The recent release of the Agency for Healthcare Research and Quality's (AHRQ) Research Priorities and Compliance Guidance signals a potential pivot point for US health services research (HSR). While the strategy includes promising commitments — such as investing in long COVID research and strengthening replication and reproducibility, there are several other key areas of concern. In particular, it is notable that AHRQ’s focus has evolved from producing evidence “to make health care safer, higher quality, more accessible, equitable, and affordable” (2024) to a focus on conducting and supporting “research into improving health outcomes, evaluating the strength of evidence for medical procedures, treatments, and preventive interventions, and investigating ways to improve healthcare treatments” (2025). While AHRQ must align with mandates for rigor and transparency, framed by the Trump administration’s push for "gold-standard science," the specific language in the guidance—particularly its skepticism toward "poorly measured factors" like systemic racism and its distinction between "health research" and "social policy research"—threatens to undermine longstanding areas of inquiry in HSR.
The core question facing the HSR community is this: will the pursuit of quantitative rigor be allowed to eclipse the deep, contextual understanding necessary for real-world health system change? The lost emphasis on accessible, equitable care is no mistake. What is at stake is the progress made and future contributions to traditional pillars of AHRQ’s work: patient-centered care, health disparities, and dissemination & implementation (D&I) science.
The Gold Standard Versus Lived Experience
The administration's interpretation of "gold-standard science" emphasizes scientific integrity, reproducibility, and the use of falsifiable hypotheses. While these are essential, they prioritize easily quantifiable data, like administrative metrics and clinical trial results, over the complex, adaptive realities of care delivery. This creates a direct clash with AHRQ’s traditional emphasis on patient-centered care.
What we risk losing:
- Patient Voice: Patient-centered care is defined by respect for and responsiveness to individual patient preferences, needs, and values. This requires understanding the subjective reality of the patient—such as their trust in the system, their communication difficulties, or their experience of bias. This context is captured via qualitative data (e.g., interviews, focus groups) and patient-reported experience measures (PREMs) like the CAHPS surveys. By warning against research based on "subjective claims," the guidance risks silencing the patient perspective. If researchers are discouraged from funding work that captures this "unfalsifiable" context, they may produce interventions that are statistically sound but emotionally, culturally, and practically irrelevant to the people they are meant to serve. The result is a system that is clinically efficient but humanly alienating.
- Contextual Insight: The guidance pushes HSR toward finding clinical solutions within a vacuum, ignoring the fact that a patient's adherence, engagement, and outcomes are driven by forces outside the clinic walls. The narrow focus risks funding "what-works-on-average" studies while sidelining the critical "what-works-for-whom, and why" research.
Health services research has long combined rigor and reproducibility with context and lived experience. Without both, research cannot translate into better care for patients.
The Paradox of Health Disparities Research
AHRQ’s guidance presents a stark paradox: it calls for "shifting to solution-oriented approaches in health disparities research" while simultaneously restricting the investigation of underlying causes.
What we risk losing:
- Structural Causality: Health equity research acknowledges that disparities (like the disproportionately high rates of maternal mortality among Black women) are not random; they are often the predictable result of systemic factors such as residential segregation, differential provider access, and historical medical mistrust. The guidance, by labeling research into "systemic racism" or other structural causes as potentially utilizing "poorly measured factors," blocks the investigative path to root causes. If researchers are only permitted to study proximate, measurable factors (e.g., patient education levels) and not the mechanisms of structural inequity (e.g., resource allocation across racial lines), the resulting solutions will be superficial and ephemeral.
- Equitable Intervention Design: The warning against research that "promotes differential treatment of people based on race or ethnicity" dangerously conflates necessary equitable intervention with malicious discrimination. To achieve equity, care must be tailored: a cancer screening program in a community with documented medical mistrust will fail without a targeted, community-based, culturally competent outreach strategy. This is not discrimination; it is public health necessity. Restricting the study of differential needs guarantees that one-size-fits-all, ineffective solutions will continue to be funded and patients and health systems will suffer.
Health disparities research is a vital part of HSR. It ensures that evidence does not just tell us what works, but helps us design care that works equitably for different people and communities.
The Erosion of Dissemination & Implementation (D&I) Science
AHRQ has historically been a key supporter of D&I science, the field dedicated to closing the chasm between research evidence and routine practice. D&I science is inherently interdisciplinary and contextual, often examining organizational culture and policy environments.
What we risk losing:
- Practical Effectiveness: D&I science is concerned with real-world effectiveness over clinical efficacy. It answers the crucial question: why does an intervention that worked perfectly in a controlled trial fail in a community hospital? The answer almost always lies in "unfalsifiable" or "subjective" contextual factors—organizational capacity, leadership buy-in, staff morale, or community-level barriers. By demanding only "precise and measurable" concepts, the guidance risks turning D&I into a purely descriptive field, incapable of identifying and intervening on the structural levers of change.
- Interdisciplinary Scope: The distinction in the guidance between "health research" and "social policy research" is profoundly misguided in an era dominated by social determinants of health (SDOH). D&I science relies on integrating clinical, population, and translational research. Separating these elements creates a false dichotomy that prevents HSR from addressing the drivers that account for the overwhelming majority of health outcomes. By labeling SDOH research as a "diversion of resources," AHRQ risks abandoning the translational work that is most critical for improving outcomes for all.
Dissemination and implementation science is quintessential HSR. It takes proven interventions and makes them work in diverse, real-world settings — turning evidence into action that improves care for patients and communities.
The Road Ahead
AHRQ’s guidance is not a final blueprint. The true impact of this emphasis on "gold-standard science" will be determined by how the agency translates this guidance into actual funding opportunities and review criteria. And with the devastation of the extramural and scientific review divisions at AHRQ breaking their ability to manage grant opportunities, it is unclear how they will put this into action at all. If the implementation is overly rigid, restricting the use of robust qualitative, ethnographic, and D&I methods, health system transformation will be hobbled. We will continue to accrue vast quantities of clean, replicable data that tell us what is failing, but we will be starved of the deep, contextual evidence necessary to tell us how to fix it and for whom. The HSR community, policymakers, and patient advocates must closely monitor the agency's subsequent actions to ensure that the pursuit of methodological rigor does not come at the expense of a truly equitable, patient-centered, and effective healthcare system. The pursuit of rigor must serve equity, not suppress it.
Together, patient-centered care, health disparities research, and D&I science reflect critical areas of health services research: rigorous, relevant, and ready to improve health and health care for all.