“…[T]oo many studies in our annual report on disparities consistently demonstrate we have to change the way health care is delivered if we’re going to get to high quality affordable care for everyone.” - Carolyn Clancy, Director, AHRQ
One of the major themes of the Scale Up & Spread Round Table was the dearth of resources for the scale and spread of innovations that are badly needed to improve health care quality. AHRQ has long recognized that the needs are even greater and the resources even scarcer for providers of underserved and vulnerable populations, such as federally qualified health centers, community clinics, substance abuse treatment centers, and mobile health vans. Their patients often present with complex health issues, which are exacerbated by economic and social resources that are limited at best. As Joseph Skelton noted, they may require basic social services such as emergency housing before they can even attend to their health needs.
Safety net providers have long been in serious need of quicker, better, and cheaper ways to deliver health care. Some of these innovations might be the same as those suitable for general populations. For example, David Dorr noted that his Care Management Plus innovation has been adopted by a range of primary care practices, including a number of federally qualified health centers. However, other innovations might be poorly suited for vulnerable populations. As Adam Zavadil pointed out, innovations involving time-consuming treatment might not well serve the working poor who often do not receive sick leave.
The serious health problems of vulnerable populations and the persistence of large disparities documented by AHRQ’s National Healthcare Disparities Report supports the need for a more in-depth examination of how innovations can be scaled and spread to strengthen and sustain safety net health care.