The theme of REACH Equity is to develop and test interventions that reduce racial and ethnic disparities in health by improving the quality of patient-centered care in the clinical encounter.
Racial and ethnic health disparities are ubiquitous, lead to excess morbidity and mortality, and are associated with substantial healthcare costs. These disparities are present even among those with similar access to care, suggesting that providers and health systems are important contributors to health disparities. Yet most studies of interventions to reduce disparities have focused on changing patient behavior and knowledge, leaving substantial gaps in the evidence base of effective interventions to reduce disparities in healthcare delivery. REACH Equity seeks to address gaps in current disparities research by focusing on the quality of healthcare delivery in the clinical encounter—a setting where racial and ethnic disparities in care are well-documented. Although proposed projects can be disease- or setting-specific, REACH Equity is particularly interested in supporting research which is ultimately applicable across diagnoses, settings of care, stages of illness, and throughout the life course.
Purpose of Award
To reduce disparities in health, we must have a research workforce engaged and skilled in the conduct of health disparities research. REACH Equity will contribute to that pipeline by providing career development support to early-stage investigators proposing rigorous research to develop or test interventions which address the REACH Equity Theme. Projects should result in preliminary data for competitive next-step grants.
The career development component of this award will include participation in REACH Equity activities, such as a core curriculum, works-in-progress seminar series, and an annual disparities research colloquium. Early-stage investigators will be invited under the Center’s “umbrella” of collaboration, fellowship, and supplemental mentorship.
We plan to fund up to 6 REACH Equity CDAs in this call for applications, with 3 awards per year in subsequent years. Consistent with REACH Equity’s goal of increasing diversity in the research work-force, we have set as a programmatic priority the selection of at least 50% under-represented racial and ethnic investigators.
Applicants must propose original research that addresses the REACH Equity theme.
Responsive proposals will:
- Propose to develop or test an intervention targeting patients, providers, and/or health system. Proposal may include observational work to identify intervention targets but should also include intervention development and/or testing during the funded award period.
- Seek to improve minority health or reduce racial and/or ethnic disparities in health/healthcare. Although all minority groups defined by NIH are eligible, regional demographics suggest that adequate power will be achieved by focusing on Blacks/African Americans and/or Hispanics.
- Seek to directly or indirectly improve quality of patient-centered care in the clinical encounter. We define the clinical encounter as interactions between patients and/or caregivers and any member or members of the healthcare team in any healthcare setting.
In developing the research proposal, applicants should consult the REACH Equity Conceptual Model as well as this Table that shows potential research examples related to REACH Equity’s Conceptual Model. Both the Conceptual Model and the Table provide information on targets for intervention and outcomes of interest; however, these examples are meant to be illustrative only, and do not define the full range of potentially responsive projects.
For other examples of research consistent with the REACH Equity theme, please see descriptions below of the R0-1 level research projects currently supported by the Center. Each of the three projects includes the Interpersonal Processes of Care Survey as one of its outcome measures.
- Development and pilot testing of an implicit bias training intervention for providers
- RCT of a communication coaching intervention for cardiologists
- RCT of a mobile app that allows patients and families to systematically report palliative care needs and clinicians to visualize needs and receive decisional support on how to address them
We recognize that the REACH Equity approach may be a new direction for many applicants and their mentors. Therefore, potential applicants are strongly encouraged to schedule a brief phone conversation with Dr. Laura Svetkey as early as possible. To schedule a phone call, please send a brief description (3-5 sentences) of your potential project to Kimberly.Dorman@duke.edu.