COHERE – COntextualized care in cHcs’ Electronic health Records

项目摘要/摘要：粮食、交通和住房不稳定、社会不稳定等因素 与世隔绝和邻里条件深刻地影响着健康结果。由漫长的历史塑造的 在美国，种族、社会和经济不平等，这些因素也是健康不平等的基础。许多医疗保健 领导人现在建议对这些社会风险因素进行系统的记录。然而，尽管社会风险数据 在电子健康记录(EHR)中越来越容易获得，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并减少健康不平等。社会风险--针对性护理 (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。另一条改善结果的途径 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 开胰岛素处方，这样当月底食物福利用完时，患者就不太可能 因低血糖住院)。这种了解社会风险的护理可能看起来很直观，但研究很少 研究了护理团队如何有效和系统地进行这种适应。这项研究将是 第一个研究基于电子病历的临床决策支持(CDS)如何支持 因地制宜的、了解社会风险的护理。我们的目标是：1.从社区获得利益相关者的意见 卫生中心(CHC)工作人员和患者调整护理计划，以缓解社会风险对 患者的健康状况和遵守护理建议的能力。开发和中试EHR集成的CDS 提出社会风险并提出相关护理计划调整建议的工具。2.将12个社区卫生控制中心随机分配到 接收：ARM 1)带有社会风险摘要、社会服务信息链接和提醒的CDS工具 在护理规划中考虑社会风险；或ARM 2)具有相同摘要、提醒和链接的CDS工具， 外加针对特定患者的社会风险量身定做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，占长期趋势的影响。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 以及对护理质量和患者-提供者互动的影响。我们的背景是全国最大的一群 单个EHR上的CHC。PI在即将发布的国家科学院报告中的工作直接通知了 在此提出了社会风险知情CDS。这项建议回应了PAR-19-093‘S提出的研究“使用”的呼吁 通过增加...来缩小差距。更高质量的护理，改善患者与临床医生之间的沟通， 和健康结果，以及在EHR系统/CDS工具中纳入和使用SDoH的模型 …提高健康公平性。此处开发的工具将立即提供给 在任何EHR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.