Addressing adverse social determinants of health in pediatric primary care: Study protocol for a hybrid type 2 effectiveness-implementation randomized controlled trial in two national pediatric practice-based research networks.
Addressing adverse social determinants of health in pediatric primary care: Study protocol for a hybrid type 2 effectiveness-implementation randomized controlled trial in two national pediatric practice-based research networks.
复制标题
解决儿科初级保健中健康的不利社会决定因素：在两个国家儿科实践研究网络中进行混合 2 型有效性实施随机对照试验的研究方案。
DOI：
10.1016/j.cct.2024.107436
复制
发表时间：
2024
影响因子：
2.2
通讯作者：
Shone,
中科院分区：
文献类型：
--
作者：
Brochier,Annelise;Torres,Alessandra;Tyrrell,Hollyce;Paz,KatherineBarahona;Wexler,MikaylaGordon;Griffith,Miranda;Joiner,Terence;Magardino,Angela;Messmer,Emily;Rogers,Stephen;Scheindlin,Benjamin;Serwint,JanetR;Sharif,Iman;Shone,
背景越来越多的证据表明健康的社会决定因素 (SDOH) 与儿童健康结果之间存在联系，这促使儿科医生广泛建议儿科医生在初级保健就诊时筛查和转诊不良 SDOH。然而，迄今为止，几乎没有证据表明基于实践的 SDOH 筛查和转诊干预措施对于提高家庭对资源的参与度是有效的。这项混合型 2 型有效性实施试验旨在证明低接触实施策略的非劣效性，以促进现有 SDOH 筛查和转诊系统 (WE CARE) 的传播，并证明其在各种儿科实践中的有效性和可持续性。方法我们通过两个基于儿科实践的研究网络在美国 14 个州招募了 18 个儿科实践。对于这个阶梯式楔形集群随机对照试验，实践在日常护理阶段作为自己的对照，并在干预阶段通过两种随机实施策略之一实施“我们关心”：自我指导、预先录制的网络研讨会与研究团队主持的实时网络研讨会。我们在实践、临床医生/工作人员和家长层面收集数据，以评估基于实施研究的 Proctor 概念模型的结果。我们使用广义混合效应模型和比例差异来比较实施策略的资源转诊率，并使用意向治疗分析来比较参与常规护理与我们护理阶段的家庭使用新资源的几率。讨论该试验的结果可能会为有关将 SDOH 筛查系统更广泛地推广到美国各地儿科实践的决策提供依据，并有可能最大限度地减少 SDOH 对儿童和家庭的不利影响。
BackgroundGrowing evidence linking social determinants of health (SDOH) to child health outcomes has prompted widespread recommendations for pediatricians to screen and refer for adverse SDOH at primary care visits. Yet there is little evidence to date demonstrating the effectiveness of practice-based SDOH screening and referral interventions on increasing family engagement with resources. This hybrid type 2 effectiveness-implementation trial aims to demonstrate the non-inferiority of a low-touch implementation strategy in order to facilitate dissemination of an existing SDOH screening and referral system (WE CARE) and demonstrate its effectiveness and sustainability in various pediatric practices.MethodsWe recruited eighteen pediatric practices in fourteen US states through two pediatric practice-based research networks. For this stepped wedge cluster RCT, practices serve as their own controls during the Usual Care phase and implement WE CARE during the intervention phase via one of two randomized implementation strategies: self-directed, pre-recorded webinar vs. study team-facilitated, live webinar. We collect data at practice, clinician/staff, and parent levels to assess outcomes grounded in the Proctor Conceptual Model of Implementation Research. We use generalized mixed effects models and differences in proportions to compare rates of resource referrals by implementation strategy, and intention-to-treat analysis to compare odds of engagement with new resources among families enrolled in the Usual Care vs. WE CARE phases.DiscussionFindings from this trial may inform decisions about broader dissemination of SDOH screening systems into a diverse spectrum of pediatric practices across the US and potentially minimize the impact of adverse SDOH on children and families.
登录
查看更多内容
成年大鼠肝脏中雄性特异性类固醇 6 β-羟化酶 P-450 2a（基因产物 IIIA2）的垂体调节。
DOI：
10.1210/mend-4-3-447
发表时间：
1990
期刊：
Molecular endocrinology (Baltimore, Md.)
影响因子：
--
作者：
Waxman,DJ;Ram,PA;Notani,G;LeBlanc,GA;Alberta,JA;Morrissey,JJ;Sundseth,SS
通讯作者：
Sundseth,SS
性腺类固醇激素对下丘脑-垂体-肝脏轴的影响控制大鼠肝脏类固醇代谢的性别差异。
影响因子：
4
作者：
A. Mode;G. Norstedt
通讯作者：
G. Norstedt
海鸟细胞色素 P-450：与纯化的大鼠细胞色素的交叉反应性研究。
DOI：
10.3109/00498258909043169
发表时间：
1989
期刊：
Xenobiotica; the fate of foreign compounds in biological systems
影响因子：
--
作者：
M. J. J. Ronis;T. Hansson;J. Borlakoglu;Colin H. Walker
通讯作者：
Colin H. Walker
影响因子：
5.2
作者：
Jay,JR;MacLaughlin,DT;Badger,TM;Miller,DC;Martuza,RL
通讯作者：
Martuza,RL
影响因子：
3.7
作者：
A. Decken;Tore Hultin
通讯作者：
Tore Hultin