Health Equity最新文献

{"title":"Doulas as Facilitators to Black Birthing People's Needs in Pennsylvania in the Context of Medicaid Coverage.","authors":"Andrea D Casas, Alexis Kiyanda, Iris Ryn Olson, Marian Jarlenski, Emma Mairson, Christine McClure, Cynthia L Salter, Linda Adodoadji, Claire Lama, Haley Director, Marquita Smalls, Sydney Sharp, Elizabeth Lusardi, Sarah A Sanders, Dara D Méndez","doi":"10.1177/24731242261455617","DOIUrl":"10.1177/24731242261455617","url":null,"abstract":"<p><strong>Introduction: </strong>Longstanding racial inequities in maternal mortality require tailored approaches to improving outcomes for Black birthing people. Doulas provide continuous emotional, physical, and informational support and have been shown to improve perinatal outcomes, particularly for Black birthing people. In response, some states have implemented Medicaid doula benefits. In January 2025, Pennsylvania-where ∼35% of births are Medicaid-covered-launched such a policy, allowing certified doulas to enroll as Medicaid providers.</p><p><strong>Methods: </strong>As part of a larger mixed-methods study on the effects of Medicaid policies on maternal and child health, the study team examined doulas' experiences participating in Pennsylvania Medicaid. Semi-structured interviews were conducted with 30 doulas statewide from December 2023 to March 2025 to examine the policy's implications for doulas and Black birthing people. Transcripts were analyzed using latent content analysis, applying inductive and deductive coding.</p><p><strong>Results: </strong>Doulas reported persistent racial inequities in health care, including delayed pain management and pressure on Black birthing people to accept unwanted interventions. They described advocating within a system marked by clinician bias and profit-driven hospital models. While some doulas viewed the Medicaid policy as improving credibility and expanding access for Medicaid recipients, concerns emerged regarding administrative burdens, credentialing, enrollment, and scale-up, especially for Black doulas, who play a central role in supporting Black birthing people.</p><p><strong>Discussion: </strong>This study highlights the need to support doulas in navigating Medicaid processes while also addressing structural barriers within the health care system. Insights from other states can inform implementation efforts in Pennsylvania.</p><p><strong>Health equity implications: </strong>These findings underscore that Medicaid doula policy must go beyond reimbursement alone to ensure that community doulas can connect with clients and provide continuous, holistic support both within and outside the health care system-unencumbered by credentialing requirements, enrollment barriers, or payment structures that constrain the scope and reach of their work. Reimagining such policy to center the experiences of both Black doulas and Black birthing people is a necessary step toward dismantling the systemic conditions that drive racial inequities in maternal mortality.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"10 ","pages":"24731242261455617"},"PeriodicalIF":2.3,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13421928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reimagining Reproductive Health Care for Refugee Women: Integrating Cultural Health Navigators into a Clinical Model.","authors":"Ehiremen Azugbene, Kathryn Claypool, Zoë Baker, Lara Johnstun, Cady Berkel, Tobin Bader, Michelle Villegas-Gold, Santosh Sapkota, Lora Nordstrom, Dean Coonrod, Jeanne Nizigiyimana, Crista Johnson-Agbakwu","doi":"10.1177/24731242261458123","DOIUrl":"10.1177/24731242261458123","url":null,"abstract":"<p><strong>Background: </strong>Refugee women face barriers to reproductive health care, including limited English proficiency, transportation challenges, inconsistent insurance coverage, socioeconomic instability, and prevalence of trauma-related mental health conditions. This study describes the characteristics, diagnoses, and health care utilization of refugee women receiving care at the Refugee Women's Health Clinic (RWHC) of Valleywise Health (VH), a safety net health care system in the southwestern United States. Further, it examines the role of an integrated cultural health navigator (CHN) program in addressing access and care barriers for refugee women. Study objectives were to characterize demographics, health diagnoses, reproductive health care utilization, and the scope of CHN service delivery.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using electronic medical record data from 21,062 refugee-identified patients seen at VH from 2009 to 2024, with a focused descriptive analysis of 7,504 women who received care at the RWHC. Analyses of CHN service delivery were conducted among a subset of 1,581 patients with available CHN flowsheet documentation.</p><p><strong>Results: </strong>Patients originated from >100 countries, demonstrating extensive racial, linguistic, and religious diversity. Among RWHC patients, 48.1% experienced at least one pregnancy; 93.2% received prenatal care, and 55.3% initiated care in the first trimester. Mental health diagnoses were common, including anxiety (10.0%) and depression (9.8%). Preventive services were widely utilized, including sexually transmitted infection screening (43.1%) and contraceptive counseling (32.2%). CHNs supported approximately 5,000 patient encounters annually, with services focused on appointment adherence, enhanced interpretation and transportation access, and linkage to behavioral health and supportive services.