Abstract
PURPOSE: The research team transformed a struggling health equity study by redesigning the clinical research infrastructure using population health management concepts and the A3 improvement methodology. The framework embeds the full cycle of clinical research in high acuity settings. This adaptive, nursing-led transformation aimed to optimize feasibility, to drive equitable access to research, and to bridge gaps in the literature.
METHODS: The research team overhauled the study using A3 improvement methodology within the framework of Lean and Plan-Do-Study-Act cycles. To optimize recruitment, our team developed workflows around sales funnel principles. Culturally competent and linguistically appropriate interactions fostered research access. Strategic resource allocation added to our research capacity.
Focusing on key success drivers, interventions were developed around the distribution of responsibilities, staff training, health equity, and data systems. Recruitment metrics—total enrollment, recruitment rate, prescreen-to-consent ratio—guided our interventions. Our sustainability plan tracked staff capacity, daily recruitment activities, and research quality indicators.
OUTCOMES: Efficiency improved with a 70% increase in the prescreen-to-consent ratio. Within six months, the team increased enrollment by 500%. Having enrolled 17% of all patients who screened positive for food insecurity, the study reached its target population.
Of those who enrolled in the study, 59% are Hispanic, 17% are non-Hispanic white, 11% are Black, and 3.6% are Asian. 42% were recruited using interpreters, highlighting research access. 80% of participants are over the age of 46, a risk of chronic illness burden in a population with unmet social needs.
IMPLICATIONS: The team integrated an emerging care model into a scalable research infrastructure. This facilitated research in clinical workflows, minimized regulatory risks, and improved feasibility. Our model informs health systems on the systematic adoption of equity-driven clinical processes and equips global research leadership with a replicable framework for continued improvement. In addition, our findings bridge critical gaps in existing literature on equity-focused infrastructure models that add research capacity while minimizing clinical disruptions. Because of this, our team effectively addressed linguistic, cultural, and socioeconomic barriers—driving equitable access to research for those with unmet social needs.
Notes
References:
B P, Kothapalli P, Vasanthan M. The role of quality assurance in clinical trials. Cureus. 2024;16(8):e67573.
Conde R. Necessary condition analysis for sales funnel optimization. J Mark Anal. 2025.
Myers JS, et al. Development and validation of an A3 problem-solving assessment tool. BMJ Qual Saf. 2022;31(4):287–296.
Rad J. Health inequities: a persistent global challenge from past to future. Int J Equity Health. 2025;24:148.
van Ede AFTM, et al. How to successfully implement population health management: a scoping review. BMC Health Serv Res. 2023;23:910.
Sigma Membership
Alpha Alpha Lambda at-Large
Type
Poster
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Health Equity or Social Determinants of Health, Public and Community Health, Interprofessional Initiatives, Clinical Research, Clinical Nursing Research, Access to Information
Recommended Citation
Salvado, Keith Henri; Tafoya, Elidia V.; Dean, Latanya; Hernandez, Grissel; and Ahuja, Neera, "An Adaptive Infrastructure Framework for Health Equity Integration into Clinical Research" (2026). International Nursing Research Congress (INRC). 57.
https://www.sigmarepository.org/inrc/2026/posters_2026/57
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-08-04
An Adaptive Infrastructure Framework for Health Equity Integration into Clinical Research
Toronto, Ontario, Canada
PURPOSE: The research team transformed a struggling health equity study by redesigning the clinical research infrastructure using population health management concepts and the A3 improvement methodology. The framework embeds the full cycle of clinical research in high acuity settings. This adaptive, nursing-led transformation aimed to optimize feasibility, to drive equitable access to research, and to bridge gaps in the literature.
METHODS: The research team overhauled the study using A3 improvement methodology within the framework of Lean and Plan-Do-Study-Act cycles. To optimize recruitment, our team developed workflows around sales funnel principles. Culturally competent and linguistically appropriate interactions fostered research access. Strategic resource allocation added to our research capacity.
Focusing on key success drivers, interventions were developed around the distribution of responsibilities, staff training, health equity, and data systems. Recruitment metrics—total enrollment, recruitment rate, prescreen-to-consent ratio—guided our interventions. Our sustainability plan tracked staff capacity, daily recruitment activities, and research quality indicators.
OUTCOMES: Efficiency improved with a 70% increase in the prescreen-to-consent ratio. Within six months, the team increased enrollment by 500%. Having enrolled 17% of all patients who screened positive for food insecurity, the study reached its target population.
Of those who enrolled in the study, 59% are Hispanic, 17% are non-Hispanic white, 11% are Black, and 3.6% are Asian. 42% were recruited using interpreters, highlighting research access. 80% of participants are over the age of 46, a risk of chronic illness burden in a population with unmet social needs.
IMPLICATIONS: The team integrated an emerging care model into a scalable research infrastructure. This facilitated research in clinical workflows, minimized regulatory risks, and improved feasibility. Our model informs health systems on the systematic adoption of equity-driven clinical processes and equips global research leadership with a replicable framework for continued improvement. In addition, our findings bridge critical gaps in existing literature on equity-focused infrastructure models that add research capacity while minimizing clinical disruptions. Because of this, our team effectively addressed linguistic, cultural, and socioeconomic barriers—driving equitable access to research for those with unmet social needs.
Description
The research team transformed a struggling health equity initiative by establishing research infrastructure centered on population health management concepts and the A3 improvement methodology. This adaptive framework facilitated the clinical integration of an emerging care model—improving recruitment and advancing health equity. The transformation showcased nursing leadership at the forefront of research and innovation.