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通过医疗体系研究提高卫生公平性。

Improving health equity through health care systems research.

机构信息

Abigail Wexner Research Institute, Nationwide Children's Hospital, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA.

Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA.

出版信息

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

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.

摘要

目的

描述医疗保健提供系统的健康公平研究重点,并制定研究和行动计划,为持续存在的健康结果种族和民族不平等问题提供循证解决方案。

数据来源和研究设置

本项目是作为医疗保健研究和质量机构(AHRQ)利益相关者参与制定公平议程和行动计划的过程的一部分进行的,该计划旨在指导优先事项设定以推进健康公平。建议是基于专家意见、证据审查和利益相关者参与制定和完善的。参与的利益相关者包括学术界、医疗保健组织、行业和政府的专家。

研究设计

专家组共识,由利益相关者参与和有针对性的证据审查提供信息。

数据收集/提取方法:通过(1)头脑风暴和想法减少、(2)对候选主题的有针对性的证据审查、(3)初步主题的确定、(4)参加 AHRQ 2022 年健康公平峰会的利益相关者对初步主题的投入、(5)以及根据该投入对主题进行细化,逐步推导出重点主题。最终确定了一套研究和行动建议,由作者达成共识。

主要发现

医疗保健提供系统促成了医疗保健方面的种族和民族差异。需要高质量的研究来为医疗保健提供系统方法提供信息,以消除系统性障碍和不平等。我们确定了六个研究重点主题;(1)机构领导、文化和劳动力;(2)数据驱动、文化适应的护理;(3)针对健康公平的绩效激励;(4)健康公平的方法来整合和获得卫生系统;(5)整体医疗;(6)以及整个社区投资。我们还建议关于研究人员队伍和研究时间表的跨领域主题。

结论

作为美国主要的卫生服务研究机构,AHRQ 可以通过资助研究和传播证据来推进公平的医疗保健提供,从而帮助改变医疗保健的组织和提供方式。

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