Diversity Supplement: Implementation of EMR-Integrated Referrals

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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.