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

• 批准号: 10078633
• 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
• 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/10078633
• 关键词: Address; Adult; African American; 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; Cost efficiency; County; Data; Diabetes Mellitus; Effectiveness; Federally Qualified Health Center; Geography; 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; base; burden of illness; cardiometabolism; cardiovascular disorder prevention; cardiovascular disorder risk; cardiovascular health; care costs; clinical encounter; community burden; community clinic; contextual factors; cost; cost estimate; data resource; density; digital; disease disparity; effectiveness evaluation; effectiveness implementation design; effectiveness implementation study; family management; health inequalities; health management; health service use; high risk; implementation science; implementation strategy; improved; innovation; minority communities; mortality; organizational readiness; pragmatic trial; premature; prevent; preventive intervention; public health relevance; rural African American; rural health network; rural healthcare; rural setting; screening; service providers; social; social health determinants; standard of care; theories

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CVD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