</p><p><strong>Conclusions: </strong>The RWHC and its integrated CHN program represent a community-based, equity-focused model of reproductive health care delivery for refugee women in a safety-net setting. Embedding CHN programs within clinical settings may mitigate socioeconomic, linguistic, and mental health-related care barriers by strengthening care coordination and access. This model offers a framework for advancing reproductive health equity among resettled refugee women.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"10 ","pages":"24731242261458123"},"PeriodicalIF":2.3,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13420392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Substance Use Treatment Retention after Redesign of a Comprehensive Addiction and Pregnancy Program in Baltimore, Maryland.","authors":"Lea A Marineau, Michael Kidorf, Jennifer D Ellis, Eric C Strain, Halle A Thomas, Denis G Antoine","doi":"10.1177/24731242261456218","DOIUrl":"10.1177/24731242261456218","url":null,"abstract":"<p><strong>Introduction: </strong>Substance use disorder (SUD) is a significant cause of morbidity and mortality among perinatal people. Integrated perinatal SUD treatment programs (SUD, obstetrics, mental health, and other services) show promising improvements in SUD and perinatal outcomes. This study describes the redesign of an integrated perinatal SUD treatment program that partnered with a community-based recovery housing facility to integrate clinical and social services and evaluated the impact of this redesign on several indices of treatment retention.</p><p><strong>Methods: </strong>This retrospective cohort study used health record data from 164 perinatal people aged 18+ years admitted to an integrated intensive outpatient SUD treatment program in Baltimore, Maryland, between March 8, 2021, and June 11, 2025. Negative binomial regression was used to examine the association between the program redesign and length of treatment, and logistic regression was used to examine associations between program redesign and retention (until delivery and at 30-, 60-, and 90-days postpartum).</p><p><strong>Results: </strong>Perinatal people admitted post-redesign had a 108% increase in length of treatment compared to people admitted pre-redesign (adjusted incidence rate ratios [aIRR] 2.08, 95% CI: 1.40, 3.10). People admitted post-redesign had greater odds of treatment retention until delivery (aOR 3.53, 95% CI: 1.39, 8.95); and greater odds of treatment retention at 30-, 60-, and 90-day postpartum compared to people admitted pre-redesign (adjusted odds ratio [aOR] 6.58, 95% CI: 2.52, 17.16; aOR 9.87, 95% CI: 3.47, 28.07; and aOR 5.50, 95% CI: 1.98, 15.27, respectively).</p><p><strong>Discussion: </strong>The study illustrates the benefits of creating community partnerships to deliver integrated clinical and social services to perinatal people with severe forms of SUD.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"10 ","pages":"24731242261456218"},"PeriodicalIF":2.3,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13420390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discipline Is Not Neutral: Racial Disparities in Resident Physician Disciplinary Action.","authors":"Vanessa Grubbs","doi":"10.1177/24731242261455433","DOIUrl":"10.1177/24731242261455433","url":null,"abstract":"<p><strong>Introduction: </strong>Disparities in medical education are documented across the training continuum, yet little is known about how racial and socioeconomic factors shape disciplinary actions during residency.</p><p><strong>Methods: </strong>We conducted a cross-sectional anonymous survey of resident physicians affiliated with the Committee of Interns and Residents. The survey captured demographic characteristics and experiences with negative feedback, remediation, and discipline. We used descriptive statistics and logistic regression.</p><p><strong>Results: </strong>We analyzed 1,755 validated responses (9.2% completion). Compared with White participants, Black participants had higher odds of being asked to meet with program leadership (unadjusted odds ratio [OR] = 1.93, 95% confidence interval [CI]: 1.32-2.82), and this association strengthened after adjustment for gender, specialty type, and early-life socioeconomic indicators (adjusted OR [AOR] = 2.24, 95% CI: 1.48-3.38). Black participants were nearly three times as likely to report ever being on remediation (OR = 2.93, 95% CI: 1.51-5.72), although adjusted models were limited by small event counts. When disciplinary outcomes were combined, Black participants were 55% more likely than White participants to experience any disciplinary action in unadjusted analyses (OR = 1.55, 95% CI: 1.10-2.19), and this association strengthened after adjustment (AOR = 1.76, 95% CI: 1.21-2.57). Hispanic and Asian participants did not demonstrate higher odds of disciplinary action compared with White participants.