Bridging the evidence-to-practice gap: Evaluating practice facilitation as a strategy to accelerate translation of a systems-level adherence intervention into safety net practices

弥合证据与实践之间的差距：评估实践促进作为加速将系统级依从性干预转化为安全网实践的策略

• 批准号: 10303004
• 负责人: OLUGBENGA G. OGEDEGBE
• 金额: $ 68.64万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-09 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10303004
• 关键词: Address; Adherence; Adult; Affect; Antihypertensive Agents; Attitude; Awareness; Blood Pressure; Caring; Clinic; Clinic Visits; Clinical; Cluster randomized trial; Consolidated Framework for Implementation Research; Data; Dimensions; Effectiveness; Electronic Health Record; Ensure; Ethnic group; Evidence based intervention; Evidence based practice; Family health status; Feedback; Health; Health Care Reform; Hypertension; Individual; Intervention; Knowledge; Latino; Laws; Learning; Medical; Medical Care Team; Methods; Minority Groups; Modeling; New York City; Not Hispanic or Latino; Outcome; Patient-Centered Care; Patients; Pharmaceutical Preparations; Pharmacy facility; Phase; Prevalence; Preventive screening; Primary Care Physician; Primary Health Care; Randomized Controlled Trials; Records; Research; Sampling; Self-Direction; Standardization; System; Testing; Time; Translating; Translation Process; Translations; Vulnerable Populations; Work; arm; base; blood pressure regulation; breast exam; clinical outcome measures; clinical practice; design; disparity reduction; effectiveness evaluation; efficacious intervention; evidence base; formative assessment; health care quality; health care service; health care settings; health goals; hypertension control; hypertension treatment; implementation facilitation; implementation fidelity; implementation outcomes; implementation strategy; improved; medication compliance; motivational enhancement therapy; patient-level barriers; personalized approach; practice factors; primary care setting; primary outcome; racial and ethnic; response; routine care; routine practice; safety net; secondary outcome; skills; statistics; systematic review; treatment as usual

ABSTRACT COVID-19 has shed light on the significant and long-standing disparities in underserved communities. Current data still show hospitalization rates among Black and Latinx individuals in the United States are 4 times greater than that of Whites. The Rapid Acceleration of Diagnostics for Underserved Populations (RADx-UP) initiative supports supplements to individual NIH awards to identify the determinants of COVID-19 testing among underserved populations. For this proposal, we will leverage the infrastructure of a NIMHD-funded project in the Family Health Centers (FHCs) of NYU Langone Health, a network of federally qualified health centers in NYC that serves over 125,000 low-income and racially and ethnically diverse patients. In the current application, we propose a three-phase community-engaged study that will employ a multipronged, sequential mixed methods design (i.e., one methodology builds on the findings of the other) to gain a comprehensive understanding of the multilevel factors that drive uptake of testing (and future vaccination) for COVID-19 of Black and Latinx patients (primary outcome), and participation in follow-up care offered by safety-net health systems. Phase 1 will consist of three steps: In step 1, we will leverage a well-characterized electronic health record database (~75% Black and Latinx) to examine differences in the individual-level factors associated with receiving a positive versus negative PCR test for COVID-19 among 400 Black and Latinx patients who receive care at the FHCs. We will also capture the community- and structural-level determinants of testing in this sample using validated self-report measures (e.g., NIH PhenX Tool Kit). In step 2, we will compare these multilevel factors across three patient groups: Group 1- patients who tested positive and received follow-up care and/or services; Group 2- patients who tested positive but did not receive follow-up care and/or services; and Group 3- patients who were eligible for testing (based on symptoms and probable exposure), but did not get tested. In step 3, we will employ predictive modeling to correctly identify patients at high-risk (group 3). In Phase 2, we will combine data from the previous phase with qualitative data (i.e., ethnographic observations, document analyses, and focus groups with FHC staff, providers, administrators, patients and community members) to capture organizational (e.g., FHC staff/provider attitudes and communications with patients, organizational culture) and ethical issues (e.g., data transparency and privacy) to shed light on important social, cultural, and contextual factors associated with uptake of COVID-19 testing and potential vaccine. Finally, in Phase 3, in collaboration with our Community Oversight Task Force, we will integrate Phase 1 and 2 data to refine, test, and disseminate tailored toolkits and ethical governance guidelines (e.g. clinical trials transparency and data privacy). These toolkits will be designed to increase knowledge and awareness of COVID-19 testing and vaccine research and will be widely disseminated among the FHCs, local community, NYULH, and the RADx-UP Coordination and Data Collection Center.

摘要 COVID-19揭示了服务不足社区长期存在的重大差距。电流 数据仍然显示，美国黑人和拉丁美洲人的住院率是黑人和拉丁美洲人的4倍， 而不是白人。快速加速服务不足人群诊断（RADx-UP）倡议 支持对NIH个人奖励的补充，以确定COVID-19检测的决定因素， 服务不足的人群。对于本提案，我们将利用NIMHD资助项目的基础设施， NYU Langone Health的家庭健康中心（FHC），纽约市联邦合格的健康中心网络 为超过125，000名低收入和种族和民族多样化的患者提供服务。在本申请中，我们 我提出了一个三阶段的社区参与的研究，将采用多管齐下，顺序混合的方法 设计（即，一种方法建立在另一种方法的研究结果的基础上），以全面了解 推动黑人和拉丁裔患者接受COVID-19检测（和未来疫苗接种）的多层次因素 （主要结果），以及参与安全网卫生系统提供的后续护理。第一阶段将包括 三个步骤：在第1步中，我们将利用一个特征良好的电子健康记录数据库（约75%黑人 和Latinx），以检查与接受积极的 400名在FHC接受治疗的黑人和拉丁裔患者的COVID-19 PCR检测结果为阴性。我们将 还捕捉社区和结构层面的决定因素，测试在这个样本中使用验证自我报告 测量（例如，NIH PhenX工具包）。在第2步中，我们将比较三名患者的这些多水平因素 组：第1组-检测呈阳性并接受后续护理和/或服务的患者;第2组- 检测呈阳性但未接受后续护理和/或服务的患者;以及第3组-符合条件的患者 测试（基于症状和可能的接触），但没有得到测试。在步骤3中，我们将使用 预测建模，以正确识别高风险患者（第3组）。在第二阶段，我们将结合联合收割机的数据， 具有定性数据的前一阶段（即，人种学观察、文件分析和焦点小组 与FHC工作人员、提供者、管理员、患者和社区成员），以获取组织（例如，FHC 工作人员/提供者的态度和与患者的沟通，组织文化）和道德问题（例如，数据 透明度和隐私），以揭示与之相关的重要社会，文化和背景因素， 接受COVID-19检测和潜在疫苗。最后，在第三阶段，与我们的社区合作， 监督工作队，我们将整合第一阶段和第二阶段的数据，以完善，测试和传播定制的工具包， 伦理治理准则（例如，临床试验透明度和数据隐私）。这些工具包将被设计成 提高对COVID-19检测和疫苗研究的认识和认识，并将广泛 在FHC、当地社区、NYULH和RADx-UP协调和数据收集之间传播 中心