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Cover of Strategies To Address Racial and Ethnic Disparities in Health and Healthcare: An Evidence Map

Strategies To Address Racial and Ethnic Disparities in Health and Healthcare: An Evidence Map

Technical Brief, No. 46

Investigators: , Ph.D., M.P.H., , M.P.H., , M.P.H., , Ph.D., , M.L.I.S., , Ph.D., , Ph.D., M.P.A., , Ph.D., M.P.H., , Ph.D., , Ph.D., M.P.H, R.N., , M.B.B.S., M.P.H., , M.D., M.A.S., , M.D., M.H.Sc., , Ph.D., , M.D., M.P.H., and , Ph.D., M.B.A.

Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 24-EHC017

Structured Abstract

Background:

Racial and ethnic disparities in health and healthcare continue to endure in the United States despite efforts in research, practice, and policy. Interventions targeted at patients, clinicians, and/or health systems may offer ways to address disparities and improve health outcomes in prevention/treatment of chronic conditions in adults.

Purpose:

This evidence map identifies existing interventions to be considered for implementation by healthcare system leaders and policymakers, and to inform researchers and funding agencies on gaps in knowledge and research needs.

Methods:

We searched MEDLINE®, CINAHL®, and Scopus from January 2017 through April 2023 for U.S.-based studies from the peer-reviewed published literature. We incorporated supplementary information from systematic reviews. We supplemented this with the gray literature, when available, from pertinent organizations, foundations, and institutes. We held discussions with Key Informants who represented stakeholders in healthcare disparities.

Findings:

A vast and varied literature addresses healthcare system interventions to reduce racial and ethnic health and healthcare disparities. We identified 163 unique studies from 174 reports, and 12 intervention types not mutually exclusive in their descriptions. The most studied intervention type was self-management support, followed by prevention/lifestyle support, then patient navigation, care coordination, and system-level quality improvement (QI). Most of the interventions specifically targeted patient behaviors. Few studies (5) used a comparator, which made it difficult to determine whether disparities between groups were reduced or eliminated. Most of the studies (45%) included multiple race/ethnic groups (i.e., enrolled participants from more than one racially/ethnically minoritized group or enrolled racially minoritized people and non-minoritized groups). We found few studies that exclusively enrolled Asians (6%) and American Indians/Alaska Natives (1%). Cancer was the most studied chronic condition. Randomized controlled trials were common, but less rigorous study designs were often used for system-level QI and collaborative care model interventions. Few studies reported patient experience as primary outcome. Studies did not report on harms or adverse events, nor did they report on factors necessary for determining applicability or sustainability of the interventions. A number of studies reported on cultural adaptation or community involvement (either partnership or collaboration). Future studies should seek to standardize the terms in which they describe interventions and aim to specifically address whether disparities between groups are reduced or eliminated. Nonetheless, this evidence map provides a resource for health systems to identify intervention approaches that have been examined elsewhere and that might be imported or adapted to new situations and environments.

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, 5600 Fishers Lane, Rockville, MD 20857; www.ahrq.gov Contract No. 75Q80120D00008 Prepared by: Minnesota Evidence-based Practice Center, Minneapolis, MN

Suggested citation:

Lamina T, Abdi HI, Behrens K, Call K, Claussen AM, Dill J, Grande SW, Houghtaling L, Jones-Webb R, Nkimbeng M, Parikh R, Rogers E, Sultan S, Widome R, Wilt TJ, Butler M. Strategies To Address Racial and Ethnic Disparities in Health and Healthcare: An Evidence Map. Technical Brief No. 46. (Prepared by the Minnesota Evidence-based Practice Center under Contract No. 75Q80120D00008.) AHRQ Publication No. 24-EHC017. Rockville, MD: Agency for Healthcare Research and Quality; March 2024. DOI: https://doi.org/10.23970/AHRQEPCTB46. Posted final reports are located on the Effective Health Care Program search page.

This report is based on research conducted by the Minnesota Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 75Q80120D00008). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. No statement in this article should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

The information in this report is intended to help healthcare decision makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of healthcare services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. Most AHRQ documents are publicly available to use for noncommercial purposes (research, clinical or patient education, quality improvement projects) in the United States, and do not need specific permission to be reprinted and used unless they contain material that is copyrighted by others. Specific written permission is needed for commercial use (reprinting for sale, incorporation into software, incorporation into for-profit training courses) or for use outside of the U.S. If organizational policies require permission to adapt or use these materials, AHRQ will provide such permission in writing.

AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.

A representative from AHRQ served as a Contracting Officer’s Representative and reviewed the contract deliverables for adherence to contract requirements and quality. AHRQ did not directly participate in the literature search, determination of study eligibility criteria, data analysis, interpretation of data, or preparation or drafting of this report.

AHRQ appreciates appropriate acknowledgment and citation of its work. Suggested language for acknowledgment: This work was based on an evidence report, Strategies To Address Racial and Ethnic Disparities in Health and Healthcare: An Evidence Map, by the Evidence-based Practice Center Program at the Agency for Healthcare Research and Quality (AHRQ).

Bookshelf ID: NBK603235PMID: 38687837DOI: 10.23970/AHRQEPCTB46

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