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Implementation of EMR-Integrated Referrals to Link Clinical and Community Services to Reduce Health Inequity

实施 EMR 集成转诊，将临床和社区服务联系起来，减少健康不平等

基本信息

批准号：
10542812
负责人：
Giselle Corbie
金额：
$ 75.2万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
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/10542812
关键词：
Accountability Address Adult African American African American population Behavior Therapy Behavioral Model Cardiovascular Diseases Caring Characteristics Child Clinic Clinical Clinical Services Communities Community Health Community Services Computerized Medical Record Consolidated Framework for Implementation Research Cost Effectiveness Analysis County Data Diabetes Mellitus Federally Qualified Health Center Glycosylated hemoglobin A Goals Health Health Care Costs Health Promotion Health care facility Heart Diseases Hybrids Hypertension Individual Intervention Knowledge Life Link Lipids Literature Maps Methods Modeling Morbidity - disease rate National Heart, Lung, and Blood Institute North Carolina Obesity Outcome Participant Patients Persons Process Research Resources Risk Risk Factors Rural Rural Community Rural Minority Self Efficacy Self Management Services Stress System Translations United States Weight burden of illness cardiometabolism cardiovascular disorder prevention cardiovascular disorder risk cardiovascular health care costs clinical encounter community clinic comparison control contextual factors cost cost estimate data resource density digital disease disparity effectiveness evaluation effectiveness/implementation design effectiveness/implementation study family management geographic disparity health assessment health inequalities health management health service use high risk implementation evaluation implementation facilitators implementation science implementation strategy improved innovation minority communities mortality organizational readiness pragmatic intervention pragmatic trial premature prevent preventive intervention public health relevance racial disparity rural African American rural health network rural healthcare rural setting screening service providers social social health determinants standard of care theories

项目摘要

ABSTRACT Cardiovascular disease (CVD) exerts a disproportionate burden of morbidity and mortality on African Americans in the rural southeast. Much of this excess has been attributed, directly and indirectly, to social determinants of health and resulting health-related social needs. While CVD prevention interventions have reduced overall disease burden, they have failed to eliminate racial and geographic disparities in CVD. New models of care, such as Accountable Health Communities, address health-related social needs through screening, referral, and community navigation services and have begun to demonstrate improvement in health care cost, use, and CVD risk factors. Rural minority communities, where the burden of CVD risk factors and social needs are high, healthcare facilities may be more fragile and density of resources may be lower, have even greater need for effective and scalable solutions to addressing health and social needs. Our proposal is anchored by Bandura's Self-Efficacy theory, Grey's Self and Family Management Framework, and Andersen's Behavioral Model of Health Services Use. We will use the Consolidated Framework for Implementation Research to study implementation and effectiveness of integrating health-promoting community resource data into the EMR via CommunityRx (CRx). The CRx-CVD intervention is a digital solution that links patients with community-based resources to address health-related social needs and cardiometabolic health in rural AA patients. Our overall objective is to identify factors that influence implementation and assess the health impact of a closed-loop referral system to community health-promoting resources in a rural setting. We use a hybrid II implementation effectiveness design to conduct a controlled pragmatic trial of patients (adults 18 years and over, children 2-17 years; N=750) in a system of federally qualified health centers in rural North Carolina. We hypothesize that integration of closed-loop referrals will increase patient knowledge of community resources, enhance self-efficacy to manage CVD risk factors, increase utilization of community resources and improve markers of cardiometabolic conditions. To our knowledge, this trial will be the first to evaluate the implementation and health impact of a low intensity, scalable, clinic-initiated intervention targeting AA adults and children at risk of CVD. Furthermore, we will conduct cost-effectiveness analysis related to implementation of CRx-CVD to inform scaling the intervention. The long-term goal is to identify scalable interventions to reduce CVD risk and health-related social needs of African Americans using a “whole person” approach to health.

摘要心血管疾病（CVD）对非洲人的发病率和死亡率造成了不成比例的负担。美国东南部农村这一过剩的大部分直接或间接地归因于社会健康的决定因素和由此产生的与健康有关的社会需求。虽然CVD预防干预措施尽管他们的研究结果显示，尽管他们的研究结果降低了总体疾病负担，但他们未能消除CVD中的种族和地理差异。新保健模式，如负责任的卫生社区，通过以下方式解决与卫生有关的社会需求筛查、转诊和社区导航服务，并已开始显示健康状况有所改善护理成本、使用和心血管疾病风险因素。农村少数民族社区，心血管疾病风险因素的负担，社会需求高，医疗设施可能更脆弱，资源密度可能更低，更需要有效和可扩展的解决方案来满足健康和社会需求。我们的建议是班杜拉的自我效能理论，格雷的自我和家庭管理框架，和安德森的卫生服务使用行为模式。我们将利用《综合执行框架》研究整合健康促进社区资源数据的实施情况和效果通过CommunityRx（CRx）进入EMR。CRx-CVD干预是一种数字化解决方案，以社区为基础的资源，以满足农村AA与健康有关的社会需求和心脏代谢健康患者我们的总体目标是确定影响实施的因素，闭环转诊系统对农村地区社区健康促进资源的影响。我们使用一个混合II实施有效性设计，用于对患者（成人18 年龄及以上，2-17岁儿童; N=750）在北部农村联邦合格的卫生中心系统中卡罗莱纳。我们假设闭环转诊的整合将增加患者对社区的了解资源，提高自我效能，以管理心血管疾病的危险因素，增加社区资源的利用，改善心脏代谢状况标志物。据我们所知，这次审判将是第一次评估针对AA成人的低强度、可扩展、临床启动干预的实施和健康影响和有CVD风险的儿童。此外，我们亦会就推行计划进行成本效益分析 CRx-CVD，以告知扩展干预。长期目标是确定可扩展的干预措施，使用“全人”方法降低非裔美国人的心血管疾病风险和与健康相关的社会需求，健康