巴尔的摩社区组织邻里网络：共同增强能力（CONNECT）集群 RCT。

The Baltimore Community-Based Organizations Neighborhood Network: Enhancing Capacity Together (CONNECT) Cluster RCT.

机构信息

Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

出版信息

Am J Prev Med. 2019 Aug;57(2):e31-e41. doi: 10.1016/j.amepre.2019.03.013. Epub 2019 Jun 25.

DOI:10.1016/j.amepre.2019.03.013

PMID:31248746

Abstract

INTRODUCTION

This cluster RCT aimed to reduce healthcare utilization and increase the referral of patients between an academic health center and local community-based organizations (CBOs) that address social determinants of health.

STUDY DESIGN

Cluster RCT.

SETTINGS/PARTICIPANTS: Twenty-two CBOs located in Baltimore, Maryland, were randomly assigned to the intervention or control group, and 5,255 patients were allocated to the intervention or control group based on whether they lived closer to an intervention or control CBO. Data were collected in 2014-2016; the analysis was conducted in 2016.

INTERVENTION

A multicomponent intervention included an online tool to help refer clients to community resources, meet-and-greet sessions between CBO staff and healthcare staff, and research assistants.

MAIN OUTCOME MEASURES

The primary outcomes were patient emergency department visits and days spent in the hospital. Additional outcomes for CBO clients included knowledge of other CBOs, number of referrals to CBOs by the healthcare system, and number of referrals to healthcare system by CBOs. Outcomes for CBO staff included the number of referrals made to and received from the healthcare system and the number of referrals made to and received from other CBOs.

RESULTS

There was no significant effect of the intervention on healthcare utilization outcomes, CBO client outcomes, or CBO staff outcomes. Ancillary analyses demonstrated a 2.9% increase in referrals by inpatient staff to intervention CBOs (p=0.051) and a 6.6% increase in referrals by outpatient staff to intervention CBOs between baseline and follow-up (p=0.027). Outpatient staff reported a significant reduction in barriers related to the lack of information about CBO services (-18.3%, p=0.004) and an increase in confidence in community resources (+14.4%, p=0.023) from baseline to follow-up.

CONCLUSIONS

The intervention did not improve healthcare utilization outcomes but was associated with increased healthcare staff knowledge of, and confidence in, local CBOs.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT02222909.

摘要

简介

本项聚类随机对照试验旨在减少医疗保健的使用并增加学术医疗中心与当地社区组织（CBO）之间的转诊，这些 CBO 旨在解决健康的社会决定因素。

研究设计

聚类随机对照试验。

设置/参与者：22 家位于马里兰州巴尔的摩的 CBO 被随机分配到干预组或对照组，5255 名患者根据他们居住在干预或对照 CBO 的距离分配到干预或对照组。数据于 2014-2016 年收集；分析于 2016 年进行。

干预措施

一项多组分干预措施包括一个帮助将患者转介给社区资源的在线工具、CBO 工作人员与医疗保健工作人员的见面会，以及研究助理。

主要结果测量

主要结果是患者急诊就诊次数和住院天数。CBO 客户的其他结果包括对其他 CBO 的了解程度、医疗保健系统向 CBO 的转诊数量，以及 CBO 向医疗保健系统的转诊数量。CBO 工作人员的结果包括向医疗保健系统的转诊数量和收到的转诊数量，以及向其他 CBO 的转诊数量和收到的转诊数量。

结果

干预对医疗保健利用结果、CBO 客户结果或 CBO 工作人员结果没有显著影响。辅助分析表明，住院工作人员向干预 CBO 的转诊增加了 2.9%（p=0.051），门诊工作人员向干预 CBO 的转诊在基线和随访期间增加了 6.6%（p=0.027）。门诊工作人员报告称，与缺乏 CBO 服务信息相关的障碍显著减少（-18.3%，p=0.004），对社区资源的信心增加（+14.4%，p=0.023）。