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

评估急诊科青少年和成人预防枪伤和死亡的循证普遍筛查和干预策略的实施情况和可行性

• 批准号: 10165067
• 负责人: Chethan Sathya
• 金额: $ 132.38万
• 依托单位: FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-17 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10165067
• 关键词: Accident and Emergency department; Address; Adult; Alcohol or Other Drugs use; Caregivers; Characteristics; Child; Child Abuse; Childhood; Clinical; Communities; Community Health; Counseling; County; Data; Development; Education; Effectiveness; Electronic Health Record; Environment; Evaluation; Experimental Designs; Family; Feasibility Studies; Feedback; Firearms; Foundations; Funding; Geography; Goals; Gun injury; Health; Health system; Healthcare; Healthcare Industry; Hospitals; Household; Human; Industry; Infrastructure; Inpatients; Institutes; Integrated Health Care Systems; Interruption; Intervention; Knowledge; Medical center; Methodology; Methods; Mission; Modeling; New York; Outcome; Outcomes Research; Outpatients; Patients; Positioning Attribute; Prevention; Prevention strategy; Preventive Intervention; Process; Protocols documentation; Public Health; Research; Resources; Risk; Risk Factors; Rural; Safety; Series; Site; Solid; Stigmatization; Surveys; System; Time; Youth; brief intervention; cohort; design; education resources; efficacy testing; evidence base; experience; follow-up; gang; gun violence; health care settings; implementation research; implementation science; improved; innovation; lens; member; modifiable risk; mortality; motivational enhancement therapy; novel; patient screening; pediatric trauma; point of care; prevent; programs; screening; screening, brief intervention, referral, and treatment; tool; trafficking; trauma centers; treatment as usual; treatment program; usability; violence prevention

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.

抽象的 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 通过医疗保健驱动的协议等问题，例如枪支受伤和预防死亡率（FIMP）（Northwell 预防枪支暴力中心）。有足够的理由使用公共卫生方法 在社区内。迫切需要实施系统级的fimp策略，以将范式转移到 将其视为医疗保健行业可以解决的可修改风险因素的公共卫生问题 通常的护理。该R61提案的目的是开发，实施和评估证据的可行性 对飞行员的风险枪支伤害的青年和成人之间的基于普遍的筛查和干预 急诊科（ED）和临床团队成员有关FIMP策略的教育。我们的理由是 确定如何在医疗保健环境中实施FIMP策略对于传播至关重要 对患者的预防策略，并为下游研究提供基础设施。多年来，我们的 诺斯韦尔卫生创新与成果中心研究一直在开发，实施和 通过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选 和针对社区健康相关问题的干预方案（例如虐待儿童，人口贩运）。 通过我们提出的诺斯韦尔筛查，简短的干预和转诊到治疗计划（SBIRT）计划 我们的系统策略的基础是在敏感的，文化上解决药物使用作为通常护理的一部分的基础 胜任的方式以及许多与FIMP的交叉切割主题，它将成为我们建议的蓝图。 拟议的具体目的是：目标1）使用混合方法来告知开发和实施 基于证据：1A）FIMP策略的临床团队成员教育，1B）枪支的普遍筛查 通过将工具嵌入电子健康记录和1C）短暂的FIMP，将工具嵌入到ED临床工作流程中 在高危青年和 成年人影响可修改的危险因素。我们通过确定促进者，障碍和差距来假设 临床团队成员和患者的知识（实施前调查），我们将设计教育 通过鱼工具来提高知识和舒适感，并制定可以集成到的鱼类策略 通常的护理。目标2：2a）试行在3 ed站点和2B处的fip筛筛选和干预策略）进行 有限的可行性研究评估实施，需求，可接受性和有限效力测试的范围 使用准实验设计。我们假设一个迭代过程结合了团队的反馈 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（PRE/POST， 中断时间序列），将增加筛查并介入更好的患者百分比 了解与风险相关的患者经验和特征，并证明有所改善 安全的枪支存储实践。

项目成果

UNIVERSAL SCREENING FOR FIREARM INJURY RISK COULD REDUCE HEALTHCARE'S HESISTANCY IN TALKING TO PATIENTS ABOUT FIREARM SAFETY.

对枪伤风险进行全面筛查可以减少医疗保健部门在与患者谈论枪械安全问题时的犹豫不决。

• DOI: 10.1097/as9.0000000000000121
• 发表时间: 2022
• 期刊: Annals of surgery open : perspectives of surgical history, education, and clinical approaches
• 作者: Sathya,Chethan;Kapoor,Sandeep
• 通讯作者: Kapoor,Sandeep

A mixed methods protocol to implement universal firearm injury risk screening and intervention among youth and adults in emergency departments across a large US health system.

• DOI: 10.1186/s43058-022-00371-6
• 发表时间: 2022-11-24
• 期刊: Implementation science communications