Southeast Collaborative for Innovative and Equitable Solutions to Chronic Disease Disparities

东南合作以创新和公平的方式解决慢性病差异

• 批准号: 10891968
• 负责人: Nancy J Cox
• 金额: $ 81.35万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-24 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10891968
• 关键词: Address; Adult; Affect; Age; Attention; Awareness; Blood Pressure; Caring; Cholesterol; Chronic; Chronic Disease; Clinic; Clinical; Clinical Trials; Collection; Communication; Communities; Complex; Data Collection; Deterioration; Diabetes Mellitus; Discrimination; Disease Management; Documentation; Economic Burden; Economic Factors; Economics; Education; Electronic Health Record; Engineering; Ensure; Environment; Equity; Ethnic Origin; Financial Hardship; Focus Groups; Fostering; Glycosylated hemoglobin A; Goals; Health; Health Care Costs; Health Professional; Health Services Accessibility; Hyperlipidemia; Hypertension; Income; Individual; Interdisciplinary Study; Intervention; Joints; Knowledge; Measurement; Measures; Medical; Medical Care Team; Medicine; Methods; Neighborhoods; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Patient Self-Report; Patient-Focused Outcomes; Patients; Persons; Pharmacists; Policies; Positioning Attribute; Prevalence; Process; Professional Organizations; Qualitative Evaluations; Qualitative Methods; Quality of life; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Regulation; Reporting; Research; Research Personnel; Resources; Risk; Risk Factors; Role; Social Environment; Stigmatization; Symptoms; Training; Translating; Translations; United States; United States National Academy of Sciences; Work; arm; behavioral and social science; built environment; clinical care; clinical decision support; clinical practice; community engaged research; community engagement; community organizations; comorbidity; design; diabetes control; disease disparity; disparity reduction; effectiveness evaluation; evidence base; experience; food insecurity; health assessment; health care service organization; health data; health disparity; health equity; health equity promotion; health inequalities; health information technology; health literacy; implementation barriers; implementation evaluation; implementation science; improved; innovation; insight; interdisciplinary approach; low health literacy; low socioeconomic status; medication compliance; member; minority patient; mortality; multidisciplinary; multiple chronic conditions; pilot test; primary care patient; process optimization; prospective; racial minority; racial minority population; safety net; scale up; screening; shared decision making; social; social factors; stakeholder perspectives; structural determinants; support tools; tool

Project Summary The United States continues to experience some of the worst health disparities in the world, in part due to the inability to address social drivers of health (SDoH). These SDoH, such as income, education/health literacy, and built environment, contribute to an estimated 50% of health inequities. The National Academy of Sciences, Engineering, and Medicine (NASEM) and other organizations have called for the systematic incorporation of SDoH assessment into electronic health records (EHRs) and clinical care. Further, new 2023 regulations from The Joint Commission now require SDoH screening, adding urgency to the need to study and establish best practices. However, surprisingly little research has evaluated implementation of SDoH data collection, assessed how multidisciplinary health care teams can best address SDoH in clinical practice, or measured the effects of social risk-informed care on patient outcomes in patients with chronic conditions, where health disparities are widespread. Concerns also exist about potential unintended consequences, such as administrative burden to clinics and stigmatization of patients. As a result, most practices do not address SDoH systematically, missing an important opportunity to foster health equity. The goal of this project is to develop and evaluate a multi-level initiative to collect and address SDoH as part of the clinical care of adult primary care patients with type 2 diabetes, plus hypertension and/or hyperlipidemia. The proposed research builds on the substantial preliminary work and expertise of our interdisciplinary research team in the measurement of SDoH and interventions to address them, as well as health disparities, implementation science, and health information technology. In Aim 1, we will use qualitative methods to assess the perspectives of stakeholders – investigators already involved in activities related to community engagement and social drivers, patients, clinicians, clinic staff, and community organization leaders – on the collection and use of patient-reported SDoH, how to optimize integration of SDoH information and clinical decision support tools in the EHR, and how to minimize potential barriers to implementation and unintended consequences. In Aim 2, we will implement a multi-level initiative (SDoH data collection, training and tools for health care professionals, care coordinator and pharmacist support, and community resources) and evaluate its effect on clinical outcomes, including hemoglobin A1c, blood pressure, and cholesterol. In Aim 3, we will perform a mixed-methods evaluation of implementation using the RE-AIM QuEST framework to inform scale-up and spread. This research will fill critical gaps in knowledge related to real-world implementation of SDoH data collection and provision of social risk-informed care. Findings will be relevant across a broad range of chronic medical conditions affected by social risk factors and health disparities, enhancing the project's potential for impact.

