Cook Nicole, Gunn Rose, McGrath Brenda M, Donovan Jenna, Pisciotta Maura, Owens-Jasey Constance, Fein Hannah L, Templeton Anna, Larson Zoe, Gold Rachel
Ochin.
Res Sq. 2024 Oct 17:rs.3.rs-4985627. doi: 10.21203/rs.3.rs-4985627/v1.
Adverse social determinants of health contribute to health inequities. Practice guidelines now recommend incorporating patient unmet social needs into patient care, and payors increasingly reimburse for screening and providing related referrals to community organizations. Emergent electronic health record (EHR)-based tools can enable clinical-community linkages, but their adoption commonly faces workflow and infrastructure barriers. Targeted implementation support such as training, championship, practice facilitation, and audit and feedback, can enhance such tools' adoption, but no prior research has assessed such strategies' impact on the adoption of 'enabling technologies' supporting clinical-community linkages. This study will test whether providing targeted implementation support to safety-net primary care health center care management teams improves the sustained adoption of EHR-based enabling technologies used to 1) screen for social needs and 2) link patients to community organizations.
Formative evaluation of barriers and facilitators to adopting EHR-enabled social needs referrals and ascertainment of services received will include semi-structured interviews and a 'guided tour' of enabling technology used by care managers serving patients with complex health and/or social needs. A modified Delphi process conducted with care management staff and subject matter experts will then inform the development of an intervention targeting adoption of social risk EHR-enabled tools. The intervention will be piloted in three health centers, refined, then tested in a pragmatic stepped-wedge cluster-randomized trial in 20 health centers (five wedges of four health centers) that provide care management to high-risk patients with social needs.
This study is among the first to evaluate an intervention designed to support care management teams' adoption of enabling technologies to increase clinical-community linkages. It was funded in September 2023 by the National Institute of Nursing Research. Formative activities will take place from January to June 2024, the intervention will be developed in July-December 2024, the pilot study will be conducted from January-March 2025, and the cluster-randomized trial will occur from July 2025 -September 2026. Study data will be analyzed and results disseminated in 2027-2028. Study results have the potential to improve clinical-community linkages and in so doing to advance health equity.
Clinicaltrials.gov registration # NCT06489002. Registered July 5, 2024, https//clinicaltrials.gov/study/NCT06489002?term=NCT06489002&rank=1.
不良的社会健康决定因素导致了健康不平等。实践指南现在建议将患者未满足的社会需求纳入患者护理中，并且支付方越来越多地为筛查以及向社区组织提供相关转诊服务提供报销。新兴的基于电子健康记录（EHR）的工具能够实现临床与社区的联系，但其应用通常面临工作流程和基础设施方面的障碍。有针对性的实施支持，如培训、倡导、实践促进以及审核与反馈，可以提高此类工具的应用率，但此前尚无研究评估这些策略对支持临床与社区联系的“赋能技术”应用的影响。本研究将测试向安全网初级保健健康中心护理管理团队提供有针对性的实施支持是否能提高用于以下两个方面的基于EHR的赋能技术的持续应用率：1）筛查社会需求；2）将患者与社区组织联系起来。
对采用基于EHR的社会需求转诊的障碍和促进因素进行形成性评估，并确定所接受的服务，这将包括半结构化访谈以及对为有复杂健康和/或社会需求的患者提供服务的护理经理所使用的赋能技术进行“导览”。然后，与护理管理工作人员和主题专家一起开展的改良德尔菲法将为针对采用支持社会风险的基于EHR的工具的干预措施的制定提供依据。该干预措施将在三个健康中心进行试点，进行完善，然后在一项务实的阶梯式楔形整群随机试验中进行测试，该试验将在20个为有社会需求的高危患者提供护理管理的健康中心（四个健康中心为一组，共五组）开展。
本研究是首批评估旨在支持护理管理团队采用赋能技术以加强临床与社区联系的干预措施的研究之一。它于2023年9月获得美国国立护理研究所的资助。形成性活动将于2024年1月至6月进行，干预措施将于2024年7月至12月制定，试点研究将于2025年1月至3月进行，整群随机试验将于2025年7月至2026年9月进行。研究数据将在2027 - 2028年进行分析并公布结果。研究结果有可能改善临床与社区的联系，从而促进健康公平。
Clinicaltrials.gov注册号# NCT06489002。于2024年7月5日注册，https//clinicaltrials.gov/study/NCT06489002?term=NCT06489002&rank=1 。
