Equitable Access and Use of Health and Community Services

Access to quality and affordable health services is shaped by social determinants of health and organizational structures and processes, financing systems, and behaviors that shape the development of disparities in service coverage, timeliness, and utilization.^1,2  Health disparities and inequities in service access and utilization (by sex, gender, race, ethnicity, income, education, disability status and other social characteristics) prompts the need for better measures and evidence-based programs and interventions.

This research priority focuses on equitable access to high value systems that deliver safe, quality, efficient, and effective services in a care continuum, inclusive of hospital, clinic, and/or home and community services.

Need and Relevance to Occupational Therapy:

Equitable Access to Use of Health and Community Services has been identified as:

• a critical issue for improving the value of occupational therapy services in diverse practice contexts across a care continuum
• an area in which evidence-based measures and interventions are needed
• an area where occupational therapy expertise would be valued.

Specifically, occupational therapy expertise is pivotal to advancing person-centered care for priority populations, including individuals with complex healthcare needs and those who identify as belonging to historically minoritized groups.³ Our professions practice framework endorses the collection and use of evidence-based patient-reported outcomes and contextual data to capture a client’s profile of unmet occupational performance and participation needs.⁴ Our profession and its relevant funders for this research priority emphasize strengthening health services and implementation research workforce capacity^5,6 to embed and harness patient-reported data for directing equitable person-centered care that is responsive to areas of unmet need.^7-11 The intentional use of real-world data, such as service records or public health data, for research can accelerate clinical decision-making to improve the patient experience. Additionally, this type of data can enable service organizations to evolve as learning health systems that effectively harness and apply information in their data systems to generate and translate knowledge that can guide decisions about delivery and payment models that improve equitable service access and use.^8-11 Furthermore, occupational therapy expertise can contribute to the development, implementation, and evaluation of person-centered and occupation-focused interventions that support the people, communities, and populations we serve in their efforts to access and use health and community services.

AOTF is committed to amplifying investigators and stakeholders from historically minoritized groups to build a scientific workforce that is adequately poised to advance this research priority. These investigative teams will advance novel approaches to understanding and improving equitable access and use of health services that are aligned with the profession’s practice scope.

1. Healthy People 2030. Social determinants of health. Retrieved on August 11, 2022 from https://health.gov/healthypeople/priority-areas/social-determinants-health 

2. Healthy People 2020. (2022). Social determinants of health. Retrieved from 
   http://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health 

3. Mroz, T., Pitonyak, J.S., Fogelberg, D., & Leland, N.E. (2015). Client-centeredness and health reform: Key issues for occupational therapy. American Journal of Occupational Therapy, 69(5), 6905090010p1-6905090010p8. https://doi.org/10.5014/ajot.2015695001.  

4. American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi. org/10.5014/ajot.2020.74S2001 

5. Hand, B., Li, C-Y, & Mroz, T. (2022). Health services research and occupational therapy: Ensuring quality and cost-effectiveness. American Journal of Occupational Therapy, 76(1). 7601170010. https://doi.org/10.5014/ajot.2022.761001. 

6. Juckett, L., Robinson, M., & Wengerd, L. (2019). Narrowing the gap: An implementation science research agenda for the occupational therapy profession. American Journal of Occupational Therapy, 73(5), 7305347010p1-7305347010p6. https://doi.org/10.5014/ajot.2019.033902 

7. Stern, B., (2022). Clinical potential of patient-reported outcome measures in occupational therapy. American Journal of Occupational Therapy, 76(2), 7602090010. https://doi.org/10.5014/ajot.2022.049367. 

8. The Agency for Healthcare Research and Quality (AHRQ) Strategic Plan (n.d.). Retrieved August 13, 2022 from: https://www.ahrq.gov/cpi/about/mission/strategic-plan/strategic-plan.html 

9. The Patient-Centered Outcomes Research Institute (PCORI) Strategic Plan (n.d.). Retrieved August 13, 2022 from: https://pcori.org/about/about-pcori/pcori-strategic-plan.  

10. National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) 2018-2023 Long-Range Plan. (n.d.). Retrieved August 13, 2022 from: https://acl.gov/sites/default/files/about-acl/2020-02/Accessible%20NIDILRR%202018-2023%20Long-Range%20Plan%20FINAL%20_%20CLEARED.docx 

11. National Institute on Mental Health (NIMH) Strategic Plan (n.d.). Retrieved August 13, 2022 from: https://nimh.nih.gov/about/strategic-planning-reports