Project 2: Addressing Social Determinants of Health in Primary Care

项目 2：解决初级保健中健康问题的社会决定因素

• 批准号: 9632477
• 负责人: Rachel M. Ceballos
• 金额: $ 8.21万
• 依托单位: FRED HUTCHINSON CANCER RESEARCH CENTER
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9632477
• 关键词: Address; Affect; Attitude; Behavior; Biological Process; Cancer Control; Caring; Clinic; Clinical; Clinical Medicine; Cognitive; Collaborations; Collection; Communities; Community Health; Computerized Medical Record; Continuity of Patient Care; Data; Data Analyses; Data Collection; Development; Documentation; Economics; Education; Educational Intervention; Emotional; Employment; Enabling Factors; Ensure; Environment; Ethics; Evaluation; Family Practice; Future; Health; Health Surveys; Housing; Individual; Institute of Medicine (U.S.); Intervention; Interview; Journals; Knowledge; Latino; Lead; Legal; Literature; Low income; Medical; Medical Residency; Medicine; Methods; Movement; New Mexico; Outcome; Patient Appointment; Patients; Perception; Physicians; Pilot Projects; Policies; Population; Predisposing Factor; Primary Health Care; Procedures; Process; Provider; Recommendation; Reinforcing Factor; Research; Research Personnel; Residencies; Safety; Scientist; Screening procedure; Security; Site; Social Identification; Social Work; System; Testing; Time; Training; Underrepresented Students; Work; anticancer research; base; biomedical referral center; cancer health disparity; cancer prevention; care providers; clinical care; data format; diagnosis evaluation; experience; follow-up; food security; health care availability; health data; health organization; improved; interest; medical schools; model development; patient oriented; programs; routine care; social; social health determinants; success; therapy development; tool

Title: Addressing Social Determinants of Health in Primary Care Project Leaders: Mary Alice Scott, Ivan de la Rosa, NMSU; Rachel Ceballos, Fred Hutch [The content of this Pilot Proposal is identical in the NMSU and Fred Hutch proposals] PROECT SUMMARY/ABSTRACT Social determinants of health (SDH), such as low food security, personal safety, employment, housing, and access to health care, are strongly associated with poor health outcomes and cancer health disparities. Recognizing the importance of SDH to health outcomes, including cancer prevention and control, state and federal agencies have issued recommendations for clinical settings to implement collection of SDH data in electronic medical records (EMR) as part of their clinical care. However, a major gap exists between recommendations for use of SDH screening tools and knowledge about how to implement SDH screening tools in a clinical setting. Current efforts to implement a SDH screening tool in a New Mexico primary care practice in a primary care residency program that serves a high need population, offers a unique opportunity to examine the tool’s implementation process, consider methods of educating medical providers about use of the tool, and explore patient and physicians’ perceptions of the tool’s usefulness. Using multiple methods to ensure high scientific rigor, the proposed project will gather the formative data needed as a step toward development of an educational intervention for medical providers. We will conduct an assessment using the PRECEDE (Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation) portion of the PRECEDE-PROCEED intervention development model in a medical facility that has implemented use of the screening tool for all patient appointments. The study’s specific aims are to: 1) identify PRECEDE factors that contribute to the patient-centered use of the SDH screening tool and subsequent referrals by primary care providers in a community health clinic serving predominantly Latino patients and 2) calculate the rate of utilization of the SDH screening tool and rate of patient-centered referrals to appropriate social services by primary care providers. These specific aims will be achieved using several data collection methods: 1) qualitative interviews and clinical observations to identify predisposing, enabling, and reinforcing factors that can affect the behavior, attitude and environment (including administration and policies) of primary care provider implementation of the screening tool; 2) chart review to record documentation of referrals in patient EMR; 3) qualitative interviews with providers to document uncharted discussions and/or referrals; and 4) qualitative interviews with patients to document patient experience with the screening tool use. This project will contribute critical descriptions of SDH screening tool implementation processes, gaps, and successes to the larger scientific literature and lead to development of an educational intervention that can be tested using expanded collaborations among investigators of the U54 Partnership.

标题：解决初级保健中健康的社会决定因素 项目负责人：Mary Alice Scott、Ivan de la Rosa、NMSU、Fred Hutch； [该试点提案的内容与 NMSU 和 Fred Hutch 提案中的内容相同] 项目概要/摘要 健康的社会决定因素 (SDH)，例如低食品安全、个人安全、就业、住房和 获得医疗保健的机会与不良健康结果和癌症健康差异密切相关。 认识到 SDH 对健康结果（包括癌症预防和控制）的重要性，国家和 联邦机构已发布临床环境建议，以实施 SDH 数据收集 电子病历（EMR）作为临床护理的一部分然而，两者之间存在重大差距。 使用 SDH 筛选工具的建议以及有关如何实施 SDH 筛选工具的知识 目前在新墨西哥州初级保健实践中实施 SDH 筛查工具的努力。 为高需求人群服务的初级保健住院医师计划，提供了独特的机会来检查 该工具的流程，考虑对医疗提供者进行该工具使用教育的实施方法，以及 使用多种方法探索患者和医生对该工具有用性的看法。 科学研究，拟议的项目将收集所需的形成性数据，作为开发 我们将使用 PRECEDE 对医疗服务提供者进行教育干预。 （教育/环境诊断和评估中的诱发、强化和启用结构） 医疗机构中 PRECEDE-PROCEED 干预开发模型的一部分 在所有患者预约中使用筛查工具 该研究的具体目标是：1) 确定有助于以患者为中心使用 SDH 筛查工具的 PRECEDE 因素，以及 随后由初级保健提供者转介到主要服务于拉丁裔的社区卫生诊所 患者，2) 计算 SDH 筛查工具的使用率和以患者为中心的转诊率 初级保健提供者提供适当的社会服务将通过多种方式实现。 数据收集方法：1) 定性访谈和临床观察，以确定诱发因素、促成因素、 以及可以影响行为、态度和环境的强化因素（包括管理和 政策）初级保健提供者实施筛查工具；2）图表审查以记录文件 患者 EMR 中的转诊；3) 与提供者进行定性访谈，以记录未知的讨论和/或 转诊；4) 与患者进行定性访谈，记录患者使用筛查工具的体验。 该项目将对 SDH 筛选工具实施流程、差距和 更广泛的科学文献的成功，并导致教育干预措施的发展，该干预措施可以 通过 U54 合作伙伴研究人员之间的合作扩大了测试范围。