Study protocol: A pragmatic, stepped-wedge trial of tailored support for implementing social determinants of health documentation/action in community health centers, with realist evaluation

Rachel Gold, Arwen Bunce, Erika Cottrell, Miguel Marino, Mary Middendorf, Stuart Cowburn, Dagan Wright, Ned Mossman, Katie Dambrun, Byron J. Powell, Inga Gruß, Laura Gottlieb, Marla Dearing, Jason Scott, Nadia Yosuf, Molly Krancari

Research output: Contribution to journalArticle

Abstract

Background: National leaders recommend documenting social determinants of health and actions taken to address social determinants of health in electronic health records, and a growing body of evidence suggests the health benefits of doing so. However, little evidence exists to guide implementation of social determinants of health documentation/action. Methods: This paper describes a 5-year, mixed-methods, stepped-wedge trial with realist evaluation, designed to test the impact of providing 30 community health centers with step-by-step guidance on implementing electronic health record-based social determinants of health documentation. This guidance will entail 6 months of tailored support from an interdisciplinary team, including training and technical assistance. We will report on tailored support provided at each of five implementation steps; impact of tailored implementation support; a method for tracking such tailoring; and context-specific pathways through which these tailored strategies effect change. We will track the competencies and resources needed to support the study clinics' implementation efforts. Discussion: Results will inform how to tailor implementation strategies to meet local needs in real-world practice settings. Secondary analyses will assess impacts of social determinants of health documentation and referral-making on diabetes outcomes. By learning whether and how scalable, tailored implementation strategies help community health centers adopt social determinants of health documentation and action, this study will yield timely guidance to primary care providers. We are not aware of previous studies exploring implementation strategies that support adoption of social determinants of action using electronic health and interventions, despite the pressing need for such guidance.

Original languageEnglish (US)
Article number9
JournalImplementation Science
Volume14
Issue number1
DOIs
StatePublished - Jan 28 2019

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Keywords

  • Community health centers
  • Electronic health records
  • Implementation
  • Implementation strategies
  • Social determinants of health

ASJC Scopus subject areas

  • Health Policy
  • Health Informatics
  • Public Health, Environmental and Occupational Health

Cite this

Gold, R., Bunce, A., Cottrell, E., Marino, M., Middendorf, M., Cowburn, S., Wright, D., Mossman, N., Dambrun, K., Powell, B. J., Gruß, I., Gottlieb, L., Dearing, M., Scott, J., Yosuf, N., & Krancari, M. (2019). Study protocol: A pragmatic, stepped-wedge trial of tailored support for implementing social determinants of health documentation/action in community health centers, with realist evaluation. Implementation Science, 14(1), [9]. https://doi.org/10.1186/s13012-019-0855-9