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Harnessing Implementation Science to Increase the Impact of Health Equity Research

Chinman, Matthew PhD*; Woodward, Eva N. PhD†,‡; Curran, Geoffrey M. PhD†,§; Hausmann, Leslie R.M. PhD*,∥

doi: 10.1097/MLR.0000000000000769
Perspectives

Background: Health disparities are differences in health or health care between groups based on social, economic, and/or environmental disadvantage. Disparity research often follows 3 steps: detecting (phase 1), understanding (phase 2), and reducing (phase 3), disparities. Although disparities have narrowed over time, many remain.

Objectives: We argue that implementation science could enhance disparities research by broadening the scope of phase 2 studies and offering rigorous methods to test disparity-reducing implementation strategies in phase 3 studies.

Methods: We briefly review the focus of phase 2 and phase 3 disparities research. We then provide a decision tree and case examples to illustrate how implementation science frameworks and research designs could further enhance disparity research.

Results: Most health disparities research emphasizes patient and provider factors as predominant mechanisms underlying disparities. Applying implementation science frameworks like the Consolidated Framework for Implementation Research could help disparities research widen its scope in phase 2 studies and, in turn, develop broader disparities-reducing implementation strategies in phase 3 studies. Many phase 3 studies of disparity-reducing implementation strategies are similar to case studies, whose designs are not able to fully test causality. Implementation science research designs offer rigorous methods that could accelerate the pace at which equity is achieved in real-world practice.

Conclusions: Disparities can be considered a “special case” of implementation challenges—when evidence-based clinical interventions are delivered to, and received by, vulnerable populations at lower rates. Bringing together health disparities research and implementation science could advance equity more than either could achieve on their own.

*Veterans Affairs Pittsburgh Healthcare System, VA Center for Health Equity Research and Promotion (CHERP), Pittsburgh, PA

Central Arkansas Veterans Healthcare System, South Central Mental Illness Research Education and Clinical Center (MIRECC)

Department of Psychiatry, University of Arkansas for Medical Sciences

§Center for Implementation Research, University of Arkansas for Medical Sciences, Little Rock, AR

Department of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA

Supported by a grant from VA Health Services Research & Development (CIN 13-405; PI, Fine) and by the Office of Academic Affiliations, Advanced Fellowship Program in Mental Illness Research and Treatment, Department of Veterans Affairs. The views expressed here are those of the authors and do not represent those of the Department of Veterans Affairs or the United States Government.

The authors declare no conflict of interest.

Reprints: Matthew Chinman, PhD, Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Research Office Building (151R), University Drive C, Pittsburgh, PA 15240. E-mail: chinman@rand.org.

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