Holcomb Jennifer L, Walton Gretchen H, Sokale Itunu O, Ferguson Gayla M, Schick Vanessa R, Highfield Linda
Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States.
Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.
Front Med (Lausanne). 2021 Jan 26;8:596873. doi: 10.3389/fmed.2021.596873. eCollection 2021.
The Accountable Health Communities (AHC) Model was designed to address the health-related social needs of Centers for Medicare & Medicaid Services beneficiaries. Bridge organizations across the AHC Model have identified lack of technical assistance and peer planning as potential barriers to Model success, particularly around patient navigation. The technical assistance and peer planning literature lacks an organizing, conceptual framework, but implementation science frameworks could serve as useful guides. The Strengthening Peer AHC Navigation (SPAN) research protocol seeks to fill this gap and will apply three implementation science frameworks, Consolidated Framework for Implementation Research, Intervention Mapping, and the Expert Recommendations for Implementing Change compilation, to develop a multi-level quality improvement intervention and evaluate the impact of peer planning on Model outcomes. The aims of the SPAN study are to implement and evaluate a novel multi-level quality improvement intervention to improve AHC implementation and navigation milestones through structured peer planning and to provide successful technical assistance for the AHC Model. The quality improvement intervention is outlined in four Tasks: (1) Assessment - to conduct an assessment of each bridge organization's current implementation, needs, and readiness in AHC Model navigation activities; (2) Planning - to engage in a peer planning approach to build capacity for AHC Model navigation activities; (3) Implementation with technical assistance - Co-creation of a quality improvement protocol for AHC Model navigation activities; and (4) Evaluation - measure the impact of the peer planning and technical assistance approach. Alongside the development and implementation of the quality improvement intervention, this protocol describes a mixed method, convergent parallel study design which will be used to evaluate whether the quality improvement intervention will lead to better outcomes. Tasks will be replicated with five bridge organizations participating in the AHC Model. This research protocol provides a framework that can be used to conduct structured peer planning with technical assistance for social needs programs. This study will provide data on both implementation and outcomes which eventually may impact healthcare cost and utilization.
accountable health communities（AHC）模式旨在满足医疗保险和医疗补助服务中心（Centers for Medicare & Medicaid Services）受益人的健康相关社会需求。AHC模式中的桥梁组织已确定缺乏技术援助和同行规划是该模式取得成功的潜在障碍，尤其是在患者导航方面。技术援助和同行规划文献缺乏一个组织性的概念框架，但实施科学框架可以作为有用的指南。加强同行AHC导航（SPAN）研究方案旨在填补这一空白，并将应用三个实施科学框架，即实施研究综合框架、干预映射和实施变革专家建议汇编，来制定一个多层次的质量改进干预措施，并评估同行规划对模式结果的影响。SPAN研究的目的是实施和评估一种新颖的多层次质量改进干预措施，通过结构化的同行规划来改善AHC的实施和导航里程碑，并为AHC模式提供成功的技术援助。质量改进干预措施概述为四项任务：（1）评估——对每个桥梁组织在AHC模式导航活动中的当前实施情况、需求和准备情况进行评估；（2）规划——采用同行规划方法来建设AHC模式导航活动的能力；（3）在技术援助下实施——共同创建AHC模式导航活动的质量改进方案；（4）评估——衡量同行规划和技术援助方法的影响。除了质量改进干预措施的开发和实施外，本方案还描述了一种混合方法、收敛平行研究设计，该设计将用于评估质量改进干预措施是否会带来更好的结果。将与参与AHC模式的五个桥梁组织重复这些任务。本研究方案提供了一个框架，可用于为社会需求项目在技术援助下进行结构化的同行规划。这项研究将提供关于实施和结果的数据，最终可能会影响医疗保健成本和利用率。
