Chicago Chronic Condition Equity Network (C3EN)

项目摘要 创伤性应激障碍和创伤后应激障碍（PTSD）非常普遍， 精神和心血管疾病。居住在社会文化背景下的种族和族裔少数群体 在社区暴力或遭受攻击的环境中，PTSD的风险特别高。 然而，许多PTSD患者没有得到诊断或治疗。目前识别创伤后应激障碍的做法是 由于诊断依赖于临床医生或患者发起的创伤相关讨论， 症状和耻辱、知识、时间和获得资源的机会往往是这些讨论的障碍。 需要系统级的解决方案来增加PTSD的诊断和治疗。系统筛选 协议可以帮助解决筛查对象的偏见。筛查创伤后应激障碍的一个关键是 患者在门诊就诊时。虽然没有关于PTSD筛查的正式建议，但 为PTSD高危患者提供服务的机构，例如退伍军人事务部，已经在诊所实施了筛查 探访使用患者门户网站可能提供另一种有前途的策略，以解决障碍，创伤后应激障碍筛查。在 在我们之前的工作中，我们使用了一种人群健康方法来筛查和评估抑郁症状， 将患者门户网站用作接触患者的工具。我们发现它导致了更高的筛选 率，并确定了更多的中度至重度抑郁症患者。在确定PTSD患者后， 下一步是提供循证治疗，如综合初级保健行为健康 （PCBH）。综合初级保健-行为健康（PCBH）是一种护理模式，其中行为健康 和初级保健团队与初级保健诊所并置，共同努力解决 影响患者健康的生物心理社会因素。已发现PCBH对以下方面的污名化程度较低： PTSD患者和积极主动并提供电话护理管理的护理模式， 增加PTSD的治疗参与度。因此，将PTSD筛查与PCBH模型相结合， 可能是改善创伤后应激障碍的一个非常有效的策略。因此，我们的目标是实施和 评估一种新的策略，用于筛查和管理创伤后应激障碍的初级保健设置与高 尤其是在芝加哥南区与芝加哥家庭健康中心合作 该中心是一个拥有五个临床中心和PCBH的医疗保健中心，我们的目标是：1）实施系统级筛查， PTSD的管理策略我们将实施一个诊所访问和人口健康检查程序， PTSD利用患者门户与PCBH模型内的护理联系，2）评估系统级 PTSD的筛查和管理策略。有了这些目标，这笔赠款将导致增加 了解实用性和可行性的筛查和管理创伤后应激障碍在一个cnhc，服务于 主要是种族/少数民族人群，创伤暴露率高。如果证明有效，我们将 在一项多中心试验中评估这种护理模式。

PROJECT ABSTRACT Traumatic stress and post-traumatic stress disorder (PTSD) are highly prevalent and lead to increases in psychiatric and cardiovascular disease. Racial and ethnic minority people residing in sociocultural environments entrenched in community violence or experiencing assault are at especially high risk of PTSD. However, many people with PTSD are not diagnosed or treated. Current practices for identifying PTSD are subject to bias because diagnosis depends on clinician- or patient-initiated discussion of trauma-related symptoms, and stigma, knowledge, time, and access to resources are often barriers to these discussions. System-level solutions are needed to increase diagnosis and treatment of PTSD. Systematic screening protocols can help address bias in who is screened. A keystone to screening for PTSD could be to screen patients when they are at clinic visits. While no formal recommendation exists for PTSD screening, clinics who serve patients at a high risk for PTSD, for example, the Veterans Affairs, have implemented screening at clinic visits. Use of patient portals may provide another promising strategy to address barriers to PTSD screening. In our previous work, we used a population health approach to screen for and assess depression symptoms, employing the patient portal as a tool to reach out to patients. We found that it resulted in a higher screening rate and identified more patients with moderate-severe depression. After identifying patients with PTSD, the next necessary step is to provide evidence-based treatments, like integrated primary-care behavioral health (PCBH). Integrated primary care-behavioral health (PCBH) is a model of care in which the behavioral health and primary care teams are collocated with the primary care clinic and work together to address the biopsychosocial factors that are affecting a patient’s health. PCBH has been found to be less stigmatizing for patients with PTSD and models of care that are proactive and provide telephonic care management have been found to increase treatment engagement for PTSD. Thus, coupling screening for PTSD with a PCBH model may be a highly effective strategy to improving PTSD outcomes. Therefore, our goal is to implement and evaluate a novel strategy for screening and management of PTSD in a primary care setting with a high prevalence of trauma, specifically the South Side of Chicago. In partnership with Chicago Family Health Center, an FQHC with five clinical sites and PCBH, we aim to 1) Implement a system-level screening and management strategy for PTSD. We will implement a process of clinic visit and population health screening for PTSD leveraging the patient portal with linkage to care within a PCBH model and 2) Evaluate a system-level screening and management strategy for PTSD. With these aims, this grant will lead to increased understanding of the utility and feasibility of screening and managing PTSD in an FQHC that serves a predominantly racial/ethnic minority population with high rates of trauma exposure. If proven effective, we will evaluate this model of care in a multi-center trial of FQHCs.