Call to Make Equity Actionable in Frontline Practice in Learning Health Systems Using Implementation Science.

Abstract

Advancing health equity is the fifth and newest addition to the Quintuple Aims guiding learning health systems (LHS). A promising way to achieve this goal is by applying an equity lens to implementation science-a foundational LHS method. Despite a recent proliferation of equity-focused implementation theories, models, and frameworks, there is a dearth of guidance on practical applications of equity-focused implementation science in frontline practice. This perspectives article provides recommendations on actionable steps to build broader capacity for health equity in front-line clinical practice using implementation science. It presents two quality improvement projects within the Veterans Health Administration, a national LHS. The first project incorporated a health equity adaptation to Evidence-Based Quality Improvement, an implementation strategy fostering multi-level, inter-professional engagement. This adapted method was applied to implement evidence-based practices into primary care to manage Veterans at high risk for hospitalization. The second project leveraged clinical operations partnerships and an equity-focused implementation framework to improve equitable delivery of a skills-based psychotherapy group for Veterans with a history of any sexual violence in their lifetimes. The article concludes with recommendations as to how researchers can structure their intervention programs and implementation strategies to prioritize equity at the frontlines of care in LHS.