Transforming Health Equity Research in Integrated Primary Care: Antiracism as a Disruptive Innovation

Increased media attention regarding COVID-related health disparities combined with horrific institutionalized violence against Black/African Americans have revitalized the call to action to address systemic racism in health care. Among the consequences of systemic racism in health care are significant health disparities in prevalence, diagnosis, and treatment of comorbid physical and mental health conditions, inequities that synergistically result in poor physical and mental health outcomes. Black/African Americans’ health inequities are further increased by their significant overrepresentation in prisons and jails, experiences directly related to poor mental and physical health outcomes both prior to and after incarceration. Despite decades of studies acknowledging racial health disparities and increased awareness of the social determinants of health, we seem to be light-years away from significant change. Racism still very much impacts the health care delivery system even in systems designed for low-income and minority populations that strive to integrate physical and mental health treatment in primary care such as Patient Centered Medical Homes.

Patient Centered Medical Homes are primary healthcare settings that provide coordinated medical and behavioral health care to patients in poverty — not providing in-home care but rather establishing a “home base” for treating the whole person. These settings centralize interactions between patients and their personal physicians to ensure patients receive care when and where they need and want it in culturally appropriate manners.

Fundamental new insight is needed to disrupt healthcare racism and improve outcomes for the individuals, families, and communities served by Patient Centered Medical Homes. As racism in health care is woven throughout a complex system, we propose that healthcare racism can be disrupted by diffusing anti-racism innovations at critical points in the system. The project aims to generate a new transformative paradigm to ignite the stagnate field of antiracism health care interventions to change behavior, policies, and practices in order to fully realize the potential of integrated primary care models such as Patient Centered Medical Homes for achieving health equity for Black/African Americans and other persons of color. The project will focus on Florida’s Patient Centered Medical Homes and develop new policy- and organizational-level antiracism innovations to test in collaboration with administrators, healthcare providers, patients, and community members.

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