Implementation Research to Address the United States Health Disadvantage: Report of a National Heart, Lung, and Blood Institute Workshop

Abstract

Four decades ago, U.S. life expectancy was within the same range as other high-income peer countries. However, during the past decades, the United States has fared worse in many key health domains resulting in shorter life expectancy and poorer health-a health disadvantage. The National Heart, Lung, and Blood Institute convened a panel of national and international health experts and stakeholders for a Think Tank meeting to explore the U.S. health disadvantage and to seek specific recommendations for implementation research opportunities for heart, lung, blood, and sleep disorders. Recommendations for National Heart, Lung, and Blood Institute consideration were made in several areas including understanding the drivers of the disadvantage, identifying potential solutions, creating strategic partnerships with common goals, and finally enhancing and fostering a research workforce for implementation research. Key recommendations included exploring why the United States is doing better for health indicators in a few areas compared with peer countries; targeting populations across the entire socioeconomic spectrum with interventions at all levels in order to prevent missing a substantial proportion of the disadvantage; assuring partnership have high-level goals that can create systemic change through collective impact; and finally, increasing opportunities for implementation research training to meet the current needs. Connecting with the research community at large and building on ongoing research efforts will be an important strategy. Broad partnerships and collaboration across the social, political, economic, and private sectors and all civil society will be critical-not only for implementation research but also for implementing the findings to have the desired population impact. Developing the relevant knowledge to tackle the U.S. health disadvantage is the necessary first step to improve U.S. health outcomes.

Comprehensive examination of the multilevel adverse risk and protective factors for cardiovascular disease among hypertensive African Americans

“…Recent published reports emphasize the need to identify the multilevel determinants of cardiovascular health inequities in African Americans . Such data are needed to strengthen the evidence base for the design, implementation, and evaluation of rigorous pragmatic interventions in real‐world settings .…”

“…Such data are needed to strengthen the evidence base for the design, implementation, and evaluation of rigorous pragmatic interventions in real‐world settings . To achieve this goal, one report recommended analysis of large cohort studies that “may lead to understand geographic variation and evolving social and health inequities.” Utilizing a multilevel framework, this study sought to describe the risk and protective factors that occur at the individual, family, provider, health care system, and community levels in a sample of over 2000 African American adults with hypertension who are followed in academic, community, and safety‐net practices in NYC.…”

“…13,14 Recent published reports emphasize the need to identify the multilevel determinants of cardiovascular health inequities in African Americans. 3,37,38 Such data are needed to strengthen the evidence base for the design, implementation, and evaluation of rigorous pragmatic interventions in real-world settings. 38 To achieve this goal, one report recommended analysis of large cohort studies that "may lead to understand geographic variation and evolving social and health inequities."…”

Building the Next Generation of Implementation Science Careers to Advance Health Equity

“…The scale-up of proven-effective interventions with sustainable implementation has the potential to close gaps in health outcomes and reduce health disparities in the United States. 6 Underrepresented groups, including those from racial, ethnic, rural, and low-income populations across the United States, have not benefitted to the same degree from implementation research advances. 6 Despite an exciting era of scientific health innovations for translation in the realworld, discoveries can move slowly, stall, or never make it successfully down the translational continuum, particularly for disadvantaged groups.…”

“…6 Underrepresented groups, including those from racial, ethnic, rural, and low-income populations across the United States, have not benefitted to the same degree from implementation research advances. 6 Despite an exciting era of scientific health innovations for translation in the realworld, discoveries can move slowly, stall, or never make it successfully down the translational continuum, particularly for disadvantaged groups. Skilled implementation scientists who use complex methodologies and engage in multidisciplinary teams are needed to keep pace with the demands of scientific discovery and implementation for diverse populations.…”