Community Health Worker Integration into Healthcare Teams: Advancing a Theory-driven Implementation Science Model

项目总结 高血压(HTN)患病率和控制率的种族和民族差异是有据可查的，而且持续存在 尽管采取了目标明确的举措，以减少排放。社区卫生工作者(CHW)的使用已经 被认为是减少脆弱社区成员之间HTN差距的最佳做法。尽管 暴露于CHW提供的干预措施与改善HTN相关结局之间联系的证据的强度 在弱势人群中，在整个医疗系统中，CHW干预措施的采用率低于最佳水平， 尤其是CHW在医疗团队中充分整合的障碍，可能会威胁到在 支持那些在心理社会和社会经济环境中需要社区卫生工作者的素质和技能的患者。 Chidinma A.Ibe博士是一位社会行为学家，也是麻省理工学院普通内科助理教授 约翰霍普金斯大学医学院。她试图支持这篇文章的翻译和传播 通过进行理论驱动的、系统的因素评估，将创新、有效的劳动力转化为常规护理 为社区卫生工作者融入护理团队做出贡献。她正在申请K01导师职业发展奖 为了获得为将应用的R01奠定基础所需的技能、经验和试点数据 在K01研究和培训期间学到的经验教训，以制定优化CHW摄取的干预措施 跨不同的医疗保健系统。她提议的研究将检查传播的背景障碍 CHW干预形成了阶梯式协作护理干预的症结所在。她将利用富人的影响力 LIFE(减少高血压护理中的不平等：每个人的生活方式改善)项目，一个务实的， 旨在减少HTN控制差异的整群随机试验，其特点是使用嵌入在 协作式护理团队：1)阐明个人内部、人际关系和结构性因素的互补性 与CHW融入护理团队相关；2)制定CHW护理的理论根基的衡量标准 团队整合；3)探索社区卫生工作者融入医疗团队与患者的关系 心血管、行为、护理管理和护理结果流程；以及4)使用以人为中心 设计方法，与主要利益攸关方合作，共同开发组织变革干预措施，以 促进社区卫生工作者融入护理团队。她的职业发展计划的特点是既说教又说教 以及实施科学、定性和混合方法以及高级统计方面的经验培训 策略，包括心理测试。这项建议的研究，与一项特殊的指导相结合 团队(主要导师：丽莎·A·库珀博士；共同导师，吉尔·马斯特勒博士)、课程作业和参与 相关工作小组、专业发展计划和科学会议将使易纲博士 实现她的目标，成为一名独立调查员，在应用执行方面具有专门知识 加强《中国日报》开发、实施和翻译的科学理论和模式 医疗保健环境中的干预。

PROJECT SUMMARY Racial and ethnic disparities in hypertension (HTN) prevalence and control are well-documented and persist despite targeted initiatives aimed at their reduction. The use of Community Health Workers (CHWs) has been endorsed as a best practice to reduce HTN disparities among members of vulnerable communities. Despite the strength of the evidence linking exposure to CHW-delivered interventions with improved HTN-related outcomes among vulnerable populations, the sub-optimal uptake of CHW interventions across healthcare systems at large, and barriers to CHWs’ full integration in healthcare teams in particular, may threaten efforts to utilize them in support of patients whose psychosocial and socioeconomic circumstances require CHWs’ qualities and skillsets. Dr. Chidinma A. Ibe is a social behavioral scientist and an Assistant Professor of General Internal Medicine at the Johns Hopkins University School of Medicine. She seeks to support the translation and diffusion of this innovative, effective workforce into routine care by conducting a theory-driven, systematic appraisal of the factors contributing CHWs’ integration into care teams. She is applying for a K01 Mentored Career Development Award in order to acquire the skills, experience, and pilot data necessary to lay the foundation for an R01 that will apply the lessons learned in the K01 research and training period to develop interventions that optimize CHW uptake across diverse healthcare systems. Her proposed study will examine contextual barriers to the diffusion of a CHW intervention that formed the crux of a stepped collaborative care intervention. She will leverage the RICH LIFE (Reducing Inequities in Care of Hypertension: Lifestyle Improvements for Everyone) Project, a pragmatic, cluster randomized trial aimed at reducing disparities in HTN control featuring the use of CHWs embedded in collaborative care teams, to: 1) illuminate the complement of intrapersonal, interpersonal, and structural factors associated with the CHWs’ integration into care teams; 2) develop a theoretically-rooted measure of CHW care team integration; 3) explore the extent to which CHWs’ integration into healthcare teams is related to patients’ cardiovascular, behavioral, care management, and process of care outcomes; and 4) use human-centered design methods to co-develop, in partnership with key stakeholders, an organizational change intervention to promote CHWs’ integration into care teams. Her career development plan is characterized by a blend of didactic and experiential training in implementation science, qualitative and mixed methods, and advanced statistical strategies, including psychometric testing. This proposed research, in combination with an exceptional mentoring team (Primary Mentor: Dr. Lisa A. Cooper; Co-Mentor, Dr. Jill Marsteller), coursework, and participation in relevant working groups, professional development programs, and scientific meetings, will position Dr. Ibe to achieve her goal of becoming an independent investigator with expertise in the application of implementation science theories and models to strengthen the development, implementation, and translation of CHW interventions in healthcare settings.