Project 2: Addressing Social Determinants of Health in Primary Care

标题：在初级保健中解决健康的社会决定因素 项目负责人：玛丽·爱丽丝·斯科特，伊万·德拉罗萨，NMSU；蕾切尔·塞巴洛斯，弗雷德·哈奇 [这项试点提案的内容在NMSU和Fred Hutch提案中是相同的] 项目摘要/摘要 健康的社会决定因素(SDH)，如低食品安全、个人安全、就业、住房和 获得医疗保健，与不良的健康结果和癌症健康差距密切相关。 认识到SDH对健康结果的重要性，包括癌症预防和控制，国家和 联邦机构发布了临床设置建议，以实施SDH数据收集 电子病历(EMR)作为他们临床护理的一部分。然而，两国之间存在着重大差距。 SDH筛选工具的使用建议和如何实施SDH筛选工具的知识 在临床环境中。目前在新墨西哥州初级保健实践中实施SDH筛查工具的努力 服务于高需求人群的初级保健驻院计划提供了一个独特的机会来检查 该工具的实施过程，考虑对医疗提供者进行有关使用该工具的教育的方法，以及 探索患者和医生对该工具的有用性的看法。多措并举确保高水平 科学严谨，拟议的项目将收集所需的形成性数据，作为开发 对医疗提供者的教育干预。我们将使用前面的评估进行评估 (教育/环境诊断和评估中的易感、强化和使能结构) 具有以下条件的医疗机构的先行干预发展模式的一部分 对所有患者预约实施了筛选工具的使用。研究的具体目的是：1) 确定有助于以患者为中心使用SDH筛查工具的先行因素 初级保健提供者在以拉丁裔为主的社区卫生诊所进行的后续转诊 患者和2)计算SDH筛查工具的使用率和以患者为中心的转诊率 初级保健提供者提供适当的社会服务。这些具体目标将通过以下几种方式实现 数据收集方法：1)定性访谈和临床观察，以确定易感、使能、 以及能够影响行为、态度和环境的强化因素(包括管理和 政策)初级保健提供者对筛查工具的实施；2)对记录文档的图表审查 患者电子病历中的转介；3)与提供者进行定性访谈，以记录未知的讨论和/或 转介；以及4)与患者的定性访谈，以记录患者使用筛查工具的经验。 本项目将对SDH筛选工具实施过程、差距和 在更大的科学文献中取得成功，并导致开发一种可以 使用U54伙伴关系调查人员之间的扩展合作进行了测试。

Title: Addressing Social Determinants of Health in Primary Care Project Leaders: Mary Alice Scott, Ivan de la Rosa, NMSU; Rachel Ceballos, Fred Hutch [The content of this Pilot Proposal is identical in the NMSU and Fred Hutch proposals] PROECT SUMMARY/ABSTRACT Social determinants of health (SDH), such as low food security, personal safety, employment, housing, and access to health care, are strongly associated with poor health outcomes and cancer health disparities. Recognizing the importance of SDH to health outcomes, including cancer prevention and control, state and federal agencies have issued recommendations for clinical settings to implement collection of SDH data in electronic medical records (EMR) as part of their clinical care. However, a major gap exists between recommendations for use of SDH screening tools and knowledge about how to implement SDH screening tools in a clinical setting. Current efforts to implement a SDH screening tool in a New Mexico primary care practice in a primary care residency program that serves a high need population, offers a unique opportunity to examine the tool’s implementation process, consider methods of educating medical providers about use of the tool, and explore patient and physicians’ perceptions of the tool’s usefulness. Using multiple methods to ensure high scientific rigor, the proposed project will gather the formative data needed as a step toward development of an educational intervention for medical providers. We will conduct an assessment using the PRECEDE (Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation) portion of the PRECEDE-PROCEED intervention development model in a medical facility that has implemented use of the screening tool for all patient appointments. The study’s specific aims are to: 1) identify PRECEDE factors that contribute to the patient-centered use of the SDH screening tool and subsequent referrals by primary care providers in a community health clinic serving predominantly Latino patients and 2) calculate the rate of utilization of the SDH screening tool and rate of patient-centered referrals to appropriate social services by primary care providers. These specific aims will be achieved using several data collection methods: 1) qualitative interviews and clinical observations to identify predisposing, enabling, and reinforcing factors that can affect the behavior, attitude and environment (including administration and policies) of primary care provider implementation of the screening tool; 2) chart review to record documentation of referrals in patient EMR; 3) qualitative interviews with providers to document uncharted discussions and/or referrals; and 4) qualitative interviews with patients to document patient experience with the screening tool use. This project will contribute critical descriptions of SDH screening tool implementation processes, gaps, and successes to the larger scientific literature and lead to development of an educational intervention that can be tested using expanded collaborations among investigators of the U54 Partnership.