Strategies To Address Racial and Ethnic Disparities in Health and Healthcare: An Evidence Map

Background. Racial and ethnic disparities in health and healthcare continue to endure in the United States despite efforts in research, practice, and policy. Interventions targeted at patients, clinicians, and/or health systems may offer ways to address disparities and improve health outcomes in prevention/treatment of chronic conditions in adults. Purpose. This evidence map identifies existing interventions to be considered for implementation by healthcare system leaders and policymakers, and to inform researchers and funding agencies on gaps in knowledge and research needs. Methods. We searched MEDLINE, CINAHL, and Scopus from January 2017 through April 2023 for U.S.-based studies from the peer-reviewed published literature. We incorporated supplementary information from systematic reviews. We supplemented this with the gray literature, when available, from pertinent organizations, foundations, and institutes. We held discussions with Key Informants who represented stakeholders in healthcare disparities. Findings. A vast and varied literature addresses healthcare system interventions to reduce racial and ethnic health and healthcare disparities. We identified 163 unique studies from 174 reports, and 12 intervention types not mutually exclusive in their descriptions. The most studied intervention type was self-management support, followed by prevention/lifestyle support, then patient navigation, care coordination, and system level quality improvement (QI). Most of the interventions specifically targeted patient behaviors. Few studies (5) used a comparator, which made it difficult to determine whether disparities between groups were reduced or eliminated. Most of the studies (45%) included multiple race/ethnic groups (i.e., enrolled participants from more than one racially/ethnically minoritized group or enrolled racially minoritized people and non-minoritized groups). We found few studies that exclusively enrolled Asians (6%) and American Indians/Alaska Natives (1%). Cancer was the most studied chronic condition. Randomized controlled trials were common; but less rigorous study designs were often used for system level quality improvement (QI) and collaborative care model interventions. Few studies reported patient experience as primary outcomes. Studies did not report on harms or adverse events and nor did they report on factors necessary for determining applicability or sustainability of the interventions. A number of studies reported on cultural adaptation or community involvement (either partnership or collaboration). Future studies should seek to standardize the terms in which they describe interventions and aim to specifically address whether disparities between groups are reduced or eliminated. Nonetheless, this evidence map provides a resource for health systems to identify intervention approaches that have been examined elsewhere and that might be imported or adapted to new situations and environments.