AHRQ’s authorizing legislation, the Healthcare Research and Quality Act of 1999, requires the agency to conduct and support research, evaluations, and demonstrations focused on healthcare in both rural and inner-city areas, as well as on a range of priority populations.14 These populations were specified in the legislation to include:
- Low-income groups.
- Minority groups.
- Women.
- Children.
- The elderly.
- Individuals with special healthcare needs (including individuals with disabilities and those who need chronic care or end-of-life healthcare).
The legislation also requires Ƶto annually develop and submit to Congress a report on “disparities in healthcare delivery as it relates to racial factors and socioeconomic factors in priority populations.”14 Since then, Ƶhas published the National Healthcare Quality and Disparities Report, which shows trends in healthcare disparities by race, ethnicity, and social determinants of heath (SDOH).16
In 2021, the National Academies of Sciences, Engineering, and Medicine (NASEM) observed that greater availability of primary care is needed for better population health and more equitable outcomes.17 Ƶhas invested in a growing number of research grants focused on understanding and addressing health disparities across priority populations. This section includes a summary of AHRQ’s primary care grants and resources focused on AHRQ’s priority populations.
Grants
Across AHRQ primary care research grants with active funding in FYs 2023 and 2024, 15 focus mainly on health disparities. This includes four R03 grants (Small Research Projects), four K01 grants (Research Career Programs), three R01 grants (Research Projects), three R18 grants (Research Demonstration and Dissemination Projects), and one K08 grant (Mentored Clinical Scientist Development Award).
Another 31 grants have some focus on health disparities and are described in other topic area sections, including seven in Practice and Quality Improvement, five in Behavioral Health and Substance Use Disorders, five in Patient Safety, four in Digital Healthcare, four in Healthcare Systems and Infrastructure, three in Primary Care Workforce, two in Person-Centered Care, and one in one in Public Health and Community Integration.
We summarize the 15 grants focused on health disparities below, organized by subtopic. The subtopics are:
- Understanding and Addressing Barriers to Care.
- Dissemination and Implementation of Equity-Focused Interventions.
- Innovative Approaches to Addressing Health Disparities.
- Insights from Patients and Caregivers.
- Costs of Care.
Understanding and Addressing Barriers to Care
The six grants described below aim to understand and/or address barriers to care experienced by different patient populations.
(R03)
PI: Monique Gill
Organization: Providence Health & Services – Oregon
Grant Start Date: September 30, 2023
Uses a longitudinal design to understand the impact of recently introduced financial incentives to increase access to interpretive services among Oregon’s Medicaid members with non-English language preference (NELP) across settings, including primary care. Assesses differences in use of interpretive services by setting, type of care, modality of interpretation, interpreter type, and population.
(R03)
PI: Abigail Williams-Butler
Organization: Rutgers University
Grant Start Date: September 30, 2024
Examines healthcare use among Black youth in foster care and the role that coordinated medical care homes (i.e., when primary care and specialty care are provided in the same setting) play in improving their health outcomes compared with youth who receive services through multiple systems. The study uses 11 years of linked child welfare and electronic health records data along with the voices of young people in the foster care system. Results can be used to improve the health of Black youth in foster care and to potentially reduce the overall cost of healthcare among foster youth.
(R01)
PI: Jennifer Audrey Andersen
Organization: University of Arkansas for Medical Sciences
Grant Start Date: September 1, 2024
Assesses the impact of COVID-19 related Medicaid policy changes on healthcare access among the Marshallese COFA (Compact of Free Association) migrant population. Actively engages the Marshallese COFA migrant population to understand barriers and facilitators to Medicaid/healthcare access and develop community-based interventions to use of primary and preventative healthcare services.
(R01)
PI: Sarah Beal
Organization: Cincinnati Children’s Hospital Medical Center
Grant Start Date: September 30, 2022
Evaluates the impact of different delivery models on health outcomes for children in foster care and examines the factors that contribute to variations in healthcare use and health outcomes for these youth. The findings can be used to implement health delivery practice changes, often in primary care, to improve the health outcomes of these vulnerable youth.
(K01)
PI: Annie Elizabeth Larson
Organization: OCHIN, Inc.
Grant Start Date: August 1, 2022
Investigates the role of telemedicine in improving access to primary care for rural patients. The research team is looking at the frequency and type of preventive care visits, differences between urban and rural patients on uptake of telemedicine, and the effect of telemedicine on the quality and equity of care for chronic health conditions among rural and urban patients.
Learn more about this study in the NCEPCR webinar: Using Large Datasets for Primary Care Research and the Impact Story: Advancing Primary Care Research Careers (PDF, 1 MB).
(R03)
PI: Ning Hsieh
Organization: Michigan State University
Grant Start Date: March 1, 2023
Aims to understand primary care utilization inequalities and the barriers to care faced by sexual and racial/ethnic minority populations. The study team analyzes data from the National Health Interview Survey (2013-2020) and the Behavioral Risk Factor Surveillance System (2014-2020) to document inequities in primary care utilization among sexual and racial minoritized populations compared with their heterosexual and White counterparts and to identify unique mechanisms underlying the inequities facing each disadvantaged group.
Dissemination and Implementation of Equity-Focused Interventions
The three grants described below each come from the grant initiative. The projects focus on prevention, screening, and managing chronic conditions, including in primary care settings.
(R18)
PI: Hannah Arem
Organization: MedStar Health Research Institute
Grant Start Date: September 30, 2023
To increase the percentage of Black and Hispanic patients who complete colorectal cancer screening, this study adapts a patient navigation intervention using the Practical, Robust Implementation and Sustainability Model (PRISM) and core health and racial equity principles. Conducts a stepped-wedged, randomized trial to roll out patient navigation and patient and clinician reminders across 15 primary care clinics (3 clinics per step, 5 six-month steps).
