DEDICATE: aDvancing carE Management aDoption In Community heAlTh cEnters
试验速览
- 阶段
- 不适用
- 状态
- 进行中（未招募）
- 发起方
- OCHIN, Inc.
- 入组人数
- 20
- 试验地点
- 1
- 主要终点
- Social needs screening
研究概览
简要总结
DEDICATE will refine and test the effectiveness of evidence-based implementation support strategies designed to support care management teams' sustained use of electronic health record (EHR)-based functionalities to address unmet non-medical health-related needs through improved clinical-community linkages. This study will test the hypothesis that providing implementation support to health center care management teams will lead to increased adoption of EHR functionalities and increased screenings and referrals to community organization to address unmet non-medical health-related needs needs through a cluster-randomized trial. This study's results will have implications for patients with non-medical health-related needs receiving care management in primary care settings.
详细描述
The investigators will use a hybrid effectiveness-implementation mixed methods design to assess the impact of evidence-based implementation support strategies designed to support the care management teams' adoption of EHR functionalities that enable screening and referrals to community organizations for non-medical health-related needs. After conducting a three-month pilot study with three health centers to test and refine the implementation support strategies, 20 community-based health centers will be recruited to participate in a stepped-wedge, cluster-randomized trial. Eligible OCHIN health centers include those that provide primary care, use an EHR-based care management tool for at least one care management or population health program that addresses non-medical health-related needs for more than 10 enrolled patients from April-June 2025. Once 20 health centers have been enrolled, health centers will be randomized to one of four wedges for staggered receipt of the intervention. This method will allow us to provide tailored support to five health centers at a time and enables all health centers to eventually receive the intervention. Participating sites will be provided implementation support strategies for using EHR-based functionalities to conduct screening and referrals for patients with unmet non-medical health-related needs. After receiving the intervention, participating health centers will be followed until Y4Q4 to assess primary and secondary outcomes.
The intervention includes implementation strategies to support adoption of EHR-based functionalities for non-medical health-related needs activities by care management teams in health centers. The intervention will be delivered to health center care management staff outside of patient care. Patients will not directly receive the intervention and will continue to receive regular care from the health center. For all study health centers, quantitative data will be collected (via EHR data extraction) on care team use of EHR functionalities and non-medical health-related needs screening and coordination provided by care teams. Limited clinical data will be collected on patients seen at included health centers during the study period. Qualitative data will also be collected, including semi-structured interviews with clinic staff from all enrolled study sites.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Crossover
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •• Health centers that use an EHR-based care management tool for at least one care management or population health program that addresses non-medical health-related needs for more than 10 enrolled patients from April-June 2025.
排除标准
- •Health center participated in pilot
- •Health center is a school-based health center
- •Health center provides care to prison population
研究组 & 干预措施
Intervention Arm
Intervention health centers will receive implementation support when they crossover from Control to Intervention.
干预措施: Implementation Support (Other)
Control Arm
Control health centers will not receive an intervention prior to crossover to Intervention.
结局指标
主要结局
Social needs screening
时间窗: From six months prior to the intervention, assessed up to 12 months.
Binary variable of whether the patient has been screened for social needs
Social needs referral
时间窗: From six months prior to the intervention, assessed up to 12 months.
Binary variable of whether patients with unmet social needs received referrals to a community organization
Screening for non-medical health-related needs
时间窗: From six months prior to the intervention, assessed up to 12 months.
Whether a patient enrolled in a care management program was screened for unmet non-medical health-related needs (binary, patient-level).
Referral for non-medical health-related need
时间窗: Baseline, through study completion, an average of 7.5 months.
Among patients with one or more identified non-medical health-related need, whether a referral was made for each identified need (binary, patient-level)
次要结局
- Community-based services receipt for referred social needs(From six months prior to the intervention, assessed up to 12 months.)
- Controlled hypertension(From six months prior to the intervention, assessed up to 12 months.)
- Controlled type 2 diabetes mellitus(From six months prior to the intervention, assessed up to 12 months.)
- Referrals with a documented outcome (all non-medical health-related needs)(Baseline, through study completion, an average of 7.5 months.)
- Referrals with an outcome documented as received (all non-medical health-related needs)(Baseline, through study completion, an average of 7.5 months.)
- Controlled hypertension(Baseline, through study completion, an average of 7.5 months.)
- Controlled type 2 diabetes mellitus(Baseline, through study completion, an average of 7.5 months.)