Bias Reduction, Better Access Key to COVID-19 Equity Gains

COVID-19 management in communities disproportionately adversely affected by the pandemic can best be optimized by targeted interventions informed by comprehensive health needs assessments at 3 levels of health care within these communities: patient, provider, and health system. In research presented by the American Medical Group Association at its 2025 annual meeting, a team of investigators explain that understanding local context and potential biases is vital to scaling up and implementing interventions to help overcome inequities in health care delivery evidenced by the pandemic.1

Three health care organizations (HCOs) used the National Institute on Minority Health and Health Disparities Research Framework to help guide their multilevel mixed-needs assessments and interventions included in this analysis.2 Among the data collected were COVID-19 treatment and treatment fills, bias in health care, minority patient health care experiences, electronic health records (EHRs), provider multiculturally competent sensitive service system assessment, and patient and provider demographics, knowledge, and attitudes.1 Quantitative data were analyzed for September 2022 to December 2024 and qualitative patient and provider data for January to May 2024. Only adult patients aged at least 18 years who had at least 1 interaction with 1 of the 3 HCOs in the prior 36 months, a documented acute COVID-19 diagnosis, and received at least 1 dose of a COVID-19 vaccine were included.

Patient and Provider Survey Results

These surveys sought to cover 5 main concerns the interventions could help address: treatment adverse effects, provider concerns of viral rebound, seeking care soon after symptom onset, provider education on timely treatment, and standardization of treatment protocols.

Overall, 4 times as many patient surveys (n = 467) vs provider surveys (n = 109) were returned during the project period, with the HCOs reviewing EHR data for more than 1.8 million patients. Three major outcomes were seen across these responses: COVID-19 vaccination increased between 4.1% and 12.9% across all patient groups, vaccination rates rose specifically for Black and Hispanic patients, and disparities dropped specifically between Black and White patients despite others persisting or increasing among other patient groups.

In this research presented at the recent annual AMGA meeting, investigators explain that understanding local context and potential biases is vital to scaling up and implementing interventions to help overcome inequities in health care delivery evidenced by the COVID-19 pandemic. | Image Credit: © Maggie L. Shaw

Up to 26% of the patients waited 4 or more days to get tested for COVID-19 after first noticing symptoms, and up to 25% waited 6 or more days to seek care. Further, up to 30% expressed concerns about adverse effects of medications to treat COVID-19 or were unaware of medications even being available to treat their infection. Patients also voiced 10% to 20% more concern about COVID-19 medications compared with being prescribed any medication by their provider, and between 27% and 30% of patients from historically marginalized communities felt their race or ethnicity may have had a negative impact on their overall care quality.

In addition, despite upwards of 80% of providers engaging with their patients to address vaccine concerns and reduce communication bias, less than 50% also engaged with coworkers in discussions on bias.

Treatment prescriptions increased between 0.1% and 13.1% for the 3 HCOs during the study period, prescribing disparities fell by a significant 13% specifically between Black and White patients at one of the HCOs, 2 of the HCOs had episodes where prescribing disparity gaps fell 2% to 14% between Black and White patients, and 2 of the HCOs were able to reduce prescribing disparities by 7% for Hispanic patients vs 4.4% for non-Hispanic patients.

Multilevel Interventions and Next Steps

To facilitate these results, at the health system level, cultural compentency was made mandatory for health care providers and staff, websites were updated with information on high-risk conditions and available treatments, and community partnerships were forged. At the provider and point-of-care level, the use of standardized smartphrases was initiated when patients reported positive at-home COVID-19 results, and education was delivered on treatment guidelines and medication efficacy. At the patient and community level, guides were published that addressed patient empowerment and advocacy, and kiosks helped address social determinants of health and provided COVID-19 education and outreach.

Even with the improvements they saw, the authors highlighted several areas needing improvement in the health equity space. HCOs could benefit from effective, targeted interventions informed by patient-, provider-, and health-system level interventions; it’s important that HCOs understand the local context and environments in which they operate if they are to provide optimal care; long-term impact assessments are vital to tracking quality outcome measures; and current interventions need to be scaled up and new interventions implemented as more information trickles in.

“Implemented interventions were an initial step to address health equity,” the authors wrote, “and HCOs were encouraged to continue to build upon completed work, including scaling up interventions and implementing additional interventions.”

References

1. Ruvalcaba E, Tallam M, Ciemins E. Health system strategies for advancing equity and reducing disparities: COVID-19 treatment and management. Presented at: AMGA Annual Conference; March 26-29, 2025; Grapevine, TX. Poster 14.

2. National Institute on Minority Health and Health Disparities Research Framework. NIMHD. Accessed April 14, 2025. https://www.nimhd.nih.gov/about/overview/research-framework/nimhd-framework.html