The inclusion of racial and ethnic groups in clinical trials has been a national priority for decades, but progress toward that end has been limited. When the Covid-19 pandemic threw into stark relief the underlying inequities in health care access (and thus in access to clinical trials), Congress and the Administration were moved to action. In parallel, trial sponsors, hospitals, and other stakeholders have been accelerating efforts to increase diverse populations’ access to clinical trials. Given the complexity of the challenge, much more action is needed at multiple levels and by all involved.

A patient’s access to clinical trials depends upon how easily he or she can access care generally, whether providers offering the appropriate trial for the patient are nearby, whether the patient has trust in the physician recommending the clinical trial, and whether the patient has health care coverage to pay for care. These conditions often are not met, resulting, even under the best circumstances, in the exclusion of people of color and lower-income patients. Many initiatives aimed at breaking down barriers to access focus on the need to build trust between providers and diverse populations in the community. Of equal importance is the need to strengthen the overall capacity of the health care delivery system infrastructure to support clinical trials at the point of care. For most people, including diverse populations, this point of care is a community hospital. Though there are examples of robust clinical trial programs being offered by community hospitals, most do not offer trials—or their capacity to do so is limited.

This paper focuses on ways to strengthen community hospitals’ capacity to offer clinical trials for all people in their communities, ways to leverage the hospitals’ ability to contribute to advancing science by supporting research related to the trials, and ways to proceed with developing such efforts.

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