypertension. We also explored the effect of the intervention on systolic blood pressure (sBP) over time. METHODS We conducted a randomized, controlled trial of ED patients with expected discharge to home with elevated BP. Participants were identified by automated alerts from the electronic health record. Those who consented received a BP cuff to take home and enrolled in the 3-week screening phase. Text responders with persistent hypertension were randomized to control or weekly prompted BP self-monitoring and healthy behavior text messages. RESULTS Among the 104 patients enrolled in the ED, 73 reported at least one home BP over the 3-week run-in (screening) period. A total of 55 of 73 reported a home BP of ≥140/90 and were randomized to SMS intervention (n = 28) or control (n = 27). The intervention group had significant sBP reduction over time with a mean drop of 9.1 mm Hg (95% confidence interval = 1.1 to 17.6). CONCLUSIONS The identification of ED patients with persistent hypertension using home BP self-monitoring and text messaging was feasible. The intervention was associated with a decrease in sBP likely to be clinically meaningful. Future studies are needed to further refine this approach and determine its efficacy.
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Affiliation(s)
- William J. Meurer
- Department of Emergency Medicine University of Michigan Ann Arbor MI
- Department of Neurology University of Michigan Ann Arbor MI
- Stroke Program University of Michigan Ann Arbor MI
| | - Mackenzie Dome
- Department of Neurology University of Michigan Ann Arbor MI
- Stroke Program University of Michigan Ann Arbor MI
| | - Devin Brown
- Department of Neurology University of Michigan Ann Arbor MI
- Stroke Program University of Michigan Ann Arbor MI
| | | | - Sandra Oska
- Oakland University William Beaumont School of Medicine Royal Oak MI
| | | | - Lesli Skolarus
- Department of Neurology University of Michigan Ann Arbor MI
- Stroke Program University of Michigan Ann Arbor MI
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Skolarus LE, Cowdery J, Dome M, Bailey S, Baek J, Byrd JB, Hartley SE, Valley SC, Saberi S, Wheeler NC, McDermott M, Hughes R, Shanmugasundaram K, Morgenstern LB, Brown DL. Reach Out Churches: A Community-Based Participatory Research Pilot Trial to Assess the Feasibility of a Mobile Health Technology Intervention to Reduce Blood Pressure Among African Americans. Health Promot Pract 2017; 19:495-505. [PMID: 28583024 DOI: 10.1177/1524839917710893] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Innovative strategies are needed to reduce the hypertension epidemic among African Americans. Reach Out was a faith-collaborative, mobile health, randomized, pilot intervention trial of four mobile health components to reduce high blood pressure (BP) compared to usual care. It was designed and tested within a community-based participatory research framework among African Americans recruited and randomized from churches in Flint, Michigan. The purpose of this pilot study was to assess the feasibility of the Reach Out processes. Feasibility was assessed by willingness to consent (acceptance of randomization), proportion of weeks participants texted their BP readings (intervention use), number lost to follow-up (retention), and responses to postintervention surveys and focus groups (acceptance of intervention). Of the 425 church members who underwent BP screening, 94 enrolled in the study and 73 (78%) completed the 6-month outcome assessment. Median age was 58 years, and 79% were women. Participants responded with their BPs on an average of 13.7 (SD = 10.7) weeks out of 26 weeks that the BP prompts were sent. All participants reported satisfaction with the intervention. Reach Out, a faith-collaborative, mobile health intervention was feasible. Further study of the efficacy of the intervention and additional mobile health strategies should be considered.
