Using Implementation Science to Move from Knowledge of Disparities to Achievement of Equity

Today's healthcare system and the people it serves face an urgent need for researchers and healthcare providers to address widespread inequitable care. Despite state and national policy initiatives seeking to improve population health and reduce health disparities, and despite the presence of a burgeoning evidence base of effective clinical and community-based approaches to reduce disparities, interventions have not been widely translated into real-world practices and communities. The observed gaps between evidence and practice, and among different racial, ethnic, and rural/urban populations, is in some part due to failure to implement known evidence effectively, consistently, and appropriately. Dissemination and translation initiatives to promote health equity are critical to efforts to reduce healthcare disparities. This chapter provides an overview of implementation science approaches and frameworks and describes their utility for healthcare equity research, using as an example the Reducing Disparities and Controlling Hypertension in Primary Care Project (ReD CHiP), a pragmatic trial funded by the National Heart, Lung, and Blood Institute. It then offers important lessons and “best practices” in healthcare disparities implementation science. A following section discusses challenges and opportunities of using implementation science in healthcare disparities research, notably in stakeholder engagement; in accounting for contextual differences in implementation settings; and in intervention design and implementation. The chapter closes with a discussion of future research areas. By incorporating implementation science methods and approaches, researchers and healthcare providers may improve the effectiveness of dissemination and translation initiatives, spreading and enhancing sustainment of evidence-based approaches to reduce healthcare disparities. These efforts may ultimately accelerate the realization of equitable healthcare for all.