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1.
Am J Manag Care ; 30(6 Spec No.): SP468-SP472, 2024 May.
Article in English | MEDLINE | ID: mdl-38820189

ABSTRACT

OBJECTIVES: To understand whether and how equity is considered in artificial intelligence/machine learning governance processes at academic medical centers. STUDY DESIGN: Qualitative analysis of interview data. METHODS: We created a database of academic medical centers from the full list of Association of American Medical Colleges hospital and health system members in 2022. Stratifying by census region and restricting to nonfederal and nonspecialty centers, we recruited chief medical informatics officers and similarly positioned individuals from academic medical centers across the country. We created and piloted a semistructured interview guide focused on (1) how academic medical centers govern artificial intelligence and prediction and (2) to what extent equity is considered in these processes. A total of 17 individuals representing 13 institutions across 4 census regions of the US were interviewed. RESULTS: A minority of participants reported considering inequity, racism, or bias in governance. Most participants conceptualized these issues as characteristics of a tool, using frameworks such as algorithmic bias or fairness. Fewer participants conceptualized equity beyond the technology itself and asked broader questions about its implications for patients. Disparities in health information technology resources across health systems were repeatedly identified as a threat to health equity. CONCLUSIONS: We found a lack of consistent equity consideration among academic medical centers as they develop their governance processes for predictive technologies despite considerable national attention to the ways these technologies can cause or reproduce inequities. Health systems and policy makers will need to specifically prioritize equity literacy among health system leadership, design oversight policies, and promote critical engagement with these tools and their implications to prevent the further entrenchment of inequities in digital health care.


Subject(s)
Academic Medical Centers , Artificial Intelligence , Academic Medical Centers/organization & administration , Humans , United States , Qualitative Research , Health Equity/organization & administration , Interviews as Topic , Racism
2.
Annu Rev Public Health ; 45(1): 89-108, 2024 May.
Article in English | MEDLINE | ID: mdl-38166499

ABSTRACT

Environmental justice research is increasingly focused on community-engaged, participatory investigations that test interventions to improve health. Such research is primed for the use of implementation science-informed approaches to optimize the uptake and use of interventions proven to be effective. This review identifies synergies between implementation science and environmental justice with the goal of advancing both disciplines. Specifically, the article synthesizes the literature on neighborhood-, community-, and policy-level interventions in environmental health that address underlying structural determinants (e.g., structural racism) and social determinants of health. Opportunities to facilitate and scale the equitable implementation of evidence-based environmental health interventions are highlighted, using urban greening as an illustrative example. An environmental justice-focused version of the implementation science subway is provided, which highlights these principles: Remember and Reflect, Restore and Reclaim, and Reinvest. The review concludes with existing gaps and future directions to advance the science of implementation to promote environmental justice.


Subject(s)
Environmental Justice , Health Equity , Implementation Science , Social Determinants of Health , Humans , Health Equity/organization & administration , Residence Characteristics , Health Policy , Environmental Health/organization & administration
3.
Annu Rev Public Health ; 45(1): 27-45, 2024 May.
Article in English | MEDLINE | ID: mdl-38166498

ABSTRACT

Implementation science focuses on enhancing the widespread uptake of evidence-based interventions into routine practice to improve population health. However, optimizing implementation science to promote health equity in domestic and global resource-limited settings requires considering historical and sociopolitical processes (e.g., colonization, structural racism) and centering in local sociocultural and indigenous cultures and values. This review weaves together principles of decolonization and antiracism to inform critical and reflexive perspectives on partnerships that incorporate a focus on implementation science, with the goal of making progress toward global health equity. From an implementation science perspective, wesynthesize examples of public health evidence-based interventions, strategies, and outcomes applied in global settings that are promising for health equity, alongside a critical examination of partnerships, context, and frameworks operationalized in these studies. We conclude with key future directions to optimize the application of implementation science with a justice orientation to promote global health equity.


Subject(s)
Global Health , Health Equity , Implementation Science , Humans , Health Equity/organization & administration
4.
Annu Rev Public Health ; 45(1): 47-67, 2024 May.
Article in English | MEDLINE | ID: mdl-38109515

ABSTRACT

Participatory approaches to implementation science (IS) offer an inclusive, collaborative, and iterative perspective on implementing and sustaining evidence-based interventions (EBIs) to advance health equity. This review provides guidance on the principles and practice of participatory IS, which enables academic researchers, community members, implementers, and other actors to collaboratively integrate practice-, community-, and research-based evidence into public health and health care services. With a foundational focus on supporting academics in coproducing knowledge and action, participatory IS seeks to improve health, reduce inequity, and create transformational change. The three main sections of this review provide (a) a rationale for participatory approaches to research in implementation science, (b) a framework for integrating participatory approaches in research utilizing IS theory and methods, and (c) critical considerations for optimizing the practice and impact of participatory IS. Ultimately, participatory approaches can move IS activities beyond efforts to make EBIs work within harmful systems toward transformative solutions that reshape these systems to center equity.


