Diversity Supplement: Implementation of EMR-Integrated Referrals

摘要 背景：中风对居住在“中风腰带”扣带上的黑人成年人的影响不成比例，或者 美国东南部的农村地区。中风之间的差异部分归因于结构性种族主义， 或在种族群体之间产生不平等的制度，如种族居住隔离。 种族隔离造成了对健康产生不利影响的社会和环境条件，可能包括 车辆通道。能够使用车辆是中风风险自我管理的关键，使旅行成为可能 到促进健康的机构。然而，缺乏车辆通道的人往往是人 有色人种，贫穷，居住在农村。社区-心血管疾病(CRX-CVD) 来自家长R01的干预生成将处方链接到社区的电子病历 满足患者健康相关社会需求的资源，目标是提高自我管理能力 心血管疾病和中风的危险因素。以前的CRX研究增加了患者的资源自我效能感，或者 寻找社区资源的信心，这是改善中风患者自我管理的潜在关键环节 风险。然而，隔离和车辆无法进入可能会削弱这些人的健康促进努力 新颖的数字工具。 方法：这项纵向的、收敛的混合方法研究的目的是检验 通过种族隔离以及社区和个人层面的车辆通道1)进行的结构性种族主义 与个人中风风险和2)影响资源自我效能感有关，这是一种自我管理策略 在中风危险因素中，工作年龄(18-岁)的黑人成年人。我们的主要假设是结构性的 种族主义(即种族隔离)和缺乏社区和个人一级的车辆通道将被联系在一起 资源自我效能感较低，与卒中风险自我管理相关的信心较低。为了测试 在这一假设下，现有的人口普查数据将与患者数据(调查、电子病历)相关联 数据和访谈)使用地理编码地址。本补充资料的具体目的是： 目标1.审查种族居住隔离(即结构性种族主义的标志)、交通工具 准入和个人中风风险。 目标2a。探索种族居住隔离的中介作用(即结构性种族主义的标志) 以及车辆使用对资源自我效能感和个体中风风险之间的关联。 目标2b。探讨车辆通行对居住关联的中介作用 种族隔离和个体中风风险。 目标3.进行混合方法分析，以确定资源自我效能的障碍和促进者 以及在居住隔离和车辆通行的背景下对中风风险的后续影响。

ABSTRACT Background: Stroke disproportionately affects Black adults residing in the buckle of the “stroke belt”, or rural southeastern United States. The disparities among stroke are partially attribute to structural racism, or systems that produce inequities among racial groups, such as racial residential segregation. Segregation creates social and environmental conditions that adversely affect health, which may include vehicle access. Having access to a vehicle is essential for self-management of stroke risk enabling travel to health-promoting institutions. Yet, individuals who lack vehicle access tend to be those who are people of color, poor, and reside in rural areas. The CommunityRx-Cardiovasular Disease (CRx-CVD) intervention from the Parent R01 generates electronic medical record linked prescriptions to community resources to meet patients’ health-related social needs with the goal of improving the self-management of CVD and stroke risk factors. Previous CRx studies have increased patients’ resource self-efficacy, or confidence in finding community resources, a potential key link to improving self-management of stroke risk. However, segregation and vehicle inaccessibility could diminish the health promotion efforts of such novel digital tools. Methods: The purpose of this longitudinal, convergent mixed methods study is to examine whether structural racism via segregation as well as community- and individual-level vehicle access 1) are associated with individual stroke risk and 2) impact resource self-efficacy, a strategy for self-management of stroke risk factors, among working age (18-64 years) Black adults. Our main hypothesis is structural racism (i.e., segregation) and lack of community- and individual-level vehicle access will be associated with lower resource self-efficacy, and less confidence related to self-management of stroke risk. To test this hypothesis, existing census tract data will be joined to patient data (survey, electronic medical record data, and interviews) using geocoded addresses. The specific aims of this supplement are: Aim 1. Examine associations of racial residential segregation (i.e. marker of structural racism), vehicle access, and individual stroke risk. Aim 2a. Explore the mediating effect of racial residential segregation (i.e. marker of structural racism) and vehicle access on the association between resource self-efficacy and individual stroke risk. Aim 2b. Explore the mediating effect of vehicle access on the association between residential segregation and individual stroke risk. Aim 3. Conduct a mixed methods analysis to identify barriers and facilitators to resource self-efficacy and the subsequent effect on stroke risk in the context of residential segregation and vehicle access.