</p><p><strong>Conclusion: </strong>Racial and socioeconomic inequities in residency discipline challenge assumptions that discipline reflects merit alone. Programs should implement transparent, uniform disciplinary processes and create supportive training environments for all trainees.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"10 ","pages":"24731242261455433"},"PeriodicalIF":2.3,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13421930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Feasibility Study of the Alliance for Representative Clinical Trials (ARC): Building Clinical Research Capacity in Community-Based Settings.","authors":"Salvatore Alesci, Jeanne M Regnante, Kristin Bodiford, Shantia M E Horsford, Makella S Coudray, Tracy A Battaglia, Nancy J Di Dia, Angelo D Moore, Terri Smith Moore, Christina Edwards, Gary Puckrein","doi":"10.1177/24731242261455193","DOIUrl":"10.1177/24731242261455193","url":null,"abstract":"<p><strong>Introduction: </strong>Most patients receive care in community settings. However, few community clinicians serve as clinical trial investigators. This limits how many underrepresented patients can take part. The National Minority Quality Forum (NMQF) created the Alliance for Representative Clinical Trials (ARC) to support community clinicians in building research capacity while delivering patient care.</p><p><strong>Methods: </strong>NMQF conducted an early-stage feasibility study to understand the conditions required for equitable patient participation in clinical research. This study examined three areas: recruiting community clinicians, completing foundational research training, and assessing site readiness to offer trials. It also explored the social and structural factors that affect readiness and capacity for equitable research participation.</p><p><strong>Results: </strong>Ten community clinicians participated in the study, completing training (100%) and site assessments (90%). Eight out of ten (80%) were satisfied with the program and would recommend it. Six out of ten (60%) felt ready to lead a trial. Key barriers included limited staff, infrastructure, and time. Facilitators included trusted recruitment networks and flexible self-paced training.</p><p><strong>Discussion: </strong>The ARC showed promise in involving community clinicians in clinical research. These findings highlight the need for broader adoption, including mentorship, infrastructure investment, and financial incentives. They also inform future implementation pathways and align with national efforts to make clinical research more accessible and equitable in community care settings.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"10 ","pages":"24731242261455193"},"PeriodicalIF":2.3,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13420975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing Birth Equity Through Quality Improvement Education: The SPEAK UP Champion Course.","authors":"Renée Byfield, Debra Bingham","doi":"10.1177/24731242261449035","DOIUrl":"10.1177/24731242261449035","url":null,"abstract":"<p><strong>Background: </strong>Black, non-Hispanic, and Indigenous perinatal patients in the United States experience disproportionately high rates of maternal mortality and morbidity compared with other racial and ethnic groups. While multiple social and institutional factors contribute to these inequities, structural racism, including implicit bias, remains key drivers shaping patient-health care professional interactions and the quality and equity of care.</p><p><strong>Objective: </strong>To evaluate, using a health equity lens, changes in perinatal health professionals' knowledge, attitudes, awareness, and self-reported preparedness and actions to mitigate racism before and after participation in the Institute for Perinatal Quality Improvement's SPEAK UP Champion course on implicit and explicit racial bias.</p><p><strong>Methods: </strong>We analyzed 1,303 pre-course surveys, 772 post-course surveys, and 48 follow-up implementation surveys collected from 28 SPEAK UP Champion courses delivered between 2021 and 2023. Surveys assessed knowledge, attitudes, awareness, and self-reported planned or implemented bias-mitigation strategies. Univariate analyses summarized outcomes, and chi-square tests examined racial differences in self-reported implicit bias.</p><p><strong>Results: </strong>Post-course surveys showed improvements in understanding race as a social construct, increased recognition of racism as a driver of perinatal disparities, and heightened awareness of disrespect toward Black and Indigenous patients. Participants reported greater preparedness to identify biased behaviors and develop equity-focused quality improvement (QI) goals, including self-reported planned or early implementation of bias-mitigation strategies. Implementation survey findings reflected respondent-reported practice changes among a small, self-selected subset of participants.</p><p><strong>Conclusion: </strong>These findings suggest that (1) the SPEAK UP Champion course was associated with increased racial bias awareness and enhanced participants' reported capacity to develop bias-mitigation QI action plans; and (2) integrating equity-focused education on implicit and explicit racial bias with QI methods may represent a promising, systems-level approach to advancing equity across the perinatal continuum that warrants broader implementation and further evaluation using rigorous outcome measures.