A Research Agenda to Mitigate Racial and Ethnic Disparities in U.S. Critical Care Medicine: An Official American Thoracic Society Research Statement.

Background: Racial and ethnic disparities exist in critical illness outcomes in the United States. Objectives: To identify research priorities for reducing disparities in U.S. critical illness outcomes. Methods: A 22-member multidisciplinary committee participated in virtual workshops to appraise the literature and discuss opportunities for structural changes to reduce disparities in critical illness outcomes. The co-chairs conducted content analysis of workshop recordings to identify research priorities, then committee members completed a survey to rate the feasibility and potential impact on health outcomes of each priority. Research priorities were classified as highly feasible and/or highly impactful if ≥85% of responses indicated agreement or strong agreement. Results: The committee identified 35 research priorities to reduce U.S. critical care disparities in the following categories: mechanisms of disparities, research outcomes, data sources, and research methods. Nearly all priorities related to data sources and research methods were considered highly impactful. Research priorities considered both highly impactful and highly feasible were as follows: 1) mechanisms: examining variability in a) evidence-based care and b) clinician communication; 2) research outcomes: the use of hierarchical outcomes that evaluate patient-relevant trade-offs; and 3) research methods: the use of a) multicenter studies to address center-level variation and structural barriers to equity, b) qualitative and mixed methods to center the patient and family voice, c) interdisciplinary research teams that incorporate the broad expertise necessary to address complex social problems, d) directed acyclic graphs to promote causal inference, and e) quality improvement collaboratives comprising multiple stakeholders working together to achieve equitable outcomes. Conclusions: These results offer a roadmap for future critical illness health equity research.