The Effectiveness of Patient Navigation to Address Social and Behavioral Health Needs for Emergency Department High Utilizers.

项目摘要/摘要 这是为该大学的医学人类学家马克·弗莱明博士申请K01奖项 加州伯克利分校(UCB)。弗莱明博士正在将自己确立为一名专注于卫生系统的调查员 采取干预措施，解决弱势群体健康的社会决定因素。对于这一K01奖项，Dr。 Fleming提出了一种新的急诊科患者导航(PN)混合方法研究 高利用率。ED高使用率者通常有多种慢性病和严重的未满足的社会和 行为健康需求。对于卫生系统来说，PN是一种有希望的干预措施，以解决这一组合 医疗、社会和行为健康需要高利用率，但其有效性尚不清楚。Dr。 Fleming将对在加州大学实施的ED PN计划进行混合方法评估 加州，旧金山(加州大学旧金山分校)。他将确定ED PN对随后的医疗、社会 使用现有复合数据库的服务和行为健康利用(目标1)。这将是第一次 测量高使用率的ED PN是否真的改变了社会和行为健康的利用的研究 医疗系统以外的服务(包括住房服务、收入支持和心理健康 和物质使用治疗)。这将使弗莱明博士能够检验与 这些服务调节了ED PN对随后急性护理利用率的减少的影响。弗莱明博士 然后进行定性研究，找出构成导航的任务和过程，并解释 基于ED的PN如何工作以实现其效果(目标2)。最后，弗莱明博士将使用利益相关者参与的 设计工程方法，为高利用率开发基于证据的、优化的PN计划(目标3) 并随后将提出R01来实施和评估优化的干预。 这一K01奖项将为弗莱明博士提供必要的支持和研究经验，以建立 关于他在医学人类学方面的培训，并制定了一项卫生服务方面的混合方法研究计划。至 为实现这一目标，该奖项将在以下方面提供有针对性的培训：1)量化方法 卫生服务研究，2)实施科学，3)专业发展，成为 独立的卫生服务调查员。弗莱明博士的培训计划包括正式的课程作业，个人 来自他的多学科指导团队的教程，以及参与卫生服务研究和 评估小组。弗莱明博士组建了一个由主要导师史蒂文博士组成的指导团队 Shortell，卫生系统研究的全国领先者，UCB-UCSF联合卫生服务主任 培训方案(AHRQ-T32)，执行科学和创新设计专家Urimala Sarkar博士 卫生服务干预方法，卫生领域混合方法研究专家南希·伯克博士 加州大学旧金山分校ED PN计划医学主任兼急诊医学专家Maria Raven博士 卫生服务研究，以及卫生系统社会需求干预方面的国家领导者Laura Gottlieb博士。

PROJECT SUMMARY/ABSTRACT This is an application for a K01 award for Dr. Mark Fleming, a medical anthropologist at the University of California, Berkeley (UCB). Dr. Fleming is establishing himself as an investigator focused on health system interventions to address social determinants of health for vulnerable populations. For this K01 award, Dr. Fleming proposes a novel mixed-methods study of patient navigation (PN) for emergency department (ED) high utilizers. ED high utilizers typically have multiple chronic illnesses and significant unmet social and behavioral health needs. PN is a promising intervention for health systems to address this combination of medical, social and behavioral health needs for high utilizers, but its effectiveness is poorly understood. Dr. Fleming will conduct a mixed-methods evaluation of an ED PN program implemented at the University of California, San Francisco (UCSF). He will determine the effect of ED PN on subsequent medical, social services and behavioral health utilization using an existing composite database (Aim 1). This will be the first study to measure whether ED PN for high utilizers actually changes utilization of social and behavioral health services situated outside of the medical system (including housing services, income support, and mental health and substance use treatment). This will enable Dr. Fleming to test the hypothesis that linkage to and use of these services mediates the effect of ED PN on subsequent reductions of acute care utilization. Dr. Fleming then will conduct a qualitative study to identify the tasks and processes that constitute “navigation” and explain how ED-based PN works to achieve its effects (Aim 2). Finally, Dr. Fleming will use stakeholder-engaged, design engineering methods to develop an evidence-based, optimized PN program for high utilizers (Aim 3) and will subsequently propose an R01 to implement and evaluate the optimized intervention. This K01 award will provide Dr. Fleming with the support and research experience necessary to build on his training in medical anthropology and develop a mixed-methods research program in health services. To achieve this goal, this award will provide targeted training the following areas: 1) quantitative methods for health services research, 2) implementation science, and 3) professional development to become an independent health services investigator. Dr. Fleming’s training plan includes formal coursework, individual tutorials from his multi-disciplinary mentorship team, and participation in health services research and evaluation groups. Dr. Fleming has assembled a mentoring team comprised of primary mentor, Dr. Steven Shortell, national leader in health systems research and Director of the joint UCB-UCSF health services training program (AHRQ-T32), Dr. Urmimala Sarkar, expert in implementation science and innovative design methods for health services interventions, Dr. Nancy Burke, expert in mixed methods research in health systems, Dr. Maria Raven, Medical Director of UCSF ED PN program and expert in emergency medicine health services research, and Dr. Laura Gottlieb, national leader in health system social needs interventions.