(R18)
PI: Elaine Khoong
Organization: University of California, San Francisco
Grant Start Date: September 30, 2023
Develops and evaluates both patient- and clinic-level strategies to increase implementation of self-measured blood pressure monitoring programs combined with clinical support in primary care for low-income, racially and ethnically diverse populations.
Learn more about this study in a Primary Care Research Profile: Increasing Patients’ Self-Monitoring of Blood Pressure in Safety Net Settings (PDF, 239 KB).
(R18)
PIs: Lisa Ross Decamp; Meredith Parrish Fort
Organization: University of Colorado – Denver
Grant Start Date: September 30, 2023
Develops the Nav-TEAM intervention to improve asthma management in children in families who communicate in a language other than English (LOE). The research team will use community-engaged processes to tailor asthma navigation for families that communicate in LOE in primary and subspecialty pediatric pulmonary care settings at a large academic children’s health system. The team will evaluate the effectiveness of Nav-TEAM on pediatric asthma outcomes, evaluate the application of implementation strategies, and assess cost and contextual factors to support sustained implementation and scaling of the intervention.
Innovative Approaches to Addressing Health Disparities
The three studies below describe a range of innovative approaches to measuring and reducing health disparities in primary care.
(K01)
PI: Kendra Liljenquist
Organization: Seattle Children’s Hospital
Grant Start Date: September 30, 2023
Aims to help address inequities in access to developmental screening for children from low-income and ethnic/racial minority families by developing a prototype for a new computer-adaptive developmental assessment to be used in primary care. The research team identifies culturally and contextually appropriate assessment items in both English and Spanish, as well as develops specifications for building a high-fidelity, computer-adaptive developmental assessment for integration into clinical care.
(R01)
PIs: Kristen Elizabeth Miller; William J. Gallagher
Organization: MedStar Health Research Institute
Grant Start Date: September 30, 2023
Evaluates diagnostic errors in ambulatory care settings, including primary care, in the context of diagnostic equity (i.e., addressing disparities in diagnostic errors due to systemic challenges in policies and practices) and uncertainty. The study team uses decision-modeling and human factors methodologies to conceptualize and measure diagnostic errors, with the goal of designing a comprehensive framework to inform interventions aimed at reducing diagnostic inequity and improving the management of diagnostic uncertainty.
(K01)
PI: Kristina Bridges
Organization: University of Kansas Medical Center
Grant Start Date: August 1, 2024
Aims to learn how to conduct QI in primary care without exacerbating health disparities by bridging health inequities research, medical informatics, and QI and implementation science. The study team identifies healthcare quality measures using a community-informed, equity-focused approach; incorporates those measures into QI dashboards; and designs strategies to decrease health inequity using community-engaged intervention mapping.
Learn more about this study in a recent NCEPCR webinar: Approaches to Address the Health of Specific Patient Populations in Primary Care.
Insights from Patients and Caregivers
The two studies described below aim to understand disparities in care by considering the perspectives of primary care patients and caregivers.
(R03)
PI: Stephen Walter Trzeciak
Organization: Rowan University
Grant Start Date: July 1, 2023
Aims to understand and mediate the impacts of disparities in primary care clinicians’ compassion from the patient perspective. In a diverse population of primary care patients, the research team conducts a cross-sectional cohort study to compare anonymous, real-time, point-of-care patient assessments of clinician compassion to identify differences across racial, ethnic, and socioeconomic groups. The team tests whether clinician compassion mediates patient distrust of the healthcare system and uses qualitative analyses to identify clinician behaviors that effectively communicate compassion from the patient perspective for each population group studied.
(K01)
PI: Nadja Vielot
Organization: University of North Carolina – Chapel Hill
Grant Start Date: August 1, 2024
Aims to (1) collaborate with healthcare personnel in rural primary care clinics to measure appropriateness and acceptability of starting HPV (human papillomavirus) vaccination at age 9, allowing more time to achieve up-to-date coverage by age 13, and use findings to develop an intervention plan; (2) gauge acceptability of HPV vaccination starting at age 9 among family caregivers in rural areas and modify the intervention plan to maximize caregiver acceptability; and (3) pilot the intervention in four rural clinics, using electronic medical records to measure HPV vaccination coverage in a cohort of 9-year-old patients over 2 years.
Costs of Care
One study looked at the financial impacts of illness across patient subgroups.
(K08)
PI: Nora V. Becker
Organization: University of Michigan at Ann Arbor
Grant Start Date: September 1, 2022
Examines "financial toxicity," or the financial consequences of illness. The grant first investigates which patient subgroups are at the highest risk of financial burden; then estimates the objective financial burden of a COVID-19 infection and assesses patients’ subjective financial distress related to their illness. The financial burden of a COVID-19 infection and patient financial distress is a topic that is integral to the delivery of primary care.
Initiatives and Resources
In addition to annual updates to the National Healthcare Quality and Disparities Report described below, Ƶshares a range of information and tools related to studying and addressing SDOHs, including maintaining an SDOH database, which includes data through 2020 at the county, ZIP code, and census tract levels.
2023 National Healthcare Quality and Disparities Report
Ƶhas published this congressionally mandated report annually since 2003. The 2023 National Healthcare Quality and Disparities Report provides an overview of the quality of healthcare in the United States as well as information about disparities in care for specific groups.
Related materials include:
