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交需求塑造了健康轨迹和 越来越多的证据表明，确定和满足这些需求可以影响健康 结果，关于如何最好地将社交需求筛选和 将社区转诊方案纳入提供护理服务的实践中。强大的研究机构 在这一领域需要通知质量措施的发展、付款和激励 模式，以及其他促进医疗和社会保健的新兴政策倡议 将一体化作为改善健康和减少疾病综合战略的一部分 健康不平等。为这些努力提供信息的必要的实施研究是 尤其具有挑战性，因为这一领域的比较研究需要现实世界 投资于综合护理的交付环境，以及可以进行试验的地方 不同的策略。拟议的研究提供了一个独特的机会 通过利用现有的两个资助的项目进行比较研究 为低收入人群提供服务的社区卫生中心，这最有可能 受益于社会筛查和干预计划的实施。两个人 这项比较试验的杠杆项目是俄勒冈州的 医疗保险和医疗补助创新中心负责的健康社区(AHC) 和OCHIN实现SDH数据收集和操作的CHC方法 (升天)审判。同时进行的和重叠的计划提供了一个机会 进行社会需求筛选和干预计划的第一次对比研究 在这一领域的实施。四组自然学习设计建议 联合试验使我们能够比较Ascend的RICH的相对有效性 实施支持俄勒冈州AHC网站的财政激励措施，以及 将每个单独的实施策略与方案的综合效果进行比较 和非干预控制。这项为期五年的混合方法提案包括 在两个活动期间对筛查和转介的程度进行定量评估 实施和18个月的维护阶段，以及 每个研究部门的计划成本。这项研究还涉及到定性数据收集， 将补充定量分析，以帮助我们理解上下文 影响采用、实施和维持社会方案的因素 以及这些计划对工作人员、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.