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 通过医疗保健驱动的协议（Northwell）解决火器伤害和死亡预防（FIMP）等问题 枪支暴力预防中心（Center for Gun Violence Prevention）有充分的理由对FIMP采用公共卫生方法 在社区内。迫切需要实施一项系统级财务执行管理计划战略， 认为这是一个公共卫生问题，医疗保健行业可以将其作为 常规护理本R61提案的目标是开发、实施和评估证据的可行性 在有火器伤害风险的青年和成年人中进行全面筛查和干预 急诊科（艾德），并教育临床团队成员关于FIMP策略。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 Northwell健康创新和成果研究中心一直在开发，实施和 利用联邦资金评估临床工具/系统。我们在全系统范围内实施了多重筛查 和针对社区卫生相关问题（如虐待儿童、贩运人口）的干预议定书。 通过我们的Northwell筛查，短暂干预和转诊治疗（SBIRT）计划，我们已经奠定了 我们的系统战略的基础，以解决物质使用作为日常护理的一部分，在一个敏感的，文化 它将以一种强有力的方式，并与FIMP有许多交叉主题，它将作为我们提案的蓝图。 拟议的具体目标是：目标1）使用混合方法为制定和实施 基于证据：1a）关于FIMP策略的临床团队成员教育，1b）枪支的普遍筛查 通过将工具嵌入到电子健康记录中，将伤害风险纳入艾德临床工作流程，以及1c）简要的FIMP 在护理点对高危青年进行干预（动机性访谈、教育、资源）， 成年人影响可改变的风险因素。我们假设，通过识别促进者，障碍和差距， 临床团队成员和患者之间的知识（实施前调查），我们将设计教育 增加对FIMP工具的了解和熟悉度，并制定可集成到 常规护理目标2：2a）在3个艾德中心试行FIMP筛查和干预战略，2b）开展 评估实施程度、需求、可接受性和有限功效测试的可行性研究有限 使用准实验设计。我们假设，一个迭代的过程，包括来自团队的反馈， 成员、利益相关者和患者/护理人员以及患者筛查和随访数据的分析（术前/术后， 中断的时间序列），将增加筛查和干预的患者比例， 了解与风险相关的患者经历和特征，并证明改善 安全的枪支储存方法。

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.