Southeast Collaborative for Innovative and Equitable Solutions to Chronic Disease Disparities

东南合作以创新和公平的方式解决慢性病差异

基本信息

批准号：
10891968
负责人：
Nancy J Cox
金额：
$ 81.35万
依托单位：
VANDERBILT UNIVERSITY MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-24 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10891968
关键词：
Address Adult Affect Age Attention Awareness Blood Pressure Caring Cholesterol Chronic Chronic Disease Clinic Clinical Clinical Trials Collection Communication Communities Complex Data Collection Deterioration Diabetes Mellitus Discrimination Disease Management Documentation Economic Burden Economic Factors Economics Education Electronic Health Record Engineering Ensure Environment Equity Ethnic Origin Financial Hardship Focus Groups Fostering Glycosylated hemoglobin A Goals Health Health Care Costs Health Professional Health Services Accessibility Hyperlipidemia Hypertension Income Individual Interdisciplinary Study Intervention Joints Knowledge Measurement Measures Medical Medical Care Team Medicine Methods Neighborhoods Non-Insulin-Dependent Diabetes Mellitus Outcome Patient Self-Report Patient-Focused Outcomes Patients Persons Pharmacists Policies Positioning Attribute Prevalence Process Professional Organizations Qualitative Evaluations Qualitative Methods Quality of life Reach, Effectiveness, Adoption, Implementation, and Maintenance Recommendation Regulation Reporting Research Research Personnel Resources Risk Risk Factors Role Social Environment Stigmatization Symptoms Training Translating Translations United States United States National Academy of Sciences Work arm behavioral and social science built environment clinical care clinical decision support clinical practice community engaged research community engagement community organizations comorbidity design diabetes control disease disparity disparity reduction effectiveness evaluation evidence base experience food insecurity health assessment health care service organization health data health disparity health equity health equity promotion health inequalities health information technology health literacy implementation barriers implementation evaluation implementation science improved innovation insight interdisciplinary approach low health literacy low socioeconomic status medication compliance member minority patient mortality multidisciplinary multiple chronic conditions pilot test primary care patient process optimization prospective racial minority racial minority population safety net scale up screening shared decision making social social factors stakeholder perspectives structural determinants support tools tool

项目摘要

Project Summary The United States continues to experience some of the worst health disparities in the world, in part due to the inability to address social drivers of health (SDoH). These SDoH, such as income, education/health literacy, and built environment, contribute to an estimated 50% of health inequities. The National Academy of Sciences, Engineering, and Medicine (NASEM) and other organizations have called for the systematic incorporation of SDoH assessment into electronic health records (EHRs) and clinical care. Further, new 2023 regulations from The Joint Commission now require SDoH screening, adding urgency to the need to study and establish best practices. However, surprisingly little research has evaluated implementation of SDoH data collection, assessed how multidisciplinary health care teams can best address SDoH in clinical practice, or measured the effects of social risk-informed care on patient outcomes in patients with chronic conditions, where health disparities are widespread. Concerns also exist about potential unintended consequences, such as administrative burden to clinics and stigmatization of patients. As a result, most practices do not address SDoH systematically, missing an important opportunity to foster health equity. The goal of this project is to develop and evaluate a multi-level initiative to collect and address SDoH as part of the clinical care of adult primary care patients with type 2 diabetes, plus hypertension and/or hyperlipidemia. The proposed research builds on the substantial preliminary work and expertise of our interdisciplinary research team in the measurement of SDoH and interventions to address them, as well as health disparities, implementation science, and health information technology. In Aim 1, we will use qualitative methods to assess the perspectives of stakeholders – investigators already involved in activities related to community engagement and social drivers, patients, clinicians, clinic staff, and community organization leaders – on the collection and use of patient-reported SDoH, how to optimize integration of SDoH information and clinical decision support tools in the EHR, and how to minimize potential barriers to implementation and unintended consequences. In Aim 2, we will implement a multi-level initiative (SDoH data collection, training and tools for health care professionals, care coordinator and pharmacist support, and community resources) and evaluate its effect on clinical outcomes, including hemoglobin A1c, blood pressure, and cholesterol. In Aim 3, we will perform a mixed-methods evaluation of implementation using the RE-AIM QuEST framework to inform scale-up and spread. This research will fill critical gaps in knowledge related to real-world implementation of SDoH data collection and provision of social risk-informed care. Findings will be relevant across a broad range of chronic medical conditions affected by social risk factors and health disparities, enhancing the project's potential for impact.

