Correction to: Designing an implementation strategy to increase health-related social needs screening: Applying the PRISM framework in a resource-limited clinical setting.
Correction to: Designing an implementation strategy to increase health-related social needs screening: Applying the PRISM framework in a resource-limited clinical setting.
复制标题
更正：设计实施策略以增加与健康相关的社会需求筛查：在资源有限的临床环境中应用 PRISM 框架。
DOI：
10.1093/tbm/ibad080
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发表时间：
2024
影响因子：
3.6
通讯作者：
中科院分区：
文献类型：
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作者：
尽管越来越多的人接受与健康相关的社会需求（HRSN）筛查，并且越来越多的政策鼓励采用，但HRSN筛查的临床实施仍然很低。对于社区卫生中心（CHCs）来说，HRSN筛查尤其困难，因为它们的资源有限，无法实施和维持新的工作流程。虽然chc为未满足社会需求的患者提供了不成比例的高水平护理，但确定考虑到chc特定情况的HRSN筛查实施策略仍然难以捉摸。本研究使用实用稳健实施和可持续性模型（PRISM）来设计一个考虑到CHCs独特背景的实施策略。我们使用快速人种学评估观察和利益相关者焦点小组来确定当前的工作流程障碍和促进HRSN筛选的因素，并制定包括多层次背景和视角的实施策略。我们确定了导致低筛查实施的八个主题：围绕筛查的感知耻辱；需要以社区为基础的解决办法；重新确认组织的优先事项和价值观；电子病历（EMR）限制；多任务压力限制了执行；员工流动率;对监管要求了解有限；以及可供转诊的社区资源。根据主题，我们确定了实施策略，包括收集非电子病历数据；集成到多个工作人员的工作流程中；创建新的培训和教育模块；并识别同行冠军进行实时再培训。行政要求是必要的，但不足以在CHCs中实施HRSN筛查。资源受限的设置受益于特定于上下文的利益相关者参与，以提高实施的成功。PRISM的使用确保了上下文因素是实施战略设计的核心。
Despite growing acceptability of health-related social needs (HRSN) screening and increasing policy incentives for adoption, clinical implementation of HRSN screening remains low. HRSN screening has been particularly difficult for Community Health Centers (CHCs), which have limited resources to implement and sustain new workflows. While CHCs provide care to patients with disproportionately high levels of unmet social needs, identifying HRSN screening implementation strategies that take CHC-specific contexts into account remains elusive. This study uses the Practical Robust Implementation and Sustainability Model (PRISM) to design an implementation strategy accounting for the unique context of CHCs. We used Rapid Ethnographic Assessment observations and stakeholder focus groups to identify current workflow barriers and facilitators to HRSN screening, and to develop implementation strategies that include multi-level contexts and perspectives. We identified eight themes contributing to low screening implementation: perceived stigma around screening; need for community-based solutions; re-confirming organizational priorities and values; Electronic Medical Record (EMR) limitations; multi-tasking pressures limiting implementation; staff turnover; limited knowledge of regulatory requirements; and community resource availability for referral. Based on the themes, we identified implementation strategies including non-EMR data collection; integration into the workflow for multiple staff members; creation of new training and educational modules; and identification of peer champions for retraining in real time. Administrative requirements are necessary but not sufficient for implementation of HRSN screening in CHCs. Resource-constrained settings benefit from context-specific stakeholder engagement to improve implementation success. The use of PRISM ensured contextual factors were central to the implementation strategy design.