Subject(s)
Community-Based Participatory Research , Health Equity , Implementation Science , Health Equity/organization & administration , Humans , Community-Based Participatory Research/organization & administration , Evidence-Based Practice/organization & administration
5.
Annu Rev Public Health ; 45(1): 1-5, 2024 May.
Article in English | MEDLINE | ID: mdl-38134404

ABSTRACT

There has been an increasing focus on making health equity a more explicit and foundational aspect of the research being conducted in public health and implementation science. This commentary provides an overview of five reviews in this Annual Review of Public Health symposium on Implementation Science and Health Equity. These articles reflect on and advance the application of core implementation science principles and concepts, with a focus on promoting health equity across a diverse range of public health and health care settings. Taken together, the symposium articles highlight critical conceptual, methodological, and empirical advances in the study designs, frameworks, and approaches that can help address equity considerations in the use of implementation science in both domestic and global contexts. Finally, this commentary highlights how work featured in this symposium can help inform future directions for rapidly taking public health to scale, particularly among systemically marginalized populations and communities.


Subject(s)
Health Equity , Implementation Science , Health Equity/organization & administration , Humans , Public Health , Health Promotion/organization & administration , Health Promotion/methods
6.
Med Educ Online ; 28(1): 2241169, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37499134

ABSTRACT

The current healthcare system disproportionately affects vulnerable populations, leading to disparities in health outcomes. As a result, medical schools need to equip future physicians with the tools to identify and address healthcare disparities. The University of Nevada, Reno School of Medicine implemented a Scholarly Concentration in Medical Social Justice (SCiMSJ) program to address this issue. Three medical students joined the program and pioneered a project to address the equitable vaccine distribution within the local Hispanic/Latinx community. After identifying the disparity in vaccine uptake and high levels of vaccine hesitancy, they collaborated with local organizations to address vaccine misinformation and accessibility. They organized outreach events, provided vaccine education, and hosted a vaccine clinic at a Catholic church with a high Hispanic/Latinx congregation. Through their efforts, they administered 1,456 vaccines. The estimated economic and societal impacts of their work was 879 COVID-19 cases avoided, 5 deaths avoided, 45 life years saved, and $29,286 in economic value. The project's success highlights the effectiveness of a student-led approach to promote skill development in social justice training. Leadership skills and coalition building were crucial in overcoming resource limitations and connecting organizations with the necessary volunteer force. Building trust with the Hispanic/Latinx community through outreach efforts and addressing vaccine hesitancy contributed to the well-attended vaccine clinic. The project's framework and approach can be adopted by other medical students and organizations to address health disparities and improve health outcomes in their communities.


Subject(s)
COVID-19 Vaccines , COVID-19 , Education, Medical , Health Equity , Healthcare Disparities , Social Justice , Students, Medical , Humans , COVID-19/prevention & control , COVID-19 Vaccines/supply & distribution , COVID-19 Vaccines/therapeutic use , Education, Medical/organization & administration , Education, Medical/standards , Hispanic or Latino , Social Justice/education , Health Equity/organization & administration , Healthcare Disparities/ethnology , Healthcare Disparities/organization & administration
9.
Clin Obstet Gynecol ; 66(1): 14-21, 2023 03 01.
Article in English | MEDLINE | ID: mdl-36657044

ABSTRACT

As Obstetrics and Gynecology begins to recognize how structural racism drives inequitable health outcomes, it must also acknowledge the effects of structural racism on its workforce and culture. Black physicians comprise ~5% of the United States physician population. Unique adversities affect Black women physicians, particularly during residency training, and contribute to the lack of equitable workforce representation. Eliminating racialized inequities in clinical care requires addressing these concerns. By applying historical context to present-day realities and harms experienced by Black women (ie, misogynoir), Obstetrics and Gynecology can identify interventions, such as equity-focused recruitment and retention strategies, that transform the profession.


