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 作为纽约最大的综合卫生系统，我们的组织使命是解决公共卫生问题 通过医疗保健方案预防枪伤和死亡(FIMP)等问题(诺斯韦尔 枪支暴力预防中心)。有充分的理由对FIMP使用公共卫生方法 在社区内部。迫切需要实施系统级的FIMP战略，以将范式转变为 将此视为具有可修改的风险因素的公共健康问题，医疗行业可以将其作为 照常照看。本R61提案的目标是开发、实施和评估证据的可行性 在飞行员中对青少年和成年人进行普遍的枪伤筛查和干预 对急诊科(ED)和临床团队成员进行FIMP策略方面的培训。我们的理由是 确定如何在医疗保健环境中实施FIMP战略是传播 为患者提供预防策略，并为下游研究提供基础设施。多年来，我们的 诺斯韦尔健康创新和成果研究中心一直在开发、实施和 使用联邦资金评估临床工具/系统。我们已经实施了多个系统范围的筛查 以及针对社区卫生相关问题(例如虐待儿童、人口贩运)的干预方案。 通过我们的Northwell筛查、短暂干预和转诊治疗(SBIRT)计划，我们制定了 我们的系统战略的基础是将物质使用作为日常护理的一部分，在敏感的、文化上的 它将作为我们提案的蓝图，以称职的方式和与FIMP的许多横向主题。 建议的具体目标是：目标1)使用混合方法通知制定和实施 证据基础：1)临床团队成员关于FIMP策略的教育，1)普遍的枪支筛查 通过在电子健康记录中嵌入工具，将伤害风险纳入急诊临床工作流程，以及1c)Brief FIMP 干预(激励性访谈、教育、资源)在高危青年和 成年人对可改变的风险因素产生影响。我们假设，通过确定促进者、障碍和差距， 临床团队成员和患者的知识(实施前调查)，我们将设计教育 要增加对FIMP工具的了解并熟悉FIMP工具，并开发可集成到 照常照看。目标2：2a)在3个ED站点试行FIMP筛查和干预策略，2b)进行 有限可行性研究评估实施程度、需求、可接受性和有限有效性测试 采用准实验设计。我们假设一个包含团队反馈的迭代过程 成员、利益相关者和患者/护理人员以及对患者筛查和随访数据的分析(前/后， 中断的时间序列)，将增加接受筛查和更好干预的患者的百分比 了解与风险相关的患者经验和特征，并证明改进了 安全的枪支储存做法。

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.