A systems-level perspective to addressing health harming legal needs via a joint Health Equity Collective and MLP network approach"

通过健康公平集体和 MLP 网络联合方法，从系统层面视角解决危害健康的法律需求”

• 批准号: 10739710
• 负责人: JEMIMA C JOHN
• 金额: $ 10.44万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-20 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10739710
• 关键词: Address; Area; Behavioral; Black race; COVID-19 pandemic; Caring; Childhood; Chronic; Clinic; Clinical; Color; Communities; Complex; Continuity of Patient Care; Data; Demographic Factors; Demographic Impact; Development; Disparity; Economics; Effectiveness; Employment; Enrollment; Ensure; Environment; Ethnic Origin; Evaluation; Exposure to; Family; Feedback; Food; Geography; Health; Health Status; Healthcare; Hispanic; Hispanic Populations; Household; Housing; Income; Individual; Inequity; Institution; Insurance; Intervention; Interview; Joints; Knowledge; Knowledge acquisition; Legal; Low income; Managed Care; Medical; Mental Health; Mentored Research Scientist Development Award; Mentorship; Methodology; Minority Groups; Morbidity - disease rate; Neighborhoods; Outcome; Parents; Participant; Patient Care; Patients; Physical environment; Physicians; Population; Populations at Risk; Predictive Factor; Prevention; Process; Protocols documentation; Public Health; Quality of life; Quasi-experiment; Race; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reporting; Research; Research Activity; Research Personnel; Resolution; Resources; Review Literature; Risk; Sampling; Social Environment; Source; System; Time; Training; Transportation; Uninsured; Visit; Voice; Work; access restrictions; adverse outcome; care coordination; community based participatory research; contextual factors; efficacy evaluation; ethnic diversity; experience; experimental study; falls; follow-up; food insecurity; health care quality; health care service utilization; health equity; housing instability; implementation evaluation; implementation outcomes; improved; informant; innovation; insight; interest; intersectionality; intervention participants; lens; medical examination; medical specialties; patient oriented; pediatric patients; pragmatic study; programs; public health priorities; racial diversity; remediation; satisfaction; screening; social; social factors; social health determinants; structural determinants; success; trend; years of life lost

PROJECT SUMMARY Adverse social determinants of health (SDoH) disproportionately impact low-income and communities of color. The multisectoral alignment of expertise and resources can effectively target these adverse SDoH needs through innovation and diverse perspectives; and one such example is that of medical legal partnerships (MLPs) wherein healthcare institutions work with legal entities to address adverse social needs through legal remediation. These adverse social needs are thereby referred to as health harming legal needs (HHLNs) as they depend on legal support for resolution. While there has been great interest in MLP implementation, research on its efficacy and factors that predict implementation success is lacking in clinical settings. Furthermore, none of these existing experimental studies were conducted in the southern region of the U.S, thus omitting geographic and cultural contexts to MLP implementation. Given this limited availability of research in support of effectiveness, we propose a systems-level approach to explore the impact of a patient- informed MLP intervention that resolves HHLNs in pediatric families enrolled across UT Physicians multispecialty clinics. This approach integrates the community voice (patient) perspective to identify lived experiences (themes) within the clinic setting that may impede the screening and care coordination process. As such, we will use key informant interviews to qualitatively explore and identify themes that influence patients' experiences with on feedback screening and resource access for adverse social needs, with particular emphasis factors that may impact utilization of an MLP program to resolve these needs (Aim 1). We will then leverage from Aim 1 tobuild an evaluation framework and protocol for assessing the reach, effectiveness, adoption, implementation, and maintenance of a real world MLP intervention (Aim 2a). This evaluation framework will be subsequently utilized in our quasi-experimental study to assess MLP effectiveness and factors that impact implementation in pediatric families who visit UT Physicians multispecialty clinics (Aim 2b). Successful project completion will inform MLP implementation across clinics, strategies to better target at-risk populations, and the submission of an R01 application where we can assess the efficacy of an MLP intervention and further examine MLP expansion and implementation across clinics in the Greater Houston area. To date, my my research has examined the impact of demographic, social, and contextual factors on adverse behavioral and health-related outcomes among low-income and minority groups. The mentorship of Drs. Sharma, Murphy, Liaw, and Huber supported by this K01 mechanism will ensure that I continue to acquire knowledge and advanced training in relevant qualitative and quantitative methodologies, systems-level interventions, and community based participatory research strategies for informing research activities.

项目摘要 健康的不利社会决定因素（SDoH）对低收入和社区的影响不成比例 颜色。多部门协调专业知识和资源可以有效地针对这些不利的SDOH 医疗法律的是一个例子 医疗保健机构与法律的实体合作，以解决不利的社会需求 通过法律的补救。这些不利的社会需求因此被称为健康损害法律的需求 （HHLN），因为它们依赖于法律的支持来解决问题。虽然对MLP有很大的兴趣， 临床上缺乏对其有效性和预测实施成功因素的研究 设置.此外，这些现有的实验研究都没有在南部地区进行， 美国，从而忽略了地理和文化背景的MLP实施。鉴于这种有限的可用性， 支持有效性的研究，我们提出了一个系统级的方法来探索病人的影响， 在UT医生招募的儿科家庭中解决HHLN的知情MLP干预 多专科诊所这种方法整合了社区的声音（病人）的角度来确定生活 可能妨碍筛查和护理协调过程的临床环境中的经验（主题）。 因此，我们将使用关键的线人访谈，定性地探索和确定影响 患者的经验， 对 反馈 为不利的社会需要进行甄别和提供资源， 可能影响利用MLP计划解决这些需求的因素（目标1）。然后我们会利用 从目标1到建立一个评估框架和协议，以评估范围，有效性， 采用、实施和维持真实的世界MLP干预措施（目标2a）。本评价 框架将随后在我们的准实验研究中使用，以评估MLP的有效性， 影响在UT医师多专科诊所就诊的儿科家庭中实施的因素（目标2b）。 项目的成功完成将为诊所的MLP实施提供信息，更好地针对风险人群的策略 人群，并提交R01申请，我们可以评估MLP的有效性 干预，并进一步研究MLP在大休斯顿诊所的扩展和实施 区 到目前为止，我的研究已经研究了人口统计学，社会和背景因素对 低收入和少数群体中的不良行为和健康相关结果。的辅导 Drs. Sharma、Murphy、Liaw和Huber在这个K01机制的支持下，将确保我继续获得 系统一级相关定性和定量方法的知识和高级培训 干预措施和基于社区的参与性研究战略，为研究活动提供信息。