Diversity Supplement: Implementation of EMR-Integrated Referrals

多样性补充：实施 EMR 集成转诊

• 批准号: 10543572
• 负责人: Giselle Corbie
• 金额: $ 9.19万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10543572
• 关键词: Address; Adult; Affect; Age; American; Black Populations; Black race; Censuses; Chronic Disease; Clinical; Color; Communities; Community Services; Community Surveys; Computerized Medical Record; Data; Data Display; Diabetes Mellitus; Disadvantaged; Disease; Fostering; Funding; Goals; Health; Health Promotion; Healthcare; Housing; Hypertension; Incidence; Individual; Institution; Intervention; Interview; Laws; Life; Link; Measures; Mediating; Methods; Modeling; Neighborhoods; Parents; Participant; Patients; Persons; Pharmaceutical Services; Policies; Race; Research Design; Resources; Risk Factors; Rural; Self Efficacy; Self Management; Southeastern United States; Stroke; Stroke Belt; Structural Racism; Structure; Surveys; System; Testing; Travel; United States National Institutes of Health; Visual; base; cardiovascular disorder risk; combat; digital; health disparity; healthy lifestyle; high risk; improved; indexing; lifestyle intervention; mortality; novel; people of color; physical separation; premature; racial discrimination; racial health disparity; residential segregation; rural area; segregation; skills; social; social factors; social health determinants; stroke incidence; stroke risk; therapy development; tool

ABSTRACT Background: Stroke disproportionately affects Black adults residing in the buckle of the “stroke belt”, or rural southeastern United States. The disparities among stroke are partially attribute to structural racism, or systems that produce inequities among racial groups, such as racial residential segregation. Segregation creates social and environmental conditions that adversely affect health, which may include vehicle access. Having access to a vehicle is essential for self-management of stroke risk enabling travel to health-promoting institutions. Yet, individuals who lack vehicle access tend to be those who are people of color, poor, and reside in rural areas. The CommunityRx-Cardiovasular Disease (CRx-CVD) intervention from the Parent R01 generates electronic medical record linked prescriptions to community resources to meet patients’ health-related social needs with the goal of improving the self-management of CVD and stroke risk factors. Previous CRx studies have increased patients’ resource self-efficacy, or confidence in finding community resources, a potential key link to improving self-management of stroke risk. However, segregation and vehicle inaccessibility could diminish the health promotion efforts of such novel digital tools. Methods: The purpose of this longitudinal, convergent mixed methods study is to examine whether structural racism via segregation as well as community- and individual-level vehicle access 1) are associated with individual stroke risk and 2) impact resource self-efficacy, a strategy for self-management of stroke risk factors, among working age (18-64 years) Black adults. Our main hypothesis is structural racism (i.e., segregation) and lack of community- and individual-level vehicle access will be associated with lower resource self-efficacy, and less confidence related to self-management of stroke risk. To test this hypothesis, existing census tract data will be joined to patient data (survey, electronic medical record data, and interviews) using geocoded addresses. The specific aims of this supplement are: Aim 1. Examine associations of racial residential segregation (i.e. marker of structural racism), vehicle access, and individual stroke risk. Aim 2a. Explore the mediating effect of racial residential segregation (i.e. marker of structural racism) and vehicle access on the association between resource self-efficacy and individual stroke risk. Aim 2b. Explore the mediating effect of vehicle access on the association between residential segregation and individual stroke risk. Aim 3. Conduct a mixed methods analysis to identify barriers and facilitators to resource self-efficacy and the subsequent effect on stroke risk in the context of residential segregation and vehicle access.

摘要 背景：中风不成比例地影响居住在“中风带”扣的黑人成年人，或 美国东南部乡村。脑卒中差异部分归因于结构性种族主义， 或制度，产生种族群体之间的不平等，如种族居住隔离。 隔离会造成对健康产生不利影响的社会和环境条件，其中可能包括 车辆进入。有机会使用车辆对于中风风险的自我管理至关重要， 健康促进机构。然而，缺乏车辆通道的人往往是那些人 贫穷，居住在农村地区。社区Rx血管病（CRx-CVD） 来自父R 01的干预生成与社区处方相关联的电子病历 资源，以满足患者的健康相关的社会需求，以提高自我管理的目标 心血管疾病和中风的危险因素。先前的CRx研究增加了患者的资源自我效能，或 有信心找到社区资源，这是改善卒中自我管理的潜在关键环节 风险然而，隔离和交通工具无法进入可能会削弱这些机构的健康促进工作。 新颖的数字化工具。 方法：这项纵向、聚合混合方法研究的目的是检查是否 通过种族隔离以及社区和个人层面车辆准入1）的结构性种族主义， 与个体中风风险相关; 2）影响资源自我效能，自我管理策略 工作年龄（18-64岁）黑人成年人中的中风风险因素。我们的主要假设是结构性的 种族主义（即，隔离）以及缺乏社区和个人层面的车辆准入将与 资源自我效能较低，对卒中风险自我管理的信心较低。测试 根据这一假设，现有的人口普查区域数据将与患者数据（调查、电子病历）相结合 数据和采访）使用地理编码地址。这一补充的具体目标是： 目标1.审查种族居住隔离的关联（即结构性种族主义的标志），车辆 和个人中风风险。 目标2a。探索种族居住隔离的中介作用（即结构性种族主义的标志） 和交通工具使用对资源自我效能与个体卒中风险之间关系的影响。 目标2b。探讨机动车通行对居民地关联的中介作用 隔离和个体中风风险。 目标3.进行混合方法分析，以确定资源自我效能的障碍和促进因素 以及在居住隔离和车辆出入的背景下对中风风险的后续影响。