The Effectiveness of Patient Navigation to Address Social and Behavioral Health Needs for Emergency Department High Utilizers.

项目总结/摘要 这是马克·弗莱明博士的K 01奖申请书，他是大学的医学人类学家 位于加州伯克利（UCB）。弗莱明博士正在确立自己作为一名专注于卫生系统的调查员的地位 采取干预措施，解决弱势群体健康的社会决定因素。对于这个K 01奖，博士。 Fleming提出了一种新的急诊科（艾德）患者导航（PN）混合方法研究 高利用率。艾德高利用者通常患有多种慢性疾病， 行为健康需求。PN是一种有希望的卫生系统干预措施，可以解决以下问题： 医疗、社会和行为健康需要高利用率，但其有效性知之甚少。博士 弗莱明将进行一个混合方法的评估艾德PN计划实施的大学 加州，旧金山弗朗西斯科（加州大学旧金山分校）。他将确定艾德PN对随后的医疗、社会 使用现有复合数据库（目标1）的服务和行为健康利用。这将是第一 一项旨在测量高利用者的艾德PN是否实际上改变了社会和行为健康利用的研究 医疗系统之外的服务（包括住房服务、收入支持和精神健康） 物质使用治疗）。这将使弗莱明博士能够测试的假设，联系和使用的 这些服务介导了艾德PN对随后急性护理利用率降低的影响。弗莱明博士 然后将进行定性研究，以确定构成“导航”的任务和过程，并解释 基于ED的PN如何发挥作用以实现其效果（目标2）。最后，弗莱明博士将使用非营利组织参与， 设计工程方法，为高利用率患者开发基于证据的优化PN计划（目标3） 并随后提出R 01，以实施和评估优化干预。 该K 01奖将为弗莱明博士提供必要的支持和研究经验， 他在医学人类学的培训，并制定了一个混合方法的研究计划，在卫生服务。到 为实现这一目标，本奖项将有针对性地提供以下几个方面的培训：1）量化方法 卫生服务研究，2）实施科学，3）专业发展，成为一个 独立的卫生服务调查员弗莱明博士的培训计划包括正式的课程，个人 他的多学科导师团队的辅导，以及参与卫生服务研究和 评价小组。弗莱明博士组建了一个指导团队， Shortell，卫生系统研究的国家领导人和UCB-UCSF联合卫生服务主任 培训计划（AHRQ-T32），Urmimala Sarkar博士，实施科学和创新设计专家 卫生服务干预方法，南希伯克博士，在卫生混合方法研究专家 加州大学旧金山分校艾德PN项目医学主任、急诊医学专家Maria Raven博士 卫生服务研究和劳拉戈特利布博士，在卫生系统的社会需求干预的国家领导人。

PROJECT SUMMARY/ABSTRACT This is an application for a K01 award for Dr. Mark Fleming, a medical anthropologist at the University of California, Berkeley (UCB). Dr. Fleming is establishing himself as an investigator focused on health system interventions to address social determinants of health for vulnerable populations. For this K01 award, Dr. Fleming proposes a novel mixed-methods study of patient navigation (PN) for emergency department (ED) high utilizers. ED high utilizers typically have multiple chronic illnesses and significant unmet social and behavioral health needs. PN is a promising intervention for health systems to address this combination of medical, social and behavioral health needs for high utilizers, but its effectiveness is poorly understood. Dr. Fleming will conduct a mixed-methods evaluation of an ED PN program implemented at the University of California, San Francisco (UCSF). He will determine the effect of ED PN on subsequent medical, social services and behavioral health utilization using an existing composite database (Aim 1). This will be the first study to measure whether ED PN for high utilizers actually changes utilization of social and behavioral health services situated outside of the medical system (including housing services, income support, and mental health and substance use treatment). This will enable Dr. Fleming to test the hypothesis that linkage to and use of these services mediates the effect of ED PN on subsequent reductions of acute care utilization. Dr. Fleming then will conduct a qualitative study to identify the tasks and processes that constitute “navigation” and explain how ED-based PN works to achieve its effects (Aim 2). Finally, Dr. Fleming will use stakeholder-engaged, design engineering methods to develop an evidence-based, optimized PN program for high utilizers (Aim 3) and will subsequently propose an R01 to implement and evaluate the optimized intervention. This K01 award will provide Dr. Fleming with the support and research experience necessary to build on his training in medical anthropology and develop a mixed-methods research program in health services. To achieve this goal, this award will provide targeted training the following areas: 1) quantitative methods for health services research, 2) implementation science, and 3) professional development to become an independent health services investigator. Dr. Fleming’s training plan includes formal coursework, individual tutorials from his multi-disciplinary mentorship team, and participation in health services research and evaluation groups. Dr. Fleming has assembled a mentoring team comprised of primary mentor, Dr. Steven Shortell, national leader in health systems research and Director of the joint UCB-UCSF health services training program (AHRQ-T32), Dr. Urmimala Sarkar, expert in implementation science and innovative design methods for health services interventions, Dr. Nancy Burke, expert in mixed methods research in health systems, Dr. Maria Raven, Medical Director of UCSF ED PN program and expert in emergency medicine health services research, and Dr. Laura Gottlieb, national leader in health system social needs interventions.