Community Health Worker Integration into Healthcare Teams: Advancing a Theory-driven Implementation Science Model

项目摘要 高血压（HTN）患病率和控制方面的种族和民族差异是有据可查的，并且持续存在 尽管有针对性的举措，旨在减少他们。社区卫生工作者的使用一直是 被认可为减少弱势社区成员之间HTN差距的最佳做法。尽管 将接触CHW提供的干预措施与改善HTN相关结果联系起来的证据强度 在弱势群体中，整个卫生保健系统对社区卫生福利干预措施的接受程度不佳， 尤其是社区卫生工作者充分融入医疗团队的障碍，可能会威胁到利用他们的努力， 支持那些心理社会和社会经济情况需要CHW素质和技能的患者。 博士奇丁马河Ibe是一位社会行为科学家，也是哈佛大学普通内科学助理教授。 约翰霍普金斯大学医学院。她寻求支持翻译和传播这一点， 创新，有效的劳动力到日常护理进行理论驱动的，系统的评估因素 帮助社区卫生工作者融入护理团队。她正在申请K 01辅导职业发展奖 为了获得必要的技术、经验和飞行试验数据，以便为R 01打下基础， 在K 01研究和培训期间吸取的经验教训，以制定优化CHW吸收的干预措施 在不同的医疗体系中。她提出的研究将探讨传播的背景障碍， CHW干预，形成了一个阶梯式的协作护理干预的关键。她会利用 LIFE（减少高血压护理中的不平等：每个人的生活方式改善）项目，一个务实的， 一项旨在减少HTN控制差异的群集随机试验，其特征是使用嵌入式CHW， 协作护理团队，以：1）阐明个人内部，人际关系和结构因素的补充 与社区卫生工作者融入护理团队相关; 2）制定基于理论的社区卫生工作者护理措施 团队整合; 3）探讨社区卫生工作者融入医疗团队与患者融入医疗团队的相关程度 心血管、行为、护理管理和护理结果的过程;以及4）使用以人为中心的 设计方法，与关键利益攸关方合作，共同制定组织变革干预措施， 促进社区卫生工作者融入护理团队。她的职业发展计划的特点是混合了说教 在实施科学、定性和混合方法以及高级统计方面的经验培训 策略，包括心理测试。这项拟议的研究，结合一个特殊的指导， 团队（主要导师：丽莎A.库珀;共同导师，吉尔马斯特勒博士），课程，并参与 相关工作组、专业发展计划和科学会议将使Ibe博士能够 实现她的目标，成为一个独立的调查员，在实施的应用方面具有专门知识， 科学理论和模型，以加强CHW的开发，实施和翻译 在卫生保健环境中的干预措施。

PROJECT SUMMARY Racial and ethnic disparities in hypertension (HTN) prevalence and control are well-documented and persist despite targeted initiatives aimed at their reduction. The use of Community Health Workers (CHWs) has been endorsed as a best practice to reduce HTN disparities among members of vulnerable communities. Despite the strength of the evidence linking exposure to CHW-delivered interventions with improved HTN-related outcomes among vulnerable populations, the sub-optimal uptake of CHW interventions across healthcare systems at large, and barriers to CHWs’ full integration in healthcare teams in particular, may threaten efforts to utilize them in support of patients whose psychosocial and socioeconomic circumstances require CHWs’ qualities and skillsets. Dr. Chidinma A. Ibe is a social behavioral scientist and an Assistant Professor of General Internal Medicine at the Johns Hopkins University School of Medicine. She seeks to support the translation and diffusion of this innovative, effective workforce into routine care by conducting a theory-driven, systematic appraisal of the factors contributing CHWs’ integration into care teams. She is applying for a K01 Mentored Career Development Award in order to acquire the skills, experience, and pilot data necessary to lay the foundation for an R01 that will apply the lessons learned in the K01 research and training period to develop interventions that optimize CHW uptake across diverse healthcare systems. Her proposed study will examine contextual barriers to the diffusion of a CHW intervention that formed the crux of a stepped collaborative care intervention. She will leverage the RICH LIFE (Reducing Inequities in Care of Hypertension: Lifestyle Improvements for Everyone) Project, a pragmatic, cluster randomized trial aimed at reducing disparities in HTN control featuring the use of CHWs embedded in collaborative care teams, to: 1) illuminate the complement of intrapersonal, interpersonal, and structural factors associated with the CHWs’ integration into care teams; 2) develop a theoretically-rooted measure of CHW care team integration; 3) explore the extent to which CHWs’ integration into healthcare teams is related to patients’ cardiovascular, behavioral, care management, and process of care outcomes; and 4) use human-centered design methods to co-develop, in partnership with key stakeholders, an organizational change intervention to promote CHWs’ integration into care teams. Her career development plan is characterized by a blend of didactic and experiential training in implementation science, qualitative and mixed methods, and advanced statistical strategies, including psychometric testing. This proposed research, in combination with an exceptional mentoring team (Primary Mentor: Dr. Lisa A. Cooper; Co-Mentor, Dr. Jill Marsteller), coursework, and participation in relevant working groups, professional development programs, and scientific meetings, will position Dr. Ibe to achieve her goal of becoming an independent investigator with expertise in the application of implementation science theories and models to strengthen the development, implementation, and translation of CHW interventions in healthcare settings.