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COHERE – COntextualized care in cHcs’ Electronic health Records

COHERE — CHCS 中的情境化护理 — 电子健康记录

基本信息

批准号：
10318926
负责人：
RACHEL GOLD
金额：
$ 60.76万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-01-29 至 2024-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10318926
关键词：
Academy Accounting Address Affect American College of Physicians Caring Clinical Clinical Decision Support Systems Data Depression screen Documentation Economics Electronic Health Record Engineering Evaluation Feedback Food Glycosylated hemoglobin A Health Health Personnel Healthcare Healthcare Systems Homelessness Housing Hypoglycemia Information Services Insulin Intervention Interview Intuition Laboratories Link Measures Medical Medical Care Team Medicine Modeling Neighborhood Health Center Neighborhoods Outcome Patient Care Team Patient-Focused Outcomes Patients Perception Pharmaceutical Preparations Population Process Provider Public Health Quality of Care Randomized Recommendation Recording of previous events Refrigeration Reporting Research Risk Risk Factors Running Services Social Conditions Social Work Social isolation Suggestion Surveys System Testing Transportation United States National Academy of Sciences Visit Work arm base blood pressure control clinical decision support clinical risk community-level factor contextual factors design disparity reduction experience follow-up food resource health care availability health care quality health disparity health equity health inequalities health outcome disparity housing instability improved improved outcome innovation patient engagement patient-clinician communication pilot test primary outcome response safety net screening secondary analysis secondary outcome social social determinants social engagement social health determinants support tools tool trend usability

项目摘要

PROJECT SUMMARY/ABSTRACT: Factors such as food, transportation, and housing instability, social isolation, and neighborhood conditions profoundly impact health outcomes. Shaped by a long history of racial, social, and economic inequity in the US, such factors also underlie health inequities. Many healthcare leaders now recommend systematic documentation of these social risk factors. Yet while social risk data are increasingly available in electronic health records (EHR), research is lacking on how healthcare teams can use these data to improve patient health and decrease health inequities. Social risk-targeted care (referrals to service agencies) can improve health outcomes, but recent research suggests that such improvements are not solely the result of addressing social conditions. Another path to improved outcomes involves social risk-informed care: modifying care plans to account for patients’ social risks (e.g., adjusting insulin prescribing so that when food benefits run out at the end of the month, patients are less likely to be hospitalized with hypoglycemia). Such social risk-informed care may seem intuitive, but very little research has examined how care teams can effectively and systematically make such adaptations. This study will be the first to examine how EHR-based clinical decision support (CDS) could support the provision of contextualized, social risk-informed care. Our Aims are: 1. Obtain stakeholder input from community health center (CHC) staff and patients on care plan adaptations that could mitigate social risks’ impact on patient health and ability to adhere to care recommendations. Develop and pilot-test EHR-integrated CDS tools that present social risks and suggest relevant care plan adaptations. 2. Randomize 12 CHCs to receive: Arm 1) a CDS tool with a social risk summary, links to social service information, and a reminder to consider social risks in care planning; or Arm 2) a CDS tool with the same summary, reminder, and links, plus specific care plan adaptation suggestions tailored to a given patient’s social risks. Assess each tool’s impact on selected national Care Quality Measures (CQM), accounting for secular trends. 3. Assess enactment of the tools’ suggested care plan adaptations, and patient / staff perceptions of the tools’ usability and impact on care quality and patient-provider interactions. Our setting is the nation’s largest group of CHCs on a single EHR. The PIs’ work on an upcoming National Academies report directly informed the social risk-informed CDS proposed here. This proposal addresses PAR-19-093’s calls for research on “using HIT to reduce disparities by increasing ... higher quality care, & improving patient-clinician communication, and health outcomes,” and on “models for the inclusion and utility of SDoH in EHR systems/CDS tools that … improve health equity.” The tools developed here will be made available immediately for implementation in any EHR system, enabling rapid dissemination and greater impact of study findings.

项目摘要/摘要：食品、交通、住房等因素不稳定，社会