Comparing Implementation Strategies for Social Needs Programs: A Natural Study of Two Pragmatic Trials

项目摘要 尽管越来越多的人认识到患者的社会需求塑造了健康轨迹， 越来越多的证据表明，确定和解决这些需求可以影响健康 结果，很少有人知道如何最好地将社会需求筛选， 社区转介方案纳入护理提供实践。强大的研究机构 在这一领域，需要为质量措施的制定、支付和激励提供信息 以及其他促进医疗和社会保健的新政策举措 作为改善健康和减少贫穷综合战略的一部分 卫生不平等。为这些努力提供信息的必要实施研究是 特别具有挑战性，因为这一领域的比较研究需要真实的世界 正在投资于综合护理的交付环境，以及在可行的情况下进行试验 不同的策略。拟议的研究提供了一个独特的机会， 通过利用两个现有的比较研究，资助计划， 为低收入人群服务的社区卫生中心，最有可能 受益于社会筛查和干预方案的实施。两 用于这项比较试验的项目是俄勒冈州的示范项目， 医疗保险和医疗补助创新中心的问责健康社区（AHC） OCHIN实现SDH数据采集和动作的CHC方法 （ASCEND）试验。这些并行和重叠的举措提供了一个机会， 进行首次社会需要甄别及介入计划的比较研究 在这一领域的实施。四组自然研究设计 联合试验使我们能够比较ASCEND丰富的 实施支持与俄勒冈州AHC网站的财政奖励，以及 将每个单独的实施策略与计划的综合效果进行比较 和非干预控制。五年混合方法提案包括 定量评估在两个活跃的阶段中筛查和转诊的程度， 实施和18个月的维护阶段，以及 每个研究组的计划成本。该研究还涉及定性数据收集， 将补充定量分析，以帮助我们了解上下文 影响社会方案的采纳、实施和维持的因素 以及这些项目对工作人员、临床医生和诊所工作流程的影响。

Project Abstract Despite increased recognition that patients’ social needs shape health trajectories and growing evidence that identifying and addressing these needs can impact health outcomes, little is known about how best to incorporate social needs screening and community referral programs into the practice of care delivery. A strong body of research in this area is needed to inform quality measure development, payment and incentive models, and other emerging policy initiatives that promote medical and social care integration as one part of a comprehensive strategy for improving health and decreasing health inequities. The necessary implementation research to inform these efforts is particularly challenging since comparative research in this field requires real world delivery settings that are investing in integrated care and where it is feasible to trial different strategies. The proposed study provides a unique opportunity to conduct comparative research by taking advantage of two existing, funded programs in community health centers serving low-income populations, which are most likely to benefit from the implementation of social screening and intervention programs. The two programs being leveraged for this comparative trial are the Oregon demonstration of the Center for Medicare and Medicaid Innovation’s Accountable Health Communities (AHC) and OCHIN’s Approaches to CHC Implementation of SDH Data Collection and Action (ASCEND) trial. The concurrent and overlapping initiatives provide an opportunity to conduct the first comparative study on social needs screening and intervention program implementation in this field. The four group natural study design proposed for the combined trial enables us to compare the relative effectiveness of ASCEND’s rich implementation supports with the Oregon AHC site’s financial incentives, as well as to compare each individual implementation strategy with the programs’ combined effects and with non-intervention controls. The five-year, mixed methods proposal includes quantitative evaluation of the extent of screening and referrals during both active implementation and an 18 month maintenance phase, as well as a comparison of the program costs for each study arm. The study also involves qualitative data collection that will complement the quantitative analyses in order to help us understand contextual factors influencing the adoption, implementation, and maintenance of social programs and the impacts of these programs on staff, clinicians, and clinic workflow.