WITHDRAWN: Reframing Implementation Science to Address Healthcare Disparities

Background: Disparities in the access, quality and outcomes of care are persistent, detrimental and costly. Health care disparities are unfair differences between groups in the access, use, and quality of care despite no differences in their needs and preference (Institute of Medicine, 2003). Difference in the quality of care people receive based on established treatment guidelines These disparities are unfair and unjust, and can be avoided. They are due to the operation of the health care system (the ecology of health care) including the legal and regulatory climate in which the health care system operates and discrimination, biases, stereotyping and uncertainty. The causes of health care disparities are complex and multifactorial. Implementation science can help healthcare disparities since in moved the types of research done in this area forward.

Method: We expand Proctor et al. (2009) implementation outcome framework to incorporate components of the Health Equity Impact Assessment (HEIA) and scientific equity. Our intent is not to develop a new framework but to show how an existing implementation science framework can be applied and used to focus on healthcare equity. As such, we have identified 5 key areas that we are expanding the framework on: (1) including focus on reach from the very beginning (or reach as a key factor for social justice); (2) design and select interventions for vulnerable populations; (3) incorporate adaptation in the implementation process; and (5) use an equity lens for implementation outcomes.

Findings: Our rationale for focusing on a framework is threefold. First, frameworks can help drive the research questions, the designs and measures of implementation studies. With the recent calls and guidelines on scoring implementation studies and reporting implementation studies, researchers will hopefully better articulate the role of the frameworks on their studies on design, implementation and evaluation of their studies. Second, the implementation science field is broad enough that serves a foundation for numerous disciplines. As such, its frameworks can have large impact in numerous disciplines. Third, the field of implementation science was set forth to decrease the quality of gap of what could be delivered to what is actually being delivered in usual care, a perfect alignment for the field of health disparities.

Conclusions: We hope that implementation researchers should avoid reinforcing the gap by implementing interventions in usual care that are not adaptable for minority and vulnerable populations by acknowledging the health inequity structure of the implementation research studies. We hope that this framework will help the field be more thoughtful about the implementation process by considering the health equity impact of our studies.