Enhancing Quality and Access to Lifestyle Counseling and Health Behavior Change

描述（由申请人提供）：尽管不断努力，种族和少数民族继续经历在医疗保健和结果的显着差异。持续存在的差距是由许多因素造成的，但质量不平等和获得预防性保健和慢性病管理的机会减少是迫切需要注意的减少差距的措施。卫生保健提供者（HCP）在帮助患者采取和保持健康的生活方式行为方面发挥着重要作用。但是，在获得有关生活方式改变和健康行为改变的提供者建议和咨询的机会和质量方面存在差异。有许多基于证据的策略，以促进健康行为的改变，并在初级保健提供生活方式咨询，但提供者可能不知道这些策略，对他们的种族和少数民族的有效性，以及如何适应现有的策略，以满足患者的需求和偏好的了解有限。增加生活方式改变和健康行为改变咨询的循证策略的转化的一种方法是确定利益相关者对这些努力的优先事项和偏好，并制定与这些优先事项和偏好以及实践中可用的资源一致的基于实践的实施和评估计划。基于社区的参与性研究（CBPR）是一种方法，可用于确定提供者和患者的优先事项和偏好是否以及在何处收敛和发散，就不同的问题达成共识，并制定基于实践的实施和评估计划，将现有的循证策略转化为护理。为响应RFA-HS-13-010《通过传播和实施以患者为中心的结局研究缩小医疗保健差异的差距》（U18），我们建议开展一项示范项目，通过与HCP和患者合作，使用CBPR减少初级保健中生活方式改变和健康行为改变咨询的质量和可及性差异。这项研究将分两个阶段进行。在第一阶段，我们将使用多层次的战略，以确定和综合循证策略的生活方式改变和健康行为的改变，有针对性的，发展，或通过系统性证据综合审查在种族和少数民族中进行评估，并在来自不同初级保健的HCP和患者中识别和优先考虑有关提供和使用生活方式改变和健康行为咨询的问题和偏好这是国家PBRN的一部分。在第二阶段，我们将制定实施和评估计划，具体说明将生活方式改变和健康行为改变的循证策略转化为初级保健所需的程序、结果和资源，与HCP和PPRNet实践中的患者合作，使用参与式规划和干预映射。我们还将评估在优先排序过程中让PPRNet实践中的提供者和患者参与的过程，以及实施和评估计划的制定和传播。

DESCRIPTION (provided by applicant): Despite ongoing efforts, racial and ethnic minorities continue to experience significant disparities in health care and outcomes. Persistent disparities are due to many factors, but unequal quality and reduced access to preventive care and chronic disease management are among the measures that are in need of urgent attention to reduce disparities. Health care providers (HCP) play an important role in helping patients to adopt and maintain healthy lifestyle behaviors. But, there are disparities in access and quality of provider advice and counseling about lifestyle modification and health behavior change. There are many evidence-based strategies to promote health behavior change and provide lifestyle counseling in primary care, but providers may not be aware of these strategies, have limited understanding about their effectiveness in racial and ethnic minorities, and how to adapt existing strategies to meet the needs and preferences of patients. One way to increase the translation of evidence-based strategies for lifestyle modification and health behavior change counseling is to identify the priorities and preferences for these efforts among stakeholders and develop practice-based implementation and evaluation plans that are consistent with these priorities and preferences and the resources that are available in the practice. Community-based participatory research (CBPR) is an approach that can be used to determine if and where the priorities and preferences of providers and patients converge and diverge, reach consensus on divergent issues, and develop practice-based implementation and evaluation plans to translate existing evidence-based strategies into care. In response to RFA-HS-13-010, Closing the Gap in Healthcare Disparities through Dissemination and Implementation of Patient Centered Outcomes Research (U18), we propose to conduct a demonstration project that uses CBPR to reduce disparities in quality and access to lifestyle modification and health behavior change counseling in primary care by working collaboratively with HCPs and patients. This research will be implemented in two phases. During Phase I, we will use a multilevel strategy to identify and synthesize evidence-based strategies for lifestyle modification and health behavior change that were targeted, developed, or evaluated in racial and ethnic minorities through a systematic evidence synthesis review and identify and prioritize the concerns and preferences about the delivery and use of lifestyle modification and health behavior counseling among HCPs and patients from diverse primary care practices that are part of a national PBRN. In Phase II, we will develop implementation and evaluation plans that specify the procedures, outcomes, and resources that are necessary to translate evidence-based strategies for lifestyle modification and health behavior change into primary care collaboratively with HCPs and patients from PPRNet practices using participatory planning and intervention mapping. We will also evaluate the process of engaging provider and patient from PPRNet practices in the prioritization process and the development and dissemination of implementation and evaluation plans.