项目概要美国继续经历着世界上最严重的健康差距，部分原因是无法解决健康的社会驱动因素（SDoH），例如收入、教育/健康。据美国国家科学院估计，识字率和建筑环境造成了 50% 的健康不平等。科学、工程和医学 (NASEM) 和其他组织呼吁建立系统的将 SDoH 评估纳入电子健康记录 (EHR) 和临床护理此外，2023 年新增。联合委员会的法规现在要求 SDoH 筛查，这增加了研究和然而，令人惊讶的是，很少有研究评估 SDoH 数据的实施。收集，评估多学科医疗保健团队如何在临床实践中最好地解决 SDoH，或者测量了社会风险告知护理对慢性病患者治疗结果的影响，健康差异普遍存在的地区也存在对潜在意外后果的担忧，例如因此，大多数做法都没有解决诊所的行政负担和患者的耻辱问题。 SDoH 系统性地错失了促进健康公平的重要机会。该项目的目标是制定和评估一项多层次举措，以收集和解决 SDoH 患有 2 型糖尿病、高血压和/或糖尿病的成人初级保健患者的临床护理的一部分拟议的研究建立在我们大量的前期工作和专业知识的基础上。跨学科研究团队致力于 SDoH 的测量和解决这些问题的干预措施，以及健康差异、科学实施和卫生信息技术。在目标 1 中，我们将使用定性方法来评估利益相关者的观点——调查人员已经参与与社区参与和社会驱动者、患者、圣人、诊所工作人员和社区组织领导者 – 关于患者报告的 SDoH 的收集和使用，如何优化将 SDoH 信息和临床决策支持工具集成到 EHR 中，以及如何最大限度地减少潜力实施障碍和意外后果在目标 2 中，我们将实施一项多层次举措。（针对医疗保健专业人员、护理协调员和药剂师的 SDoH 数据收集、培训和工具）支持和社区资源）并评估其对临床结果的影响，包括血红蛋白 A1c、在目标 3 中，我们将使用混合方法评估实施情况。 RE-AIM QuEST 框架为扩大规模和传播提供信息。这项研究将填补与 SDoH 数据实际实施相关的知识空白收集和提供社会风险知情护理的研究结果将与广泛的慢性病相关。受社会风险因素和健康差异影响的医疗状况，增强了该项目的潜力影响。

项目成果

期刊论文数量（2）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Barriers to Community-Based Eradication of Helicobacter pylori Infection.

以社区为基础根除幽门螺杆菌感染的障碍。

DOI：
10.1016/j.cgh.2024.03.008
发表时间：
2024
期刊：
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
影响因子：
0
作者：
Kumar,Shria;Araque,Manuela;Stark,ValerieS;Kleyman,LeoS;Cohen,DamianA;Goldberg,DavidS
通讯作者：
Goldberg,DavidS

Sleep-Disordered Breathing Destabilizes Ventricular Repolarization.

睡眠呼吸障碍会破坏心室复极的稳定性。

DOI：
10.1101/2023.02.10.23285789
发表时间：
2024
期刊：
medRxiv : the preprint server for health sciences
影响因子：
0
作者：
Solhjoo,Soroosh;Haigney,MarkC;Siddharthan,Trishul;Koch,Abigail;Punjabi,NareshM
通讯作者：
Punjabi,NareshM