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Affiliation(s)
| | - Joan Cowdery
- 2 Eastern Michigan University, Ypsilanti, MI, USA
| | - Mackenzie Dome
- 1 University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Jonggyu Baek
- 4 University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Sarah E Hartley
- 1 University of Michigan Medical School, Ann Arbor, MI, USA.,5 Veterans' Administration Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Staci C Valley
- 1 University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sima Saberi
- 6 Ann Arbor Endocrinology & Diabetes Associates, Ypsilanti MI, USA
| | | | | | - Rebecca Hughes
- 1 University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | - Devin L Brown
- 1 University of Michigan Medical School, Ann Arbor, MI, USA
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Latulippe K, Hamel C, Giroux D. Social Health Inequalities and eHealth: A Literature Review With Qualitative Synthesis of Theoretical and Empirical Studies. J Med Internet Res 2017; 19:e136. [PMID: 28450271 PMCID: PMC5427250 DOI: 10.2196/jmir.6731] [Citation(s) in RCA: 202] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 02/09/2017] [Accepted: 03/02/2017] [Indexed: 01/08/2023] Open
Abstract
Background eHealth is developing rapidly and brings with it a promise to reduce social health inequalities (SHIs). Yet, it appears that it also has the potential to increase them. Objectives The general objective of this review was to set out how to ensure that eHealth contributes to reducing SHIs rather than exacerbating them. This review has three objectives: (1) identifying characteristics of people at risk of experiencing social inequality in health; (2) determining the possibilities of developing eHealth tools that avoid increasing SHI; and (3) modeling the process of using an eHealth tool by people vulnerable to SHI. Methods Following the EPPI approach (Evidence for Policy and Practice of Information of the Institute of Education at the University of London), two databases were searched for the terms SHIs and eHealth and their derivatives in titles and abstracts. Qualitative, quantitative, and mixed articles were included and evaluated. The software NVivo (QSR International) was employed to extract the data and allow for a metasynthesis of the data. Results Of the 73 articles retained, 10 were theoretical, 7 were from reviews, and 56 were based on empirical studies. Of the latter, 40 used a quantitative approach, 8 used a qualitative approach, 4 used mixed methods approach, and only 4 were based on participatory research-action approach. The digital divide in eHealth is a serious barrier and contributes greatly to SHI. Ethnicity and low income are the most commonly used characteristics to identify people at risk of SHI. The most promising actions for reducing SHI via eHealth are to aim for universal access to the tool of eHealth, become aware of users’ literacy level, create eHealth tools that respect the cultural attributes of future users, and encourage the participation of people at risk of SHI. Conclusions eHealth has the potential to widen the gulf between those at risk of SHI and the rest of the population. The widespread expansion of eHealth technologies calls for rigorous consideration of interventions, which are not likely to exacerbate SHI.
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Affiliation(s)
- Karine Latulippe
- Department of Studies of Teaching and Learning, Laval University, Québec, QC, Canada
| | - Christine Hamel
- Department of Studies of Teaching and Learning, Laval University, Québec, QC, Canada
| | - Dominique Giroux
- Faculté de médecine, Département de réadaptation, Laval University, Québec, QC, Canada.,Centre d'Excellence du Vieillissement de Québec, Chu de Québec, Québec, QC, Canada
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Decker KM, Singh H. Reducing inequities in colorectal cancer screening in North America. J Carcinog 2014; 13:12. [PMID: 25506266 PMCID: PMC4253036 DOI: 10.4103/1477-3163.144576] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 10/14/2014] [Indexed: 12/26/2022] Open
Abstract
Colorectal cancer (CRC) is an important cause of mortality and morbidity in North America. Screening using a fecal occult blood test, flexible sigmoidoscopy, or colonoscopy reduces CRC mortality through the detection and treatment of precancerous polyps and early stage CRC. Although CRC screening participation has increased in recent years, large inequities still exist. Minorities, new immigrants, and those with lower levels of education or income are much less likely to be screened. This review provides an overview of the commonly used tests for CRC screening, disparities in CRC screening, and promising methods at the individual, provider, and system levels to reduce these disparities. Overall, to achieve high CRC participation rates and reduce the burden of CRC in the population, a multi-faceted approach that uses strategies at all levels to reduce CRC screening disparities is urgently required.
