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Strengthening Health Research to Advance Equitable, Patient-Centered Care
Lila J Finney Rutten1, Richard J Bold2, Nathan L Delafield3
1Professor of Health Services Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
NEJM Catalyst Innovations in Care Delivery
|July 15, 2026
Summary
Clinical trials must improve equitable participation by addressing barriers like restrictive criteria and mistrust. Strategies include community engagement, decentralized designs, and AI tools to enhance real-world relevance and patient partnership.
Area of Science:
- Health research methodology
- Clinical trial design
- Health equity
Background:
- Clinical trials are crucial for evidence-based medicine but often lack diversity and real-world applicability.
- Structural barriers impede equitable participation in clinical research.
- Historical mistrust and inequitable access to trial sites are significant challenges.
Purpose of the Study:
- To identify structural barriers limiting equitable participation in clinical trials.
- To propose strategies for enhancing equity, real-world relevance, and patient partnership in clinical research.
- To outline a cross-sector approach for improving clinical research design, funding, and implementation.
Main Methods:
- Analysis of insights from the 2025 Symposium to Strengthen Health Research.
- Identification of structural barriers to equitable participation.
- Development of a cross-sector strategy for research reform.
Main Results:
- Key barriers include restrictive eligibility criteria, historical mistrust, inequitable site access, and misaligned incentives.
- Community-engaged research, pragmatic and decentralized trial designs, and AI tools are essential solutions.
- A strategic shift is needed to embed equity and patient partnership into all research phases.
Conclusions:
- Overcoming barriers requires a multifaceted approach involving community engagement and innovative trial designs.
- Artificial intelligence can facilitate patient-trial matching and improve access.
- Embedding equity and patient partnership is vital for the future of clinical research.
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