Transforming Health Equity Research in Integrated Primary Care: Antiracism as a Disruptive Innovation

媒体对与COVID相关的健康差距的关注增加，同时 针对美国黑人的制度化暴力重新唤起了采取行动解决系统性种族主义的呼吁 在医疗保健方面。医疗保健中系统性种族主义的后果之一是在以下方面存在严重的健康差距 身心健康并存疾病的流行、诊断和治疗。尽管几十年来 研究承认基于种族的健康差异和对社会意识的提高 健康的决定因素，我们似乎距离重大变化还有几光年的距离。令人震惊的是，这里几乎没有 循证干预，以改变提供者的种族主义态度、行为和做法，并 组织系统层面。需要新的范式来干预种族主义，而不仅仅是记录 医疗保健系统。我们建议开发和测试一个用于翻译Basic的变革性范式 将行为和社会科学纳入初级保健环境中新的反种族主义干预措施。这个范例就是 首次将基于社区的参与性研究、系统科学、创新扩散 理论和项目反应理论，利用已建立的早期阶段翻译行为框架 和社会科学严格定义复杂卫生系统内的新的反种族主义干预措施 严格制定评估影响的措施。反种族主义是一体化初选的颠覆性创新 美国的护理系统，一个可以使用社区参与系统严格绘制地图的系统 科学的方法。这张图确定了可能导致最具影响力的干预目标的“拐点”， 然后，建立的路径可以用来转化基本的行为和社会科学发现 在这些点上进行新的干预。然后，系统科学建模可以模拟潜在的干预和 在未来的试验中为干预效果制定数学标准。这一变革性的范式还将 详细说明开发高效和有效的测量工具以严格监控结果的创新方法。 这种将反种族主义作为一项颠覆性创新的变革性范式不仅将彻底改变卫生公平 综合初级保健系统的干预措施，但将为改善保健种族主义提供基础 在其他系统中。

Increased media attention regarding COVID-related health disparities combined with horrific institutionalized violence against Black Americans have revitalized the call to action to address systemic racism in health care. Among the consequences of systemic racism in health care are significant health disparities in prevalence, diagnosis, and treatment of comorbid physical and mental health conditions. Despite decades of studies acknowledging health disparities based on race and an increased awareness of the social determinants of health, we seem to be lightyears away from significant change. There are shockingly few evidence-based interventions to change racism attitudes, behaviors, and practices at the provider and organizational-systems level. New paradigms are needed to intervene on, and not just document, racism in health care systems. We propose to develop and test a transformative paradigm for translating basic behavioral and social science into new anti-racism interventions for primary care settings. The paradigm is the first of its kind to integrate community-based participatory research, systems science, diffusion of innovation theory, and item response theory, leveraging an established framework of early phase translational behavioral and social science to rigorously define new anti-racism interventions within complex health systems and rigorously develop measures to assess impact. Anti-racism is a disruptive innovation in integrated primary care systems in the United States, one that can be rigorously mapped using community-engaged systems science methods. This map identifies “inflection points” likely to result in the most impactful intervention targets, and then established pathways can be used to translate fundamental behavioral and social science discoveries into new interventions at these points. Systems science modeling can then simulate potential interventions and produce mathematical standards for intervention efficacy in future trials. This transformative paradigm will also detail innovative methods to develop efficient and effective measurement tools to rigorously monitor outcomes. This transformative paradigm of antiracism as a disruptive innovation will not only revolutionize health equity interventions in integrated primary care systems but will provide a foundation for improving health care racism in other systems.