Subject(s)
Gynecology , Health Equity , Obstetrics , Female , Humans , Black or African American/psychology , Black or African American/statistics & numerical data , Gynecology/education , Gynecology/organization & administration , Health Equity/organization & administration , Health Status Disparities , Health Workforce/organization & administration , Healthcare Disparities/ethnology , Internship and Residency , Obstetrics/education , Obstetrics/organization & administration , Organizational Culture , Physicians, Women/psychology , Professionalism , Racism/prevention & control , United States
10.
Fam Syst Health ; 41(1): 61-67, 2023 03.
Article in English | MEDLINE | ID: mdl-35679217

ABSTRACT

INTRODUCTION: Telehealth is the use of electronic information and technology for long-distance clinical care. In direct-to-patient (DTP) telehealth, the patient initiates care from a personal computer or mobile device to a medical provider. While information on standard clinic-to-clinic telehealth exists, less is known about DTP telehealth in pediatric populations. Using quantitative and qualitative data, we examined DTP telehealth for low-income pediatric patient-families and compared the experience of English and non-English speakers. METHOD: Telehealth visits for acute and preventive care took place from April 2020 to May 2020 at a pediatric primary care clinic (80% Medicaid-insured, 40% non-English-speaking). Patients and primary care providers conducted the visit through the clinic's portal or other platforms (WhatsApp, FaceTime, Zoom). Providers completed an electronic survey with patient feedback about the telehealth experience and their own observations. An iterative inductive/deductive approach informed a coding scheme for free-text survey responses consisting of five domains. RESULTS: REDCap surveys were completed for 258 (52%) of telehealth visits. There was an overrepresentation of English visits compared to the overall clinic population and the majority of visits were via mobile phone. Visits with English speakers utilized the patient portal and had positive process ease ratings more often than those with non-English speakers. Providers rated most telehealth visits as satisfactory, with contributing elements including family call environment, technology process and experience, value added, and barriers. DISCUSSION: Expanding telehealth in pediatrics without worsening health disparities requires building digital health that is user-friendly on mobile technology, facilitating patient preferred language, and simplifying logistical processes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).


Subject(s)
Health Equity , Pediatrics , Primary Health Care , Telemedicine , Child , Humans , Primary Health Care/organization & administration , Telemedicine/methods , Telemedicine/organization & administration , Health Equity/organization & administration , Health Care Surveys , Pediatrics/organization & administration , Language
11.
J Health Care Poor Underserved ; 34(3S): 183-207, 2023.
Article in English | MEDLINE | ID: mdl-38661925

ABSTRACT

Capacity-building in trauma-informed care and harm reduction approaches with Southern HIV service organizations must be implemented in ways that foster trust and spur organizational change. Using an equity-centered implementation science framework, this study examines implementation strategies of the SUSTAIN COMPASS Coordinating Center's person-centered care (PCC) capacity-building interventions. METHODS: Fifty-eight (58) in-depth qualitative interviews with staff (N=116) who received PCC capacity-building were analyzed using modified grounded theory. RESULTS: Analysis identified four factors of equity-centered implementation that facilitated PCC capacity-building implementation. 1) Innovation factors: SUSTAIN models PCC approaches when implementing PCC capacity-building. 2) Inner factors: SUSTAIN employs PCC approaches. 3) Outer factors: SUSTAIN highlights socio-political factors that may influence PCC implementation. 4) Bridging factors: SUSTAIN facilitates partnerships to promote PCC learning and sustainability. CONCLUSION: SUSTAIN PCC capacity-building advances health equity through operationalizing personcentered care in capacity-building implementation.


Subject(s)
Capacity Building , HIV Infections , Patient-Centered Care , Humans , Capacity Building/organization & administration , HIV Infections/therapy , HIV Infections/prevention & control , Patient-Centered Care/organization & administration , Health Equity/organization & administration , Qualitative Research , Interviews as Topic , Organizational Innovation
12.
Nurs Outlook ; 70(6 Suppl 1): S48-S58, 2022.
Article in English | MEDLINE | ID: mdl-35504756

ABSTRACT

The Future of Nursing 2020-2030 report identifies coalitions as a driving force for advancing health equity. Five coalitions provided insight into their accomplishments, lessons learned, and role in advancing health equity. The exemplar coalitions included Latinx Advocacy Team and Interdisciplinary Network for COVID-19, Black Coalition Against COVID, Camden Coalition, National Coalition of Ethnic Minority Nurse Associations, and The Future of Nursing: Campaign for Action. While all exemplar coalitions, credited relationship building and partnerships to their success, they used unique strategies for striving to meet their populations' needs, whether the needs arose from COVID-19, racial and/or ethnic disparities, socioeconomic disparities, or other barriers to health. Research and policy implications for coalitions are discussed. Nurses play a critical role in every highlighted coalition and in the national effort to make health and health care more equitable.


