Clinical and Health Services Research
Under this research interest area, NIMHD supports clinical research to generate new knowledge to improve health outcomes and quality of healthcare for minority and other disparity populations. The scientific portfolio includes extramural grants, cooperative agreements and training awards related to the following:
Clinical Research and Treatment Interventions Within Health Care Settings
Research to describe and further understand the health profile and clinical manifestations of diseases in minority populations (minority health) and identify the most effective methods to screen, diagnose, treat, or manage medical conditions in populations affected by health disparities.
Population-Focused Clinical Research Within the Context of Healthcare
Research to understand and address population-specific clinical presentation and/or manifestation of diseases and their complications, and similarities and differences among populations affected by health disparities. Examples of such research include (but are not limited to) identifying appropriate screening criteria to determine disease risk and identifying more targeted screening and disease management methods or biomarkers, based on clinical presentation of diseases and their complications, interventions or clinical trials, to assess response to therapy.
Health Disparities Within the Context of Health Care Settings
Research to understand and address etiologies of health disparities within the context of clinical care and services, such as screening and diagnostic thresholds, treatment access, treatment response, patient safety, adverse events, health system errors, and quality of care. Examples of such research include (but are not limited to) assessment of effectiveness and implementation of evidence-based guidelines of diagnosis and treatment of diseases with high prevalence or burden among populations affected by health disparities (including in rural healthcare settings), clinical and translational research, access to care and effective treatment for individuals with multiple chronic diseases, emergency medical care response, understanding and preventing increased in-hospital complications and/or mortality, understanding the causes of disparities in severe maternal morbidity and mortality, implementing interventions to reduce maternal and infant mortality in populations at high risk, implementing interventions to reduce maternal morbidity and improve postpartum maternal and infant health outcomes, studies that analyze the relationship between social determinants of health and clinical outcomes, pragmatic trials, effectiveness assessment of different health information technologies in improving access to health care, and defining effective metrics of quality of care.
Preventive and Health Promotion Interventions in Health Care Settings
Research to develop and evaluate preventive or health promotion interventions delivered within the healthcare system including underserved rural healthcare settings (e.g., health education, wellness programs, early screening, immunizations/vaccinations).
Implementation and Dissemination Research in Health Care Settings
Research to understand barriers and facilitators to the adoption of and adherence to evidence-based practices and interventions in healthcare settings, and to test different strategies to enhance successful adoption, adherence, feasibility and sustainability of evidence-based practices and interventions, including in underserved rural healthcare settings. This type of research may include observational or intervention designs.
Program Contacts: Dr. Beda Jean-Francois
Patient-Health Care System Interactions
Research to understand patient-clinician and/or patient-healthcare system engagement/partnership, trust, communication and shared decision-making, the impact of these interactions on health outcomes in populations affected by health disparities (including underserved populations in rural areas), and interventions to enhance these interactions and improve health outcomes.
Clinician and/or Health Care System Bias and Cultural Competence
Research to assess and understand conscious and unconscious bias and cultural competency of healthcare providers and other actors within the healthcare system regarding patients from populations affected by health disparities, as well as interventions to reduce these biases, improve cultural competence, and understand how these interventions impact quality of care, improve patients’ health outcomes (e.g., severe maternal morbidity and mortality, infant mortality), and reduce health disparities.
Patient-Clinician/Healthcare System Communication
Research to understand the nature and patterns of communication between patients from populations affected by health disparities and points of contact at different levels within the healthcare system (in addition to clinicians), interventions to facilitate effective bidirectional communication, patient empowerment/partnership and shared decision-making between healthcare systems and patients from populations affected by health disparities and their families, and the impact of such interventions on quality of care and health outcomes.
Patient Engagement and/or Partnership in Care
This type of research intends to understand factors that trigger, facilitate or deter engagement/partnership of patients from populations affected by health disparities in clinical care across the care cascade (screening, diagnosis, engagement in care, treatment adherence), interventions to enhance it, and the impact of these interventions on health outcomes. Interventions can occur within clinical settings or in the community but are offered in conjunction with clinical care. This research assesses patient-reported outcomes, self-management, patient navigation, the impact of different health information technologies on health education interventions, and health education interventions offered within medical settings.
Program Contact: Dr. Beda Jean-Francois
Epidemiology of Health Care Utilization and Outcomes
Research to identify patterns of healthcare utilization, quality and outcomes in populations affected by health disparities (including underserved rural populations), as well as to identify social, environmental and other determinants of healthcare utilization patterns and health outcomes. This type of research may include natural experiments (resulting from change in public or health policies, for example).
System-Level Health Services Research
Research to understand how healthcare system factors influence health outcomes in health disparity populations.
Health Care System Organization and Coordination
Research to examine how the structure and organization of healthcare impact service utilization and health outcomes (e.g., accountable care organizations, patient-centered medical homes, co-located services, virtual/remote services, use of patient navigators, effectiveness of various strategies to increase the supply of and access to healthcare practitioners in medically underserved areas, implementation of strategies to reduce system bias and increase health equity, etc.)
Health Care Policies
Research that examines and evaluates the impact of changes in local, state and federal healthcare and non-healthcare environments policies (e.g., laws/policies regarding insurance coverage, eligibility for services, cultural competency standards, workplace safety, sick leave) on service utilization and health outcomes, including maternal and infant mortality and maternal morbidity, and the health and healthcare of underserved populations in rural areas.
System/Multilevel Interventions to Improve Quality of Care
Research to develop and/or evaluate healthcare system-wide interventions or multi-level interventions that include system-level components to reduce system bias, increase health equity, improve access to or quality of care for populations affected by health disparities (e.g., studies that optimally define and assess the integration of social determinants of health in electronic health records and clinical practice, patient-health system communication initiatives, interaction between outpatient/inpatient medical informatics, pharmacy and in-home medical services), including underserved populations in rural areas
Health Care Delivery in Non-Medical/Community Settings
Research to understand health care utilization and outcomes for health disparity populations in non-medical, community-based settings.
Health Care Delivery in Behavioral Health Settings
Research to understand or improve formal care for populations affected by health disparities in community-based mental health and drug treatment settings, including clinics, private practice settings, residential treatment facilities and detoxification centers.
Health Care Delivery in Long-Term Care or Palliative Care Settings
Research to understand or improve formal healthcare provided to populations affected by health disparities (including underserved rural populations) in nursing homes, rehabilitation centers, assisted-living facilities and hospice settings, as well as in home-based long-term healthcare.
Program Contact: Dr. Rick Berzon
Health Care Delivery in Non-Health Care Settings
Research to understand or improve formal healthcare provided to populations affected by health disparities in school-based health centers, the workplace and criminal justice settings. This does not include health promotion activities that may be delivered by non-medical personnel in these settings or other settings (e.g., health fairs).
Program Contact: Dr. Rada Dagher