Advancing Health Equity through Implementation Science: Phase II Administrative Supplement

摘要 健康及其下游社会风险的社会决定因素，如住房不稳定、粮食不安全和 经济压力，是癌症健康不平等的关键驱动因素。医疗保健系统参与识别和 解决社会需求是一个新的和不断发展的领域。特别是，用于指导医疗保健的资源有限 诊所选择、实施和优化针对其特定需求的社会服务资源定位器(SSRL) 背景。本附录的目的是借鉴我们团队以前在 支持诊所采用不同的SSRL方法，以制定实用的实施指南 社会风险推荐书的制作和记录。本补充资料是四个ISC3之间的协作成果 中心：Bridge-C2，哈佛ISCCCE，OPTICC(癌症控制优化实施)中心，以及 华盛顿大学-ISC3。我们建议：(1)制定一本实用的临床指南(《指南》) 寻求实施、扩展或优化使用援助来解决患者报告的社会风险的努力 战略；(2)使用快速周期测试来确定执行指南的最佳做法；和(3)反复和 传播精炼指南。在目标1中，我们将制定一份实用指南，以帮助初级保健实践：1) 选择协助策略和相关的SSRL方法，以及执行这些操作的相关工作流 实践中的战略，包括记录社会风险转介；2)采用、优化和维持这些战略 工作流程。随后，在目标2中，我们将1)提供多样化诊所指南(城市和农村联邦 合格的卫生中心；初级保健诊所)在三个ISC3的SSRL实施的不同阶段 实验室；2)确定执行《指南》的促进者和障碍；3)确定需要的支持 使用《指南》。ISCCCE、OPTICC和WU-ISC3将在其临床应用中使用一系列快速循环 合作伙伴网站。我们将使用第一阶段补充外部环境数据集来确定关键的社会资源需求 应该在每个诊所环境中解决这个问题，并使用以用户为中心的设计方法进行快速周期测试 将用于在试点学习的基础上完善指南。使用OPTICC STATE II方法快速检测Small 改进的变化将被系统地跟踪。我们还将跟踪使用的实施策略 以支持指南的使用，无论是由ISC3中心工作人员提供还是由参与的诊所站点提供。诊所是 被选中是为了确保与他们服务的人群相关的“社区生命体征”的变化，例如 使用我们在阶段1中开发的外部上下文数据库以及 实施援助战略，提高普适性。最后，在目标3中，我们将最终完善 根据目标2的调查结果进行指导，并将其作为公益进行传播。最终，这项提议将导致 可立即在ISC3成员的社区合作伙伴中传播的公共指南，以及 全国范围内。

SUMMARY Social determinants of health and its downstream social risks such as housing instability, food insecurity, and financial strain, are key drivers of cancer health inequities. Healthcare systems’ engagement in identifying and addressing social needs is a new and evolving field. In particular, limited resources exist to guide healthcare clinics in selecting, implementing, and optimizing social service resource locators (SSRLs) for their specific context. The purpose of this supplement is to draw on learnings from our team’s previous pilot efforts in supporting clinics’ adoption of different SSRL approaches to develop a pragmatic guide for implementation of social risk referral-making and documentation. This supplement is a collaborative effort across four ISC3 Centers: BRIDGE-C2, Harvard ISCCCE, OPTICC (Optimizing Implementation in Cancer Control) Center, and Washington University-ISC3. We propose to: (1) develop a pragmatic, applied guidebook (the Guide) for clinics seeking to implement, expand, or optimize efforts to address patient-reported social risks using Assistance strategies; (2) use rapid-cycle testing to identify best practices for implementing the Guide; and (3) iterate and disseminate the refined Guide. In Aim 1, we will develop a pragmatic Guide to help primary care practices: 1) select an Assistance strategy and a related SSRL approach, and associated workflows for conducting these strategies in practice, including documenting social risk referrals; and 2) adopt, optimize, and sustain these workflows. Subsequently, in Aim 2 we will 1) provide the Guide to diverse clinics (urban and rural Federally Qualified Health Centers; primary care clinics) at different stages of SSRL implementation, in three ISC3 laboratories; 2) identify facilitators and barriers to implementing the Guide; and 3) identify the support needed to use the Guide. ISCCCE, OPTICC, and WU-ISC3 will use a series of rapid cycle turns with their clinical partner sites. We will use the Phase I supplement outer context dataset to identify key social resource needs that should be addressed in each clinic setting and rapid cycle testing using user-centered designed methods will be used to refine the Guide based on pilot learnings. Rapid tests using OPTICC state II methods of small changes for improvement will be tracked systematically. We will also track the implementation strategies used to support the Guide’s use, whether provided by ISC3 center staff or participating clinic sites. Clinics were selected to ensure variation in the ‘community vital signs’ associated with the populations they serve, as determined using our outer contextual database that was developed in Phase 1, and in the stages of implementing Assistance strategies, increasing generalizability. Finally, in Aim 3, we will finalize refining the Guide based on the findings of Aim 2, and disseminate it as a public good. Ultimately, this proposal will lead a public guide that can immediately be disseminated across ISC3 members’ community partners, and nationwide.