DEDICATE: aDvancing carE management aDoption In Community heAlTh cEnters

奉献：推进社区卫生中心护理管理的采用

基本信息

批准号：
10834669
负责人：
Nicole Jill Cook
金额：
$ 212.21万
依托单位：
OCHIN, INC.
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-21 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10834669
关键词：
Address Adopted Adoption Ambulatory Care Caring Characteristics Chronic Disease Clinic Clinical Cluster randomized trial Communities Community Health Networks Contracts Delphi Technique Diabetes Mellitus Disease Management Disease Outcome Electronic Health Record Exclusion Feedback General Population Goals Health Personnel Hypertension Incidence Individual Infrastructure Intervention Investments Knowledge Link Low income Managed Care Managed Care Programs Medicaid Medicare Methods Neighborhood Health Center Outcome Patients Persons Population Primary Care Randomized Reduce health disparities Resources Risk Role Services Social Work System Technology Testing Time Training Work acute care care coordination care providers community based service community building community clinic community engagement community intervention community organizations community partnership comparison control design effectiveness evaluation effectiveness/implementation hybrid ethnic minority ethnic minority population evidence base experience formative assessment health disparity health disparity populations health inequalities health information technology implementation science implementation strategy improved minority patient new technology payment primary care setting primary outcome provider adoption public health insurance racial minority racial minority population safety net screening secondary outcome service organization social tool

项目摘要

Project Summary/Abstract Low-income and racial/ethnic minority populations experience disparately high rates of chronic disease incidence and poor disease outcomes, as well as the social and contextual risks that hinder disease management. Care management is an evidence-based strategy for chronic disease management. It involves coordinating the necessary, appropriate care for an individual's needs, including connecting them to community-based organizations (CBOs) to address social risks. Increasingly, payors (e.g., CMS and state Medicaid / Managed Care Organizations) are reimbursing healthcare providers for conducting social risk screening and making related referrals that involve clinic-CBO linkages as part of care management. However, in under-resourced care settings, the systematic implementation of these activities is often substantially hampered by the initial investment in technology and workflow redesign needed to operationalize such tasks. Such barriers to establishing clinic-CBO linkages are most pronounced in Community Health Centers (CHCs), non-profit primary care safety net clinics serving health disparate populations. There is a clear need to identify best practices for supporting CHCs' ability to connect and match patients to available services using electronic health record (EHR)-based clinic-CBO linkage functionality, as improving receipt of needed services could reduce health disparities. In 2022, a national network of CHCs sharing one EHR made available a new EHR- integrated application (Compass Rose) that is designed to support care management, including assessing patients' social risks, referring them to CBOs, and tracking referral outcomes . However, extensive evidence shows that targeted implementation support (such as training, championship, practice facilitation, and audit and feedback) may be critical to enhance clinical organizations' and care providers' adoption of new technologies. We will partner with CHC stakeholders to develop and refine implementation strategies designed to support the implementation and optimization of EHR-based tools (and related workflows) for CHC team coordination and use of clinic-CBO linkages. Our specific aims are to: 1) identify barriers and facilitators to CHCs' use of EHR-based care management functions as a means to systematize (i) referring patients with social risks to CBOs and (ii) assessing referred patients' service receipt (closed-loop referral); 2) partner with community stakeholders to refine a set of implementation strategies to optimize their potential to support CHCs' adoption of linkage functionality in Compass Rose; and 3) conduct a trial of whether the refined strategies improve clinic-CBO linkages for patients with social risks. Study findings will provide knowledge needed to support CHCs' adoption of existing technologies for clinic-CBO linkages, as a pragmatic means to reduce health inequities. As the first trial of strategies to support the implementation of clinic-CBO linkages via adoption of an EHR-based care management application in the primary care safety net setting, the proposed work directly addresses NINR's goal of increasing clinical-CBO linkages in health disparate populations.

项目概要/摘要低收入和少数种族/族裔人群的慢性病发病率高得惊人发病率和不良疾病结果，以及阻碍疾病的社会和背景风险管理。护理管理是慢性病管理的循证策略。它涉及到协调对个人需求的必要、适当的护理，包括将他们与社区组织（CBO）应对社会风险。付款人（例如 CMS 和州政府）越来越多地医疗补助/管理式医疗组织）正在补偿医疗保健提供者承担社会风险作为护理管理的一部分，筛选和进行涉及诊所与 CBO 联系的相关转诊。然而，在资源贫乏的护理环境中，系统地实施这些活动往往会大大减少由于实施此类任务所需的技术和工作流程重新设计的初始投资而受到阻碍。建立诊所与 CBO 联系的此类障碍在社区卫生中心 (CHC) 中最为明显，为不同健康人群提供服务的非营利性初级保健安全网诊所。明确需要识别支持 CHC 使用电子设备将患者与可用服务联系和匹配的能力的最佳实践基于健康记录 (EHR) 的诊所-CBO 链接功能，因为改善所需服务的接收可以减少健康差距。 2022 年，共享一个 EHR 的全国 CHC 网络提供了一个新的 EHR- 集成应用程序（Compass Rose）旨在支持护理管理，包括评估患者的社会风险、将他们转介给 CBO 并跟踪转介结果。然而，大量证据表明有针对性的实施支持（例如培训、锦标赛、实践促进和审计）和反馈）对于加强临床组织和护理提供者采用新的方法可能至关重要技术。我们将与 CHC 利益相关者合作，制定和完善设计的实施策略支持 CHC 团队实施和优化基于 EHR 的工具（及相关工作流程）协调和利用诊所与 CBO 的联系。我们的具体目标是：1）找出障碍和促进因素 CHC 使用基于 EHR 的护理管理功能作为系统化的手段 (i) 转诊患者社区组织面临的社会风险以及 (ii) 评估转诊患者的服务收据（闭环转诊）； 2) 与合作伙伴社区利益相关者完善一套实施策略，以最大限度地发挥其支持的潜力 CHC 采用 Compass Rose 中的链接功能； 3) 试验是否精制策略改善了具有社会风险患者的诊所与 CBO 的联系。研究结果将提供知识需要支持 CHC 采用现有技术来建立诊所与 CBO 的联系，以此作为一种务实的手段减少健康不平等。作为支持实施诊所与 CBO 联系的战略的首次试验在初级保健安全网环境中采用基于电子病历的护理管理应用程序，建议这项工作直接解决了 NINR 的目标，即加强健康不同人群中的临床与 CBO 联系。