Reframing implementation science to address inequities in healthcare delivery
Reframing implementation science to address inequities in healthcare delivery
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DOI：
10.1186/s12913-020-4975-3
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发表时间：
2020-03-12
影响因子：
2.8
通讯作者：
Cabassa, Leopoldo J.
中科院分区：
文献类型：
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作者：
Baumann, Ana A.;Cabassa, Leopoldo J.
背景研究已经产生了宝贵的知识，在识别，理解和干预，以解决医疗保健提供的不公平，但这些不公平仍然存在。旨在解决医疗保健不平等问题的最佳干预措施、方案和政策没有在常规实践中得到采用。实施科学可以通过研究影响弱势群体对这些计划的吸收、使用和可持续性的护理系统的多个层面的因素、过程和策略来帮助解决这一差距。我们建议，一个公平的透镜，可以帮助整合领域的实施科学和研究，重点是在医疗保健服务的不公平。Main text使用普罗克特等人作为一个案例研究框架，我们重新构建了实施科学的五个要素，以研究医疗保健中的不公平现象。这些要素包括：（1）从一开始就注重覆盖面;（2）为弱势群体和资源匮乏社区设计和选择干预措施，同时考虑到执行情况;（3）执行有效措施，并制定有助于减少护理不平等现象的执行战略;（4）发展适应科学;（5）对执行结果采用公平透镜。结论本文的目标是继续就如何在实施研究中批判性地注入公平方法进行对话，以主动解决历史上服务不足人群的医疗不公平问题。我们的例子提供了如何操作，我们可以融合实施科学和医疗保健不公平的研究。
Background Research has generated valuable knowledge in identifying, understanding, and intervening to address inequities in the delivery of healthcare, yet these inequities persist. The best available interventions, programs and policies designed to address inequities in healthcare are not being adopted in routine practice settings. Implementation science can help address this gap by studying the factors, processes, and strategies at multiple levels of a system of care that influence the uptake, use, and the sustainability of these programs for vulnerable populations. We propose that an equity lens can help integrate the fields of implementation science and research that focuses on inequities in healthcare delivery. Main text Using Proctor et al.' (12) framework as a case study, we reframed five elements of implementation science to study inequities in healthcare. These elements include: 1) focus on reach from the very beginning; 2) design and select interventions for vulnerable populations and low-resource communities with implementation in mind; 3) implement what works and develop implementation strategies that can help reduce inequities in care; 4) develop the science of adaptations; and 5) use an equity lens for implementation outcomes. Conclusions The goal of this paper is to continue the dialogue on how to critically infuse an equity approach in implementation studies to proactively address healthcare inequities in historically underserved populations. Our examples provide ways to operationalize how we can blend implementation science and healthcare inequities research.