COHERE – COntextualized care in cHcs’ Electronic health Records

项目总结/摘要：食品、交通和住房不稳定、社会 隔离和邻里条件深刻地影响着健康结果。历史悠久， 在美国，种族、社会和经济的不平等，这些因素也是健康不平等的基础。许多医疗保健 领导人现在建议系统地记录这些社会风险因素。尽管社会风险数据 电子健康记录（EHR）越来越多，但缺乏关于医疗团队如何 可以使用这些数据来改善患者健康和减少健康不平等。针对社会风险的护理 （转介到服务机构）可以改善健康结果，但最近的研究表明， 改善不仅仅是解决社会状况的结果。改善结果的另一条途径 涉及社会风险知情护理：修改护理计划以考虑患者的社会风险（例如，调整 胰岛素处方，以便当食物福利在月底用完时，患者不太可能 低血糖住院）。这样的社会风险知情护理可能看起来很直观，但很少有研究 研究了护理团队如何有效和系统地进行这种调整。本研究将 第一个研究如何EHR为基础的临床决策支持（CDS）可以支持提供 情境化的、社会风险知情的护理。我们的目标是：1。从社区获得利益相关者的意见 健康中心（CHC）的工作人员和病人对护理计划的适应性，可以减轻社会风险的影响， 患者的健康状况和遵守护理建议的能力。开发和试点测试EHR集成CDS 提出社会风险并建议相关护理计划调整的工具。2.随机分配12个CHC， 接收：1）CDS工具，包含社会风险摘要、社会服务信息链接和提醒， 在护理计划中考虑社会风险;或第2组）具有相同摘要、提醒和链接的CDS工具， 加上针对特定患者的社会风险定制的特定护理计划适应性建议。评估每个工具的 对选定的国家护理质量指标（CQM）的影响，占长期趋势。3.评估 制定工具建议的护理计划调整，以及患者/工作人员对工具可用性的看法 以及对护理质量和医患互动的影响。我们的背景是全国最大的 单个EHR上的CHC。PI在即将到来的国家科学院报告中的工作直接告知了 社会风险知情CDS在这里提出。该提案回应了PAR-19-093关于“使用 为了减少差距，增加...更高质量的护理，改善患者与临床医生的沟通， 和健康结果，以及在EHR系统/CDS工具中纳入和使用SDoH的模型， 改善卫生公平性”这里开发的工具将立即提供给 在任何电子健康记录系统中实施，使研究结果能够迅速传播和产生更大的影响。

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.