A systems-level perspective to addressing health harming legal needs via a joint Health Equity Collective and MLP network approach"

通过健康公平集体和 MLP 网络联合方法，从系统层面视角解决危害健康的法律需求”

• 批准号: 10739710
• 负责人: JEMIMA C JOHN
• 金额: $ 10.44万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-20 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10739710
• 关键词: Address; Area; Behavioral; Black race; COVID-19 pandemic; Caring; Childhood; Chronic; Clinic; Clinical; Color; Communities; Complex; Continuity of Patient Care; Data; Demographic Factors; Demographic Impact; Development; Disparity; Economics; Effectiveness; Employment; Enrollment; Ensure; Environment; Ethnic Origin; Evaluation; Exposure to; Family; Feedback; Food; Geography; Health; Health Status; Healthcare; Hispanic; Hispanic Populations; Household; Housing; Income; Individual; Inequity; Institution; Insurance; Intervention; Interview; Joints; Knowledge; Knowledge acquisition; Legal; Low income; Managed Care; Medical; Mental Health; Mentored Research Scientist Development Award; Mentorship; Methodology; Minority Groups; Morbidity - disease rate; Neighborhoods; Outcome; Parents; Participant; Patient Care; Patients; Physical environment; Physicians; Population; Populations at Risk; Predictive Factor; Prevention; Process; Protocols documentation; Public Health; Quality of life; Quasi-experiment; Race; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reporting; Research; Research Activity; Research Personnel; Resolution; Resources; Review Literature; Risk; Sampling; Social Environment; Source; System; Time; Training; Transportation; Uninsured; Visit; Voice; Work; access restrictions; adverse outcome; care coordination; community based participatory research; contextual factors; efficacy evaluation; ethnic diversity; experience; experimental study; falls; follow-up; food insecurity; health care quality; health care service utilization; health equity; housing instability; implementation evaluation; implementation outcomes; improved; informant; innovation; insight; interest; intersectionality; intervention participants; lens; medical examination; medical specialties; patient oriented; pediatric patients; pragmatic study; programs; public health priorities; racial diversity; remediation; satisfaction; screening; social; social factors; social health determinants; structural determinants; success; trend; years of life lost

PROJECT SUMMARY Adverse social determinants of health (SDoH) disproportionately impact low-income and communities of color. The multisectoral alignment of expertise and resources can effectively target these adverse SDoH needs through innovation and diverse perspectives; and one such example is that of medical legal partnerships (MLPs) wherein healthcare institutions work with legal entities to address adverse social needs through legal remediation. These adverse social needs are thereby referred to as health harming legal needs (HHLNs) as they depend on legal support for resolution. While there has been great interest in MLP implementation, research on its efficacy and factors that predict implementation success is lacking in clinical settings. Furthermore, none of these existing experimental studies were conducted in the southern region of the U.S, thus omitting geographic and cultural contexts to MLP implementation. Given this limited availability of research in support of effectiveness, we propose a systems-level approach to explore the impact of a patient- informed MLP intervention that resolves HHLNs in pediatric families enrolled across UT Physicians multispecialty clinics. This approach integrates the community voice (patient) perspective to identify lived experiences (themes) within the clinic setting that may impede the screening and care coordination process. As such, we will use key informant interviews to qualitatively explore and identify themes that influence patients' experiences with on feedback screening and resource access for adverse social needs, with particular emphasis factors that may impact utilization of an MLP program to resolve these needs (Aim 1). We will then leverage from Aim 1 tobuild an evaluation framework and protocol for assessing the reach, effectiveness, adoption, implementation, and maintenance of a real world MLP intervention (Aim 2a). This evaluation framework will be subsequently utilized in our quasi-experimental study to assess MLP effectiveness and factors that impact implementation in pediatric families who visit UT Physicians multispecialty clinics (Aim 2b). Successful project completion will inform MLP implementation across clinics, strategies to better target at-risk populations, and the submission of an R01 application where we can assess the efficacy of an MLP intervention and further examine MLP expansion and implementation across clinics in the Greater Houston area. To date, my my research has examined the impact of demographic, social, and contextual factors on adverse behavioral and health-related outcomes among low-income and minority groups. The mentorship of Drs. Sharma, Murphy, Liaw, and Huber supported by this K01 mechanism will ensure that I continue to acquire knowledge and advanced training in relevant qualitative and quantitative methodologies, systems-level interventions, and community based participatory research strategies for informing research activities.

项目概要 健康的不利社会决定因素 (SDoH) 对低收入和社区的影响尤为严重 的颜色。专业知识和资源的多部门协调可以有效地针对这些不利的 SDoH 通过创新和多元化视角满足需求；医疗法律就是这样一个例子 医疗机构与法人实体合作解决不良社会需求的伙伴关系（MLP） 通过法律补救。因此，这些不利的社会需求被称为损害健康的法律需求 (HHLN)，因为它们依赖法律支持来解决。虽然人们对 MLP 很感兴趣 临床上缺乏对其疗效和预测实施成功因素的研究 设置。此外，这些现有的实验研究都不是在南部地区进行的。 美国，因此忽略了 MLP 实施的地理和文化背景。鉴于这种有限的可用性 为了支持有效性的研究，我们提出了一种系统级方法来探索患者的影响 知情的 MLP 干预可解决 UT 医生招募的儿科家庭中的 HHLN 多专科诊所。这种方法整合了社区声音（患者）的观点来识别生活 诊所环境中可能妨碍筛查和护理协调过程的经历（主题）。 因此，我们将利用关键知情人访谈来定性探索和识别影响的主题 患者的经历 在 反馈 筛选和获取资源以满足不利的社会需求，特别强调 可能影响利用 MLP 程序来解决这些需求的因素（目标 1）。然后我们将利用 从目标 1 建立一个评估框架和协议来评估范围、有效性、 采用、实施和维护现实世界的 MLP 干预（目标 2a）。本次评价 该框架随后将用于我们的准实验研究中，以评估 MLP 的有效性和 影响到 UT 医生多专科诊所就诊的儿科家庭实施的因素（目标 2b）。 项目的成功完成将为跨诊所的 MLP 实施以及更好地针对高风险人群的策略提供信息 人群，以及提交 R01 申请，我们可以在其中评估 MLP 的功效 干预并进一步检查 MLP 在大休斯顿地区诊所的扩展和实施 区域。 迄今为止，我的研究已经考察了人口、社会和背景因素对 低收入群体和少数群体的不良行为和健康相关结果。的指导 博士。 Sharma、Murphy、Liaw 和 Huber 在这个 K01 机制的支持下将确保我不断获得 相关定性和定量方法、系统级的知识和高级培训 干预措施以及为研究活动提供信息的基于社区的参与性研究策略。