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：
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
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/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

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.

抽象的心血管疾病（CVD）对非洲人的发病率和死亡率施加了不成比例的燃烧东南部的美国人。超过的大部分超过了，直接或间接地归因于社会健康的决定因素以及与健康相关的社会需求。而CVD预防干预措施有伯恩（Burnen）的总体疾病减少了，他们未能消除CVD中的Rata和地理分布。新的诸如责任健康社区之类的护理模式通过筛查，推荐和社区导航服务，并已开始证明健康的改善护理成本，使用和CVD风险因素。农村少数民族社区，CVD风险因素的燃烧和社会需求很高，医疗机构可能更脆弱，资源密度可能较低，有更需要有效且可扩展的解决方案来满足健康和社会需求。我们的建议是由班杜拉（Bandura）的自我效能理论，格雷的自我和家庭管理框架和安德森（Andersen）的基础卫生服务的行为模型使用。我们将使用合并的框架进行实施研究实施和整合促进健康的社区资源数据的研究和有效性通过CommunityRX（CRX）进入EMR。 CRX-CVD干预是一种数字解决方案，可将患者与基于社区的资源以解决与健康相关的社会需求和农村地区的心脏代谢健康患者。我们的总体目标是确定影响实施并评估健康的因素在粗糙环境中，闭环转介系统对社区促进资源的影响。我们使用一个混合II实施有效性设计，以进行患者的受控务实试验（成人18 年及以上的儿童2-17岁； n = 750）卡罗来纳州。我们假设闭环转介的整合将增加患者对社区的了解资源，提高自我效能感，以管理CVD风险因素，增加社区资源的利用改善心脏代谢条件的标记。据我们所知，该审判将是第一个评估针对AA成人的低强度，可扩展的诊所发起的干预措施的实施和健康影响和有CVD风险的孩子。此外，我们将进行与实施有关的成本效益分析 CRX-CVD的信息，以告知缩放干预措施。长期目标是确定可扩展干预措施使用“整个人”的方法来减少非洲裔美国人的CVD风险和与健康相关的社会需求健康。