Clinical and Health Services Research
Under this research interest area, NIMHD supports clinical and health services research to generate new knowledge to improve health/clinical outcomes and quality of health care for populations that experience health/health care disparities.
The scientific portfolio includes extramural grants, cooperative agreements and training awards related to the topics below.
Toward alignment with NIMHD’s goals and priorities, we strongly encourage prospective grantees to contact extramural program officials before submitting applications whether in response to topic-based or parent grant funding announcements.
Clinical Research and Treatment Interventions Within Health Care Settings
Research to describe and understand the health profile and clinical manifestations of diseases in minority populations (that is, research on minority health) and identify the most effective methods to screen, diagnose, treat, and/or manage medical conditions that improve health/clinical outcomes within specific populations that experience health/health care disparities, and reduce the latter within the context of health care settings.
Population-Focused Clinical Research Within the Context of Health Care
Research to understand and address the various population-specific clinical presentations and/or manifestations of diseases and their complications, and the similarities and differences among populations that experience health disparities. Examples of such research include, but are not limited to identifying appropriate screening criteria to determine disease risk and delineating tailored screening and disease management methods or biomarkers, based on clinical presentation of diseases and their complications, screening and diagnostic thresholds, treatment response, interventions or clinical trials’ findings, to assess response to clinical interventions and treatment.
Health Disparities Within the Context of Health Care Settings
Research to understand and address etiologies of health disparities within the context of clinical care and health services, such as treatment access, patient safety, adverse events, quality of care, health system errors, mistrust, structural racism and inequities, and health policies. Examples of such research include but are not limited to, assessment of effectiveness and implementation of evidence-based guidelines of diagnosis and clinical care for diseases with high prevalence or burden among patients of different ages from populations that experience health disparities (including those in rural healthcare settings); evaluation of access to care and effective treatment for individuals with multiple chronic diseases; assessment of the timeliness and effectiveness of emergency medical care response and resulting health outcomes in low-income or low-resource settings; reduction of preventable visits to the emergency department, hospitalizations and in-hospital complications and/or mortality; understanding and implementing interventions on disparities in pediatric health services; understanding and addressing disparities in surgical care and post-surgical recovery; understanding the causes of disparities in severe maternal morbidity and mortality; implementing interventions to reduce maternal and infant mortality in populations at high risk; implementing interventions to reduce maternal morbidity and improve postpartum maternal and infant physical and mental health outcomes; studies that analyze the relationship between social determinants of health and clinical outcomes; studies that integrate genetics/genomics or social care into clinical practice; pragmatic clinical trials; clinical and translational research, effectiveness assessment of different health information technologies in improving access to health care; and defining effective metrics of quality of care.
Preventive and Health Promotion Interventions in Health Care Settings
Research to develop and evaluate preventive or health promotion interventions delivered to patients from populations that experience health/health care disparities within the health care system including underserved rural health care settings and low-resource health care settings. The goal of such interventions is to keep patients healthy or reduce the severity or progression of diseases. Activities may include health communication, health education, wellness programs, early screening, and immunizations/vaccinations, as well as other health systems and policy changes that encourage, make available, and enable patients and their families to use information and/or health services. These may include digital information technology and analytics (e.g., artificial intelligence, simulation modeling) to improve clinical and health outcomes.
Program Contact(s): Dr. Sundania Wonnum
Implementation and Dissemination Research in Health Care Settings
Research to understand barriers and facilitators to the adoption of and adherence to evidence-based practices, interventions, and policies within clinical system processes and health care settings, and to develop, test, and evaluate different strategies to enhance successful adoption, adherence, feasibility and sustainability of evidence-based practices, interventions, and policies for patients from populations that experience health/health care disparities, including in underserved rural health care settings. This type of research may include observational or intervention studies, interventions in multiple components of existing or newly designed health care models, and studies that leverage user-centered or rapid cycle designs or embeds research as part of a learning health care system. Research should incorporate elements of scalability and sustainability particularly to low-resource clinical and community settings that serve populations that experience health disparities. The ultimate outcome of these implementation and dissemination strategies is to attain optimal health outcomes and move clinical care towards health equity. These may include digital information technology and analytics (e.g., artificial intelligence, simulation modeling) to improve clinical and health outcomes.
Patient-Clinician-Health Care System Interactions
Research to understand patient-clinician, clinician-clinician, clinician-health care system and/or patient-health care system engagement/partnership, trust, communication, and shared decision-making. Also, research to understand the patient-clinician communication and/or relationship on health/clinical outcomes in populations that experience health/health care disparities (including underserved populations in rural areas), and the development, testing and evaluation of interventions that enhance these interactions, and its impact on health/clinical outcomes, and the reduction of health/health care disparities.
Clinician and/or Health Care System Bias and Cultural Competence
Research focused on assessing and understanding conscious and unconscious biases and cultural competency of health care providers and other actors within the health care system regarding patients from populations that experience health/health care disparities; and assessment and understanding of patients’ conscious and unconscious biases regarding health care providers, and interventions to reduce those biases and improve cultural competence. In addition, studies that assess the impact of those interventions on quality of care, patients’ health/clinical outcomes and reduction of health/health care disparities.
Patient-Clinician/Health Care System Communication
Research to understand the nature and patterns of communication (including implicit and explicit bias) between patients from populations that experience health disparities and points of contact at different levels within the health care system (not limited to clinicians and health care teams); interventions to facilitate effective bidirectional communication, build trust and mutual respect between patient and clinician, patient self-advocacy, empowerment/partnership, organizational health literacy, and shared decision-making (for example, decision aids for risk assessment and informed choice) between health care systems and patients and their families including the impact of such interventions on quality of care and health/clinical outcomes, and on reducing health/health care disparities.
