A Community Based Participatory Research Initiative Addressing Alcohol Use in the Refugee Population from Burma

Posted on July 30, 2020August 4, 2020 by coprhcon

BACKGROUND

The country of Burma (Myanmar) has been riddled with conflict, strife, and sectarian violence for over 30 years. Since 2006, the United States has taken in just over 150,000 refugees from Burma, of which an estimated 5,000 reside in Colorado. Once granted refugee status in the United States, the challenges that this population faces are enormous, including finding sustainable employment, affordable housing, and the lack of access to culturally competent healthcare. The newfound challenges of refugee life can be incredibly taxing both physically and mentally. When previous mental stressors, such as exposure to trauma in their home country, are combined with these newfound challenges, refugees are over two times more likely to exhibit Substance Abuse Disorder as defined by DSM-IV. The specific purpose of this study is to assess the effects of alcohol use on the local refugee population from Burma and formulate an appropriate intervention utilizing a community based participatory research (CBPR) model.

METHODS

A multiphase community-based participatory research model was utilized to conduct this research. True to the CBRP model, the first phase was establishing a partnership with the community, and subsequent identification of an issue ripe for intervention. A group of young adults from the refugee community were recruited to form the Youth Advisory Board. They identified alcohol use as the dominant health-related concern within their own community. With this issue identified, the project moved into phase two. Phase two involved conducting semi-structured one-on-one, audio-recorded interviews with members of the refugee community from Burma. The data from these interviews was then analyzed using immersion crystallization methodology. The next phase to be undertaken is presentation of the findings to the community and generation of a culturally competent intervention.

Getting Everyone on The Same Page: Development and Implementation of a Multidisciplinary Electronic Discharge Readiness Tool

Posted on July 30, 2020August 4, 2020 by coprhcon

BACKGROUND

Typical solutions for improving discharge planning often rely on one-way communication mechanisms and static data entry into the eHR. We have designed a discharge readiness tool that has been integrated into the electronic health record (eHR), which allows providers to communicate the status of patient discharge readiness in real-time to all clinical staff providing care. This information will enhance prioritization of care and patient flow. Stakeholder engagement to inform user-centered design was imperative to ensure our discharge readiness tool is successfully integrated into existing workflows such that all clinical staff will this tool with every patient.

RESULTS

We found most providers who responded to the survey reported that the tool either saved time or did not change the amount time required to complete their discharge workflow (21, 87