ASCEND: ApproacheS to CHC ImplEmeNtation of SDH Data Collection and Action

ASCEND：CHC 实施 SDH 数据收集和行动的方法

基本信息

批准号：
9376920
负责人：
RACHEL GOLD
金额：
$ 70.32万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-08-25 至 2022-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9376920
关键词：
Address Adopted Adoption Adult Affect Baseline Surveys Caring Child health care Clinic Clinical Cluster randomized trial Communities Community Health Centers Community Healthcare Data Data Collection Diabetes Mellitus Disease Electronic Health Record Evaluation Funding General Population Glycosylated hemoglobin A Guidelines Health Health Insurance Health Personnel Impact evaluation Informatics Institute of Medicine (U.S.)Intervention Knowledge Lipids Measures Medical Medicare Methods National Institute of Diabetes and Digestive and Kidney Diseases Obesity Outcome Patients Pattern Pilot Projects Positioning Attribute Prevalence Prevention Preventive care Primary Health Care Process Provider Public Health Quality of Care Randomized Recommendation Recruitment Activity Reporting Research Resources Risk Risk Management Social Work Standardization Testing Training United States Centers for Medicare and Medicaid Services Variant Work base blood pressure regulation clinical practice community health study community intervention data management design diabetes risk electronic structure formative assessment health data health information technology implementation science improved multidisciplinary obesity prevention obesity risk programs safety net screening social health determinants social integration standard care tool treatment planning uptake

项目摘要

PROJECT SUMMARY/ABSTRACT: Health risks, outcomes, and care quality for people with / at risk for diabetes mellitus (DM) are profoundly affected by non-clinical factors called ‘social determinants of health’ (SDH). Diverse public health leaders and initiatives – including the Institute of Medicine, the Office of the National Coordinator for Health Information Technology, the Medicare Access & CHIP Reauthorization Act of 2015, and the Centers for Medicare & Medicaid Services 2016 Quality Strategy – emphasize the importance of documenting patients’ SDH data in electronic health records (EHRs), and using this data to inform care. However, little is known about how to help primary care teams routinely collect and act on SDH data using EHR-based tools. This knowledge gap is particularly problematic for the community health centers (CHCs) serving our nation’s most vulnerable patients, whose DM prevalence and risk (notably, obesity rates) are higher than the general population’s, and whose health is particularly impacted by SDH. The proposed trial builds on an NIDDK-funded pilot study in which we developed a suite of EHR-based SDH data management tools for primary care CHCs. In June 2016, these tools went live in 440 CHCs that are located in 19 states, but share a centrally-managed EHR. Having demonstrated that ‘SDH data tools’ can be built for CHCs, we now propose to assess: whether and how pragmatic implementation strategies that support other types of practice change will also help CHC teams systematically identify and take action on the SDH-related needs of adult patients with / at risk for DM; and, the impact of doing so on DM risk management. We will do this as follows. Step 1: Evaluate current EHR-based SDH data collection in 440 CHCs; use those formative results to hone a set of approaches for helping CHCs routinely collect SDH data and integrate it into care plans. Step 2: Conduct a pragmatic, stepped-wedge, cluster-randomized trial. Thirty CHCs will be randomized to one of five 6-month wedges, with staggered timing for receiving the intervention: a scalable implementation support package including technical assistance, training, and six months of access to an ‘SDH Implementation Team’ that will tailor support to meet each CHC’s needs. Step 3: Conduct a realist evaluation of how the impact on: (i) integration of SDH data collection into workflows; (ii) integration of SDH data into care; and (iii) DM risk management (controlled BP, HbA1c, BMI, lipids, etc.; up- to-date recommended care). Per PAR-15-157, we will test implementation strategies that are pragmatic, replicable, delivered under routine conditions, use existing resources, and target standard care processes. Our multidisciplinary team includes experts in SDH, implementation science, informatics, and primary care transformation. Study deliverables will include scalable strategies; results will inform SDH data collection and action implementation guidelines and materials for use by CHCs and primary care providers nationwide.

项目摘要/摘要：患有/有风险的人的健康风险、结果和护理质量糖尿病 (DM) 深受称为“健康社会决定因素”的非临床因素的影响 (SDH)。不同的公共卫生领导者和倡议——包括医学研究所、卫生署办公室。国家健康信息技术协调员、《医疗保险准入和 CHIP 重新授权法案》 2015 年以及医疗保险和医疗补助服务中心 2016 年质量战略 – 强调重要性在电子健康记录 (EHR) 中记录患者的 SDH 数据，并使用这些数据为护理提供信息。然而，对于如何帮助初级保健团队定期收集 SDH 数据并采取行动，人们知之甚少。基于 EHR 的工具对于社区卫生中心 (CHC) 来说尤其成问题。为我国最弱势的患者提供服务，他们的糖尿病患病率和风险（尤其是肥胖率）高于一般人群，其健康尤其受到 SDH 的影响。基于 NIDDK 资助的试点研究，我们开发了一套基于 EHR 的 SDH 数据管理初级保健 CHC 工具 2016 年 6 月，这些工具在 19 个州的 440 个 CHC 中投入使用。但在证明可以为 CHC 构建“SDH 数据工具”后，我们共享一个集中管理的 EHR。现在建议评估：是否以及如何支持其他方面的务实实施战略实践变革的类型也将帮助 CHC 团队系统地识别并采取行动患有糖尿病/有糖尿病风险的成年患者的 SDH 相关需求，以及这样做对糖尿病风险的影响；我们将按以下步骤进行：评估 440 当前基于 EHR 的 SDH 数据收集。 CHC；利用这些形成性结果来完善一套帮助 CHC 定期收集 SDH 数据的方法并将其纳入护理计划第 2 步：进行务实的、阶梯式楔形、整群随机试验。三十名 CHC 将被随机分配到五个为期 6 个月的楔形中的一个，并交错时间接收干预：可扩展的实施支持包，包括技术援助、培训和六几个月的时间联系“SDH 实施团队”，该团队将根据每个 CHC 步骤的需求提供定制支持。 3：对以下方面的影响进行现实评估：(i) 将 SDH 数据收集集成到工作流程中；(ii) 将 SDH 数据整合到护理中；(iii) 糖尿病风险管理（控制血压、HbA1c、BMI、血脂等；根据 PAR-15-157，我们将测试务实的实施策略，可复制、在常规条件下交付、使用现有资源并以标准护理流程为目标。我们的多学科团队包括 SDH、实施科学、信息学和初级保健方面的专家研究成果将包括可扩展的战略；结果将为 SDH 数据收集和制定提供信息。供全国社区卫生中心和初级保健提供者使用的行动实施指南和材料。