Subject(s)
Health Equity , Nursing , Humans , COVID-19/ethnology , Ethnicity , Health Equity/organization & administration , Minority Groups , Racial Groups , Nursing/organization & administration , Nursing/trends , Health Status Disparities , Forecasting
13.
J Public Health (Oxf) ; 44(2): 228-233, 2022 06 27.
Article in English | MEDLINE | ID: mdl-33161436

ABSTRACT

BACKGROUND: To describe the Strategic Allocation of Fundamental Epidemic Resources (SAFER) model as a method to inform equitable community distribution of critical resources and testing infrastructure. METHODS: The SAFER model incorporates a four-quadrant design to categorize a given community based on two scales: testing rate and positivity rate. Three models for stratifying testing rates and positivity rates were applied to census tracts in Milwaukee County, Wisconsin: using median values (MVs), cluster-based classification and goal-oriented values (GVs). RESULTS: Each of the three approaches had its strengths. MV stratification divided the categories most evenly across geography, aiding in assessing resource distribution in a fixed resource and testing capacity environment. The cluster-based stratification resulted in a less broad distribution but likely provides a truer distribution of communities. The GVs grouping displayed the least variation across communities, yet best highlighted our areas of need. CONCLUSIONS: The SAFER model allowed the distribution of census tracts into categories to aid in informing resource and testing allocation. The MV stratification was found to be of most utility in our community for near real time resource allocation based on even distribution of census tracts. The GVs approach was found to better demonstrate areas of need.


Subject(s)
Epidemics , Health Resources , Resource Allocation , Health Care Rationing/organization & administration , Health Equity/economics , Health Equity/organization & administration , Health Resources/organization & administration , Humans , Resource Allocation/organization & administration
15.
Am J Public Health ; 112(1): 29-33, 2022 01.
Article in English | MEDLINE | ID: mdl-34936402

ABSTRACT

Minority populations have been disproportionately affected by the COVID-19 pandemic, and disparities have been noted in vaccine uptake. In the state of Arkansas, health equity strike teams (HESTs) were deployed to address vaccine disparities. A total of 13 470 vaccinations were administered by HESTs to 10 047 eligible people at 45 events. Among these individuals, 5645 (56.2%) were African American, 2547 (25.3%) were White, and 1068 (10.6%) were Hispanic. Vaccination efforts must specifically target populations that have been disproportionately affected by the pandemic. (Am J Public Health. 2022;112(1):29-33. https://doi.org/10.2105/AJPH.2021.306564).


Subject(s)
COVID-19/prevention & control , Ethnic and Racial Minorities , Ethnicity/statistics & numerical data , Health Equity/organization & administration , Healthcare Disparities/ethnology , Vaccination/statistics & numerical data , Adult , Aged , Arkansas , COVID-19 Vaccines/administration & dosage , Health Promotion/organization & administration , Healthcare Disparities/statistics & numerical data , Humans , Middle Aged , Social Determinants of Health
18.
N Z Med J ; 134(1543): 51-58, 2021 10 08.
Article in English | MEDLINE | ID: mdl-34695076

ABSTRACT

AIM: Gout is a health equity issue for Maori and Pacific peoples because disparities in quality of care exist. This study aims to describe domains of access that may contribute to the optimisation of gout care and, therefore, address health inequity. METHODS: The practice management system at one general practice in Auckland was used to identify enrolled patients with gout, using disease codes and medication lists. Barriers to access for the cohort were investigated using staff knowledge and the practice management system. The general practice is uniquely situated within an urban marae (traditional meeting house) complex serving a predominantly Maori community. This enables a focus on domains of access other than cultural safety. RESULTS: Of 3,095 people enrolled at the practice, 268 were identified as having gout. Of these, 94% had at least one other long-term health condition. The majority of people with gout enrolled at the practice have employment roles incongruent with the clinic's opening hours. CONCLUSIONS: Social circumstances, such as employment and availability of transport, should be actively discussed with all patients and recorded in the practice management system. Reorientation of health services, including hours of access, is evidentially required to ensure optimal management of gout and possibly other health conditions.


Subject(s)
Community Pharmacy Services/organization & administration , Gout/drug therapy , Gout/ethnology , Health Equity/organization & administration , Adult , Aged , Aged, 80 and over , Female , General Practice/economics , Gout Suppressants/therapeutic use , Humans , Male , Middle Aged , Native Hawaiian or Other Pacific Islander , New Zealand/epidemiology
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