项目概要 美国继续经历着世界上最严重的健康差距，部分原因是 无法解决健康的社会驱动因素（SDoH）。这些 SDoH，例如收入、教育/健康 据估计，识字率和建筑环境造成了 50% 的健康不平等。国家科学院 科学、工程和医学 (NASEM) 和其他组织呼吁建立系统的 将 SDoH 评估纳入电子健康记录 (EHR) 和临床护理。此外，新的2023 联合委员会的法规现在要求 SDoH 筛查，这增加了研究和 建立最佳实践。然而，令人惊讶的是，很少有研究评估 SDoH 数据的实施 收集，评估多学科医疗保健团队如何在临床实践中最好地解决 SDoH，或者 测量了社会风险告知护理对慢性病患者治疗结果的影响， 健康差距普遍存在的地方。人们还担心潜在的意外后果，例如 造成诊所的行政负担和患者的耻辱。因此，大多数实践并没有解决 SDoH 系统性地错失了促进健康公平的重要机会。 该项目的目标是制定和评估一项多层次举措，以收集和解决 SDoH 患有 2 型糖尿病、高血压和/或糖尿病的成人初级保健患者的临床护理的一部分 高脂血症。拟议的研究建立在我们大量的前期工作和专业知识的基础上 跨学科研究团队致力于 SDoH 的测量和解决这些问题的干预措施，以及 健康差异、实施科学和卫生信息技术。 在目标 1 中，我们将使用定性方法来评估利益相关者的观点——调查人员已经 参与与社区参与和社会推动者、患者、临床医生、诊所工作人员相关的活动，以及 社区组织领导者 – 关于患者报告的 SDoH 的收集和使用，如何优化 将 SDoH 信息和临床决策支持工具整合到 EHR 中，以及如何最大限度地减少潜力 实施障碍和意想不到的后果。在目标2中，我们将实施多层次的举措 （针对医疗保健专业人员、护理协调员和药剂师的 SDoH 数据收集、培训和工具 支持和社区资源）并评估其对临床结果的影响，包括血红蛋白 A1c、 血压和胆固醇。在目标 3 中，我们将使用以下方法对实施情况进行混合方法评估： RE-AIM QuEST 框架为扩大规模和传播提供信息。 这项研究将填补与 SDoH 数据实际实施相关的知识空白 收集和提供社会风险知情护理。研究结果将与广泛的慢性病相关 受社会风险因素和健康差异影响的医疗状况，增强了该项目的潜力 影响。

项目成果

Barriers to Community-Based Eradication of Helicobacter pylori Infection.

以社区为基础根除幽门螺杆菌感染的障碍。

• DOI: 10.1016/j.cgh.2024.03.008
• 发表时间: 2024
• 期刊: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
• 作者: Kumar,Shria;Araque,Manuela;Stark,ValerieS;Kleyman,LeoS;Cohen,DamianA;Goldberg,DavidS
• 通讯作者: Goldberg,DavidS

Sleep-Disordered Breathing Destabilizes Ventricular Repolarization.

睡眠呼吸障碍会破坏心室复极的稳定性。

• DOI: 10.1101/2023.02.10.23285789
• 发表时间: 2024
• 期刊: medRxiv : the preprint server for health sciences
• 作者: Solhjoo,Soroosh;Haigney,MarkC;Siddharthan,Trishul;Koch,Abigail;Punjabi,NareshM
• 通讯作者: Punjabi,NareshM