RFA-DP-19-001, Health Promotion and Disease Prevention Research Centers

摘要 北卡罗来纳州和美国东南部农村的居民患上了一些最严重的慢性病 受健康的社会决定因素的显著影响，该国的死亡率和最大的健康差距 (SDH)。此应用程序的目标是：(1)与我们的社区合作伙伴一起，建立和维护强大的中心 支持应用预防研究、翻译研究成果和传播证据的基础设施- 以产品为基础，以及(2)确定我们行之有效的生活方式干预(中南地区)的过程 生活方式计划(MSLP)可以有效地转化为公共卫生和临床实践，由 以社区为基础的资源，以应对粮食不安全问题。MSLP，基于地中海饮食，但 根据南方低资源人口的口味偏好和食物可获得性量身定做，导致了 对高血压、糖尿病和肥胖症的积极健康结果。尽管科学上的理由是 实施生活方式干预措施是强有力的，支持大规模实施的证据有限 这些干预措施在临床和公共卫生环境中的应用。我们提出了一项实施核心研究 项目分三个阶段，运用多种实施理论，将知识转化为行动框架。 我们的研究旨在确定MSLP能够最有效和 有效地转化为公共卫生(地方卫生部门)和临床(社区卫生中心) 积极影响少数民族、农村和医疗服务不足的人群降低慢性病风险的做法 人口。在第1阶段，我们将确定实施和开发、试行测试和 完善将用于使MSLP规模化的实施战略。在第二阶段，我们将应用 有效性-实施混合设计，用于比较两种在实施上扩展MSLP的格式 结果(主要目的)并确认MSLP对行为和临床结果的影响(次要目的)。在……里面 第三阶段，我们将在北卡罗来纳州启动MSLP的全面实施，与NC目前的 过渡到医疗补助管理的医疗保健，其中州卫生部门(HD)的政策将指导计划和 向提供者提供以全人为中心的、协调良好的护理系统， 解决医疗和非医疗健康的驱动因素。“我们正在讨论将MSLP整合到 几家健康保险公司申请作为新的预付费健康计划的承保计划 医疗补助管理保健系统。我们将使用我们国家认可的培训和研究中心 翻译以传播MSLP材料以及HPDP产生的其他循证干预措施 和中华人民共和国网络，突出那些支持疾控中心资助的新节目的人。最后，我们会 继续与州住房管理局合作，为全州范围内强大的资源平台提供信息--数据库和呼叫 中心将公共卫生和临床从业者与其社区中的资源联系起来，解决社会问题 健康的决定因素，如粮食不安全。该平台将跟踪连接并监控结果。

ABSTRACT Residents of North Carolina and the rural southeastern US experience some of the highest chronic disease rates and greatest health disparities in the country, influenced significantly by social determinants of health (SDH). The goals of this application are to: (1) with our community partners, build and maintain a strong Center infrastructure to support applied prevention research, translate research findings, and disseminate evidence- based products, and (2) determine the processes by which our proven lifestyle intervention (Med-South Lifestyle Program - MSLP) can be efficiently translated into public health and clinical practice supported by community-based resources to combat food insecurity. The MSLP, based on the Mediterranean diet but tailored to the taste preferences and food availability of a southern low-resource population, has resulted in positive health outcomes for hypertension, diabetes, and obesity. Although the scientific rationale for implementing lifestyle interventions is robust, evidence is limited on supporting the broad-scale implementation of these interventions in clinical and public health settings. We propose an Implementation Core Research Project with 3 phases informed by multiple implementation theories and the Knowledge into Action Framework. Our research is designed to determine the processes by which the MSLP can be most efficiently and effectively translated into public health (local health departments) and clinical (community health centers) practice to positively impact chronic disease risk reduction among minority, rural, and medically underserved populations. In Phase 1, we will identify facilitators and barriers to implementation and develop, pilot test, and refine implementation strategies that will be used to take the MSLP to scale. In Phase 2, we will apply an effectiveness-implementation hybrid design to compare two formats for scaling up MSLP on implementation outcomes (primary aim) and confirm MSLP impact on behavioral and clinical outcomes (secondary aim). In Phase 3, we will initiate MSLP's full-scale implementation in North Carolina in coordination with NC's current transition to Medicaid Managed Care where state health department (HD) policies will “guide plans and providers toward implementation of a whole-person centered, well-coordinated system of care, which addresses both medical and non-medical drivers of health.” We are discussing integrating the MSLP in the coverage plans of several health insurance companies applying to serve as Pre-paid Health Plans in the new Medicaid Managed care system. We will use our nationally recognized Center for Training and Research Translation to disseminate MSLP materials along with other evidence-based interventions produced by HPDP and the PRC Network, highlighting those supporting the new CDC-funded programming. Finally, we will continue working with the State HD to inform a robust Statewide Resource Platform - a database and call center linking public health and clinical practitioners to resources in their communities addressing social determinants of health like food insecurity. The Platform will track connections and monitor outcomes.