Leveraging an implementation science partnership network to understand how Federally Qualified Health Centers operationalize and address health equity

Abstract

Health equity-focused implementation research requires using definitions and approaches that are relevant and meaningful to implementation partners. We examined how health equity was operationalized and addressed at Federally Qualified Health Centers (FQHCs). We conducted semi-structured interviews with leadership (n = 19) and staff (n = 12) at 10 FQHCs in an implementation science partnership network for cancer control equity to understand how they operationalized and addressed health equity. We performed rapid qualitative analysis and shared findings with a larger group of 13 community health centers (including the 10 FQHCs) at an Implementation Learning Community (ILC) to identify action areas for research and practice, followed by a second phase of synthesizing qualitative codes into themes and mapping themes onto a framework for advancing health equity in healthcare organizations. Participants defined health equity as central to the mission of FQHCs, and identified barriers (e.g. financing models) and facilitators (e.g. interpreter services) to advancing health equity at FQHCs. These findings resonated with ILC participants who emphasized the challenge of addressing root cause social determinants of inequities using limited available resources in FQHCs and the importance of developing meaningful collaboration with communities for data collection, data interpretation, data use, and data ownership. Themes captured recommendations to advance health equity in daily work at FQHCs, including investments in staffing, training, and resources. Mapping qualitative themes from health equity-centered interviews with FQHC partners onto a framework for advancing health equity in healthcare organizations can provide clear, context-specific direction for actions aimed at improving health and healthcare equity.

A Federally Qualified Health Center-led Ethics & Equity Framework & Workflow Checklist: An Invited Commentary in Response to a Relational Public Health Framing of FQHCs During COVID-19

“…FQHCs are necessarily agile and focused on rapid implementation of action-oriented quality and policy improvements that maximize limited resources to achieve health equity. 6 Pacia et al situate their analysis of "FQHC actions, policies, and cultures" during COVID-19 as critical to understanding their role in "ensuring public health policy [that] is effective and equitable." 7 Within this climate and structure, we developed an FQHC-led ethics and equity framework and workflow checklist 8 through the NIH Rapid Acceleration of Diagnostic Testing in Underserved Populations (RADx) 9 initiative, highlighting the underlying fabric of health centers' historic and adaptive leadership in the delivery of equity-informed care.…”