Evaluating a Health Equity Adaptation to Evidence-based Quality Improvement

Patient groups with known vulnerabilities to poor health outcomes may be less likely to receive or benefit from evidence-based practices (EBPs). Implementation science-the study of methods and strategies to promote EBP adoption into routine clinical practice-can both mitigate and exacerbate health inequities. Despite increasing recognition of health equity's importance to implementation science, implementation strategies do not typically integrate health equity. We aimed to pilot and evaluate a health equity adaptation to Evidence-Based Quality Improvement (EBQI), a multi-faceted implementation strategy bundle. The health equity adaptation provided specific steps to incorporate health equity into practice facilitation and quality improvement (QI) training, including a health equity didactic session provided to frontline primary care clinical champions. Our mixed methods evaluation included a clinical champion survey to assess acceptability of the health equity training and clinical champion and practice facilitator interviews to assess feasibility and acceptability of embedding health equity within the implementation strategy. We calculated survey response means and used rapid qualitative analysis to analyze interviews. Survey responses indicated neutral to high acceptability of the health equity didactics. In interviews, clinicians and facilitators reported that equity-infused practice facilitation was valuable and effective in supporting equity considerations in implementation. Facilitators felt comfortable incorporating the adaptation into future EBQI facilitation. Champions noted the equity adaptation influenced how they provided care to their patients. Our evaluation also revealed areas for improvement, and challenges inherent in implementation and health equity work. Future work can refine the health equity adaptation for other implementation projects that use EBQI.