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Affiliation(s)
- Kathleen M Decker
- Department of Community Health Sciences, University of Manitoba, Canada ; Screening Programs, Cancer Care Manitoba, Canada
| | - Harminder Singh
- Department of Community Health Sciences, University of Manitoba, Canada ; Department of Internal Medicine, University of Manitoba, Canada ; Department of Haematology and Medical Oncology, Cancer Care Manitoba, Canada
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Implementation science approaches for integrating eHealth research into practice and policy. Int J Med Inform 2013; 83:e1-11. [PMID: 23910896 DOI: 10.1016/j.ijmedinf.2013.07.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 07/03/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To summarize key issues in the eHealth field from an implementation science perspective and to highlight illustrative processes, examples and key directions to help more rapidly integrate research, policy and practice. METHODS We present background on implementation science models and emerging principles; discuss implications for eHealth research; provide examples of practical designs, measures and exemplar studies that address key implementation science issues; and make recommendations for ways to more rapidly develop and test eHealth interventions as well as future research, policy and practice. RESULTS The pace of eHealth research has generally not kept up with technological advances, and many of our designs, methods and funding mechanisms are incapable of providing the types of rapid and relevant information needed. Although there has been substantial eHealth research conducted with positive short-term results, several key implementation and dissemination issues such as representativeness, cost, unintended consequences, impact on health inequities, and sustainability have not been addressed or reported. Examples of studies in several of these areas are summarized to demonstrate this is possible. CONCLUSIONS eHealth research that is intended to translate into policy and practice should be more contextual, report more on setting factors, employ more responsive and pragmatic designs and report results more transparently on issues important to potential adopting patients, clinicians and organizational decision makers. We outline an alternative development and assessment model, summarize implementation science findings that can help focus attention, and call for different types of more rapid and relevant research and funding mechanisms.
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Hall KL, Stipelman BA, Eddens KS, Kreuter MW, Bame SI, Meissner HI, Yabroff KR, Purnell JQ, Ferrer R, Ribisl KM, Glasgow R, Linnan LA, Taplin S, Fernández ME. Advancing collaborative research with 2-1-1 to reduce health disparities: challenges, opportunities, and recommendations. Am J Prev Med 2012; 43:S518-28. [PMID: 23157775 PMCID: PMC3993989 DOI: 10.1016/j.amepre.2012.09.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 09/14/2012] [Accepted: 09/14/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Kara L Hall
- Science of Research and Technology Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA.
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Linnan LA. Research collaboration with 2-1-1 to eliminate health disparities: an introduction. Am J Prev Med 2012; 43:S415-9. [PMID: 23157758 PMCID: PMC7135801 DOI: 10.1016/j.amepre.2012.09.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 09/08/2012] [Accepted: 09/14/2012] [Indexed: 11/25/2022]
Affiliation(s)
- Laura A Linnan
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina 27599, USA.
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Daily LS. Health research and surveillance potential to partner with 2-1-1. Am J Prev Med 2012; 43:S422-4. [PMID: 23157760 PMCID: PMC7135616 DOI: 10.1016/j.amepre.2012.09.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 09/07/2012] [Accepted: 09/13/2012] [Indexed: 11/17/2022]
Affiliation(s)
- Linda S Daily
- United Way Worldwide, Alexandria, Virginia 22314-2045, USA.
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Eddens KS. Guiding principles for collaborative research with 2-1-1. Am J Prev Med 2012; 43:S512-7. [PMID: 23157774 DOI: 10.1016/j.amepre.2012.09.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 09/11/2012] [Accepted: 09/13/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Katherine S Eddens
- Department of Health Behavior, College of Public Health, University of Kentucky, Lexington, Kentucky 40536, USA. .
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Reach, effectiveness, and connections: the case for partnering with 2-1-1 to eliminate health disparities. Am J Prev Med 2012; 43:S420-1. [PMID: 23157759 PMCID: PMC3960992 DOI: 10.1016/j.amepre.2012.09.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 08/27/2012] [Accepted: 09/13/2012] [Indexed: 11/21/2022]
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