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"10 ","pages":"24731242261449035"},"PeriodicalIF":2.3,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13421816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stories, Systems, and Survival: Photovoice Insights on Structural Racism and Cystic Fibrosis Care.","authors":"Brooke W Jones, Subhashini Sellers, Kristin Z Black","doi":"10.1177/24731242261451646","DOIUrl":"10.1177/24731242261451646","url":null,"abstract":"<p><strong>Introduction: </strong>People who identify as Black, Indigenous, and People of Color (BIPOC) represent an increasing proportion of patients with cystic fibrosis (CF). Despite the transformative potential of highly effective modulator therapies, BIPOC people with CF (pwCF) experience disproportionately worse outcomes, including lower lung function and increased risk of hospitalization. Social and structural conditions exacerbate these inequities. To better understand these dynamics, this study used photovoice, a community-based participatory research method, to explore how BIPOC pwCF describe the influence of systemic and structural inequities on their health and disease management.</p><p><strong>Material and methods: </strong>Using the photovoice method, participants documented their lived experiences through photography and facilitated group discussion using the <b>S</b>ee, <b>H</b>appening, <b>O</b>ur, <b>W</b>hy, <b>E</b>xist, <b>D</b>o, or SHOWED method. Group generated prompts focused on CF-related experiences, barriers, and supports. Transcripts were analyzed using the Sort and Sift, Think and Shift^© method.</p><p><strong>Results: </strong>Participants described challenges unique to BIPOC pwCF, including delayed diagnosis of CF, limited CF knowledge among nonspecialist providers, and systemic barriers such as geographic isolation, language differences, and ineligibility for modulator therapies. Many described the need to self-advocate, seek alternative resources, or forgo local care in favor of distant CF centers.</p><p><strong>Conclusions: </strong>BIPOC pwCF face systemic barriers across the care continuum that reflect a gap between the promise of modern CF care and equitable access to it. Participants' narratives underscore the enduring consequences of viewing CF as a \"White disease\" and the urgent need for structural reform to ensure that advances in CF treatment are accessible and effective for all patients, regardless of race or ethnicity.</p><p><strong>Primary source of funding: </strong>Cystic Fibrosis Foundation.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"10 ","pages":"24731242261451646"},"PeriodicalIF":2.3,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13420421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antiracist Practices Across the Stages of a Research Project: A Narrative Review.","authors":"Kate E Wallis, Tala Allababidi, Fahmida Sarmin, Sarah Wozniak-Kelly, Sherry Morgan, Kristine Andrews, Andrea F Duncan, Nia Heard-Garris, Diana Montoya-Williams","doi":"10.1177/24731242261450046","DOIUrl":"10.1177/24731242261450046","url":null,"abstract":"<p><strong>Objectives: </strong>There is a need for formal guidance around antiracist research practices to dismantle structural racism, which has been embedded into the design and conduct of health sciences research. Our objective is to review and summarize recommendations from published literature published on antiracist research practices applicable to all health sciences research studies.</p><p><strong>Method: </strong>In 2022, we systematically reviewed PubMed, SCOPUS, Excerpta Medica Database, British Nursing Index, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Sociological Abstracts using search terms about antiracist research. We found 5362 papers, screened 3962 titles, assessed 171 abstracts for eligibility, and reviewed 103 using a standardized extraction form. We reviewed 11 papers twice to confirm accuracy. We narratively synthesized recommendations relevant to six stages of the research process via combined deductive and inductive qualitative analysis.</p><p><strong>Results: </strong>A total of 1407 individual recommendations were grouped into themes and subthemes within each research stage. Project development had the most themes (n = 7) and subthemes (n = 24); dissemination of findings had the fewest (2 themes and 5 subthemes). When designing a project, researchers are encouraged to develop diverse, representative, and empowered research teams; design projects important to marginalized groups; and use conceptual frameworks that build on the work of marginalized scholars. Researchers were encouraged to promote inclusive consent processes, accessible recruitment materials, and recruitment and retention strategies that maximized diversity. When analyzing data, recommendations included involving community partners to ensure appropriate conceptualization and measurement of race, justifying the selection of reference groups, and considering intersectional identities. Recommendations for data interpretation include contextualizing findings, considering structural racism, and improving community involvement to enhance the transparency of data analysis. During dissemination, recommendations highlighted increasing accessibility of research findings.