Patient Engagement and/or Partnership in Care
Research to understand factors in clinical care that trigger, facilitate, or deter agency/engagement/partnership of patients from populations affected by health disparities across the care cascade (for example, screening, diagnosis, continuity of care); interventions to enhance agency/engagement/partnership and the impact of these interventions on health/clinical outcomes and/or health/health care disparities. Interventions can occur within clinical settings or in the community but are offered in conjunction with clinical care. Examples include developing, testing, and evaluating patient self-management interventions; interventions including patient-reported outcomes; assessing the impact of different health information technologies on health education interventions; and health education interventions offered within medical settings.
Clinician-Clinician/Healthcare Team Interactions
Research to understand care team structure and teamwork processes that promote comprehensive care coordination, proper hand-offs/care transitions, and continuity of care across the care continuum among populations that experience health disparities. Interventions to improve team-based care delivery and interprofessional competencies and to address challenges to and breakdowns in care coordination, communication, collaboration, as well as other teamwork structures and processes that impact care decisions, clinical care processes, equitable access to quality care, and health/health care disparities. Health workforce research to understand and address the needs of the health workforce, including workforce supply, distribution, competencies, and diversity as well as clinical burden, burnout, and resilience.
Epidemiology of Health Care Utilization and Outcomes
Research to identify patterns of healthcare utilization, quality, and outcomes in populations that experience health disparities (including underserved rural populations), as well as to identify social, environmental, and other determinants of health care utilization patterns and health/clinical outcomes, and their contributions to health/health care disparities across the life course. This type of research may include longitudinal studies, natural experiments (resulting from change in public or health policies, for example), and predictive or simulation modelling. The use of advance analytics may include data mining, machine learning, and artificial intelligence. Research may include the linkage of existing and emerging data sources that capture and harmonizes data from multiple contextual levels, including the patient, clinician, healthcare team, health system, neighborhood, and policy levels; and the establishment of data repositories and data standardization using common data elements such as the PhenX toolkit.
System-Level Health Services Research
Research to understand how health care system factors influence health/clinical outcomes in populations that experience health/health care disparities.
Health Care System Organization and Coordination
Research to examine how the structure and organization of health care delivery impact health service utilization and health/clinical outcomes in populations that experience health/health care disparities. This research includes but is not limited to evaluation or interventions involving different units or levels of health care coordination within a health care system or across health care systems serving patient populations that experience health care disparities. This research may also focus on health care models or their components, whether existing or newly designed models. Examples include developing, testing and/or evaluating interventions or policies within health care models such as accountable care organizations and patient-centered medical homes; assessment of co-located services, virtual/remote health services, use of patient navigators; and evaluation of the effectiveness of various strategies to increase the supply of and access to health care practitioners in medically underserved areas, among others. Research may include the development and testing of coordination and collaboration tools/modalities using health information technology or telemedicine (potential funding through SBIR/STTR programs).
Health Care Policies
Research that examines and evaluates the impact of changes in local, state and/or federal health care policies (e.g., laws/policies regarding insurance coverage, financial incentives, eligibility for services, health professionals’ and health care systems’ cultural competency standards, family and medical leave, sick leave, accreditation) on health services utilization and health/clinical outcomes for populations that experience health/health care disparities, including maternal and infant mortality and maternal morbidity, utilization of health services and continuity of care after disasters, and the health/health care of underserved populations in rural areas. Health policy interventions that make the health care delivery system more affordable, equitable, and higher quality for populations that experience health/health care disparities.
System/Multilevel Interventions to Improve Quality of Care
Research to develop and/or evaluate health care system-wide interventions or multi-level interventions that include system-level components to reduce system bias, increase health equity, improve access to or quality of care for populations that experience health/health care disparities. Examples include studies that optimally define and assess the integration of social determinants of health in electronic health records or social care into clinical practice; assessments on the impact of telemedicine on continuity of care, treatment adherence and/or clinical outcomes; patient-care team/ health system communication initiatives; interaction between outpatient/inpatient medical informatics; and effects of in-home medical services (including pharmacy) on health/clinical outcomes.
Health Care Delivery in Community-Based Settings
Research to understand health care utilization and outcomes in association with services and treatment provided in community-based settings (outside of traditional health care systems) for populations that experience health/health care disparities. Studies that explore community-health system and/or academic partnerships. Studies that seek to understand the medical neighborhood and interactions between health care systems and community-based settings.
Health Care Delivery in Behavioral Health Settings
Research to understand and/or improve formal care for populations that experience health/health care disparities in community-based mental health, drug treatment and related settings, including clinics, private practice settings, residential treatment facilities and detoxification centers.
Health Care Delivery in Long-Term, Palliative or End-of-Life Care Settings
Research to understand or improve formal health care provided to populations that experience health/health care disparities (including underserved rural populations) in nursing homes, rehabilitation centers, assisted-living facilities, hospice settings, long-term care facilities, ambulatory or home-based palliative care, and in home-based long-term health care.
Health Care Delivery in Non-Healthcare Settings
Research to understand or improve formal health care provided to populations that experience health/health care disparities in school-based health centers, the workplace and criminal justice settings. This does not include health promotion activities that may be delivered by non-medical personnel in those or other settings (for example, health fairs).
Page updated Oct. 13, 2023