Community participation gaps look less like a question of patient willingness and more like a financing and infrastructure problem that no single bill has yet solved.
Commentary|Articles|November 5, 2026
Closing the Community Access Gap: Q&A with Kent Thoelke, Paradigm Health
Author(s)Kent Thoelke, Andy Studna, Senior Editor
In this Q&A, Kent Thoelke, CEO of Paradigm Health, discusses why participation gaps in community and rural settings come down to both patient cost barriers and site infrastructure, how legacy workflows weigh on community clinics, and what policy and technology changes it would take to make clinical research a real care option for more patients.
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For most patients in the United States, community and rural clinics are where care happens, yet those same settings are where clinical research is least available. The barriers run in two directions at once: patients who cannot absorb the financial cost of participating, and sites that cannot absorb the administrative weight of running trials on workflows built decades ago.
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