</p><p><strong>Conclusions: </strong>We identified a comprehensive list of recommendations describing antiracist research practices. Our synthesis can be used to guide individual research teams, institutional review boards, and grant committees, and to develop educational curricula around antiracist research practices.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"10 ","pages":"24731242261450046"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13421814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perinatal Quality Improvement Among Medicaid Populations in Hawai'i: Insights from a Statewide Learning Collaborative.","authors":"Andrea C Ng, Meldrick Ravida, Reinie G Gerrits-Goh, Fang Yuan, Charlie Iwata, Eva McKinsey, John P Barile, Yan Luo","doi":"10.1177/24731242261448657","DOIUrl":"10.1177/24731242261448657","url":null,"abstract":"<p><strong>Introduction: </strong>Hawai'i reports favorable perinatal health outcomes compared to national averages (preterm birth rate: 9.8%; infant mortality rate: 4.6 per 1,000 live births), yet disparities persist. Native Hawaiian and Pacific Islander women experience higher rates of preterm birth (12.6%) and lower early prenatal care (62.7%). Med-QUEST, Hawai'i's Medicaid program, supported implementation of a Perinatal Quality Collaborative (PQC) to expand access to evidence-based maternal safety practices across birthing facilities. Hospitals implemented protocols (e.g., training, drills, and equipment changes) aligned with the Alliance for Innovation on Maternal Health (AIM) Patient Safety Bundles, with cross-hospital learning facilitated through structured monthly meetings and peer exchange. This study examines how the PQC operationalized quality improvement (QI) among Medicaid-serving hospitals.</p><p><strong>Methods: </strong>We used a mixed-methods approach, including observational analysis of severe maternal morbidity (SMM) rates among Hawai'i's Medicaid population and 10 semi-structured interviews from participating birthing facilities. Interviews explored implementation processes, supports, and barriers. Hospitals' progress was tracked through milestone completion.</p><p><strong>Results: </strong>Participants reported structured AIM bundle implementation, gap analyses, and sustained peer exchange within a cooperative, non-competitive culture. SMM rates increased from 2016 to 2022 and stabilized in 2023 to 2024; racial/ethnic disparities persisted throughout the PQC implementation. Qualitative findings emphasized infrastructure and context-specific adaptations rather than targeted disparity-reduction strategies.</p><p><strong>Health equity implications: </strong>Expanding access to structured implementation support across diverse and rural hospitals may strengthen statewide QI infrastructure; targeted strategies beyond inpatient bundle implementation are likely necessary to reduce disparities.</p><p><strong>Conclusion: </strong>The state-level Pay-for-Performance effectively facilitated statewide implementation of AIM bundles and hospital-level QI processes among Medicaid-serving facilities. Observed SMM trends underscore the importance of sustained implementation efforts and complementary strategies to address disparities.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"10 ","pages":"24731242261448657"},"PeriodicalIF":2.3,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Africa's Place in Precision Medicine: Implications for Global Health Equity and Health Systems.","authors":"Sharif Kavuma","doi":"10.1177/24731242261451644","DOIUrl":"10.1177/24731242261451644","url":null,"abstract":"<p><p>Precision medicine, which is based on the idea of tailoring health care for individual genetic, environmental, and lifestyle factors, is rapidly revolutionizing biomedical research and clinical practice across the world. Despite the progress across the world, Africa only has a limited representation in precision medicine research and implementation. This view looks at where Africa stands today in the precision medicine sphere and identifies gaps in genomic data, infrastructure, workforce capacity, and policy frameworks. It examines the implications of these gaps for health equity globally the potential dangers of growing health disparities if African populations are not included in research and innovation. Furthermore, it outlines the strategies to enhance Africa's involvement in precision medicine, such as capacity building, regional partnerships, investment in bioinformatics, and research policies to ensure inclusivity. Strengthening Africa's role in precision medicine is crucial not only for improving health at the local level but also for ensuring equitable health outcomes across the globe.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"10 ","pages":"24731242261451644"},"PeriodicalIF":2.3,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13421976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}