Evaluating implementation and feasibility of evidence-based universal screening and intervention strategies for firearm injury and mortality prevention among youth and adults in emergency departments

摘要

Abstract As the largest integrated health system in New York, it is our organizational mission to address public health issues such as firearm injury and mortality prevention (FIMP) through healthcare driven protocols (Northwell Center for Gun Violence Prevention). There is ample justification to use a public health approach for FIMP within communities. There is a critical need to implement a system-level FIMP strategy to shift the paradigm to view this as a public health issue with modifiable risk factors the healthcare industry can address as part of usual care. The objective of this R61 proposal is to develop, implement, and evaluate the feasibility of evidence based universal screening and intervention among youth and adults at risk firearm injury across pilot emergency departments (ED) and educate clinical team members about FIMP strategies. Our rationale is that determining how to implement FIMP strategies into the healthcare setting is central to disseminating preventative strategies to patients and to provide infrastructure for downstream research. For years, our Northwell Center for Health Innovations and Outcomes Research has been developing, implementing and evaluating clinical tools/systems with federal funding. We have implemented multiple system-wide screening and intervention protocols specific to community health-related issues (e.g. child abuse, human trafficking). Through our Northwell Screening, Brief Intervention, and Referral to Treatment (SBIRT) program we have laid the foundation for our system strategy to address substance use as part of usual care in a sensitive, culturally competent manner and with many cross-cutting themes with FIMP, it will serve as a blueprint for our proposal. The proposed specific aims are: Aim 1) Use mixed methods to inform the development and implementation of evidence based: 1a) clinical team member education on FIMP strategies, 1b) universal screening for firearm injury risk into ED clinical workflows by embedding tools into the electronic health record, and 1c) brief FIMP intervention (motivational interviewing, education, resources) at the point of care among at-risk youth and adults to impact modifiable risk factors. We hypothesize that by identifying facilitators, barriers and gaps in knowledge among clinical team members and patients (pre-implementation surveys), we will design education to increase knowledge and comfort with FIMP tools and develop FIMP strategies that can be integrated into usual care. Aim 2: 2a) Pilot the FIMP screening and intervention strategy at 3 ED sites and 2b) conduct a limited feasibility study evaluating extent of implementation, demand, acceptability and limited efficacy testing using quasi-experimental designs. We hypothesize that an iterative process incorporating feedback from team members, stakeholders, and patients/caregivers and analysis of patient screening and follow-up data (pre/post, interrupted time series), will increase the percentage of patients screened and intervened with better understanding of the patient experience and characteristics associated with risk and demonstrate improved safe firearm storage practices.