ANDREA JIMENEZ-ZAMBRANO, PhD, MPH
ACCORDS

Asthma is a common chronic disease for children that disproportionately impacts low-income families. Our school-based asthma management program focused in urban, low-income schools, has reduced health care utilization and school absences through active management of asthma and social determinants of health (SDOH). As part of scaling this program to 5 new Colorado regions, we engaged regional Community Advisory Boards (CABs) to identify priority outcomes of success.

The CABs, formed in 5 underserved regions with higher SDOH needs, have 39 members that include school nurses, health care providers, parents of children with asthma, and SDOH agency leads.

Each CAB meets quarterly with our team to develop and guide program planning. Using a two-step nominal group differences technique (NGDT) process, each CAB identified outcomes of success for managing asthma in 4 distinct categories: 1) schools, 2) child/family, 3) health care provider, and 4) community SDOH agencies. Step one of our NGDT process identified candidate outcomes of success themes through brainstorming and dialogue with CAB members. In step two, candidate outcomes were reviewed and discussed, followed by each CAB member confidentially voting on their top 2 priority outcomes of success in each of the 4 categories – this led to each of the 5 CABs ranking their top 2-3 priority outcomes in each category.

Priority outcomes of success selected by the highest number of regional CABs are listed, by category:

• Child/family: well-controlled asthma (2 regions); accurate inhaler technique (2 regions); multiple outcomes prioritized in one region, including reduced school absenteeism and ED visits
• School: increased school asthma care plan on-file early in school year (4 regions); increased connection between schools and health care providers (4 regions) Health provider: school asthma care plan completed by provider early in school year without school nurse prompting (3 regions); improved use of asthma follow-up care – shift from reactive episodic to preventive/routine follow-up (4 regions)
• SDOH: address health literacy needs for parents/family (3 regions); transportation resources (3 regions); availability of fun, low-literacy, educational resources (e.g., fun how-to-use inhaler resources for children) (2 regions)

The highest priority outcomes of success identified include health outcomes related to well controlled asthma (including reduced urgent care use and school absenteeism), process outcomes (e.g., accurate inhaler technique; inhalers/care plans in schools), and health equity-focused outcomes related to transportation and health literacy. Our NGDT process to prioritize outcomes of success has informed our context-driven implementation strategy selection and the study outcomes we will track/report back to CABs. This process may be replicated for other studies.

BRYAN GARNER, PhD
Ohio State University

In 2018, the National Institute on Drug Abuse funded the Substance Treatment Strategies for HIV Care (STS4HIV) Project (R01-DA044051) as part of its effort to help improve the integration of substance use disorder (SUD) services within HIV service settings. This presentation will introduce and provide an overview of the STS4HIV Project’s novel Dissemination, Implementation, effectiveness, Sustainment, Economic, and Level-of-scaling (DIeSEL) hybrid trial design.

The STS4HIV Project’s Engaged Community of Organizational Stakeholders (ECOS) system, which includes several hundreds of HIV service organizations (HSOs) across the United States.

Development of the DIeSEL hybrid trial design was guided by more than a decade of experience conducting hybrid trials focused on accelerating advancements regarding the integration of evidence-based interventions for substance use disorders within real world settings. As part of the STS4HIV Project, we are conducting a multilevel 2×2 factorial DIeSEL hybrid trial focused on testing the individual and combined effects of the following two strategies: financial reimbursement (FR; i.e., an organizational-level strategy in which an ECOS team is offered up to $2,000 of reimbursement to help offset the costs associated with their team participation in key activities during the project’s exploration, preparation, and implementation phases), and external facilitation (EF; i.e., an organizational-level strategy in which an ECOS team is offered up to $2,000 of external facilitation support as provided by one of the project’s trained Implementation and Sustainment Facilitation [ISF] Strategy facilitators). The project’s primary aim is to test the main and combined impacts these two organizational-level strategies on organizational-level decision-to-adopt (i.e., the primary Dissemination outcome) and staff-level implementation effectiveness (i.e., the primary Implementation outcome). The project’s secondary aim is to test the main and combined impacts these two strategies on client-level change in days of substance use (i.e., the primary effectiveness outcome) and the sustainment of staff trained in the project’s motivational interviewing-based brief intervention (i.e., the primary sustainment outcome). The project’s tertiary aim is to estimate these strategies incremental cost-effectiveness ratios (the primary economic outcome), as well as test the main and combined impacts of these strategies on organizational-level scale-up of the project’s motivational interviewing-based brief intervention (i.e., the primary level-of-scaling outcome).

Similar to how a diesel engine is often a more powerful and efficient alternative to a gasoline engine, the STS4HIV Project’s novel DIeSEL hybrid trial design is believed to be a more powerful and efficient alternative to the implementation-effectiveness hybrid trial design introduced by Curran and colleagues (2012) a decade ago.

HILLARY LUM, MD, PhD
JESSICA CASSIDY, LMSW
University of Colorado School of Medicine

There is a need to reduce disparities in the care of persons with dementia and their family care partners (i.e., dementia dyads). The use of clinical digital tools may improve communication but may also be limited by digital health equity issues. Engagement with dementia dyads as research stakeholders can help identify priorities for testing in pragmatic clinical trials. To promote communication between dementia dyads and clinical teams, we engaged with stakeholders to identify priorities and refinements to digital tools. We describe pragmatic methods for stakeholder recruitment and involvement in a participatory action research process.

We convened a council, “Memory Research Partners in Caring and Technology” comprised of 18 individuals of diverse background, including three dementia dyads, two additional family care partners, and 10 community members with experience as patient research partners. The council met six times over seven months (two in person, four virtually).

We recruited research partners by collaborating with an existing patient research council, clinicians from dementia clinical settings, and community organizations. Pragmatic stakeholder engagement methods included: a) brief talks by expert guest speakers; b) participatory methods such as a World Café and small group discussions with Google Jamboards at virtual meetings; c) mailing preparatory educational materials; and d) contacting partners between meetings by phone to invite any additional input. Through these collaborative methods, the direction of this study was informed by research partner perspectives regarding areas of need to existing systems of care, as well as digital tools. We used rapid qualitative analysis methods to identify, share, and clarify findings from each meeting. Partners were compensated for their time and expertise.

Research partner engagement was high with only one participant unable to continue due to physical health issues. Virtual meetings allowed continuity when COVID-19 imposed barriers to meeting in-person and when care partners were juggling caregiving needs. Several research partners voluntarily discovered and shared pertinent materials with the University team indicating commitment to the project. Using multiple stakeholder engagement methods, research partners and the University team collaboratively identified key gaps and priorities related to dementia care communication and the use of digital tools. The use of multiple and pragmatic stakeholder engagement methods supported active and consistent engagement.

We engaged with patients, care partners, and community members of diverse backgrounds in a participatory research process to prioritize and refine digital health tools. The use of these methods yielded rich insight on user experiences which will inform future aims of supporting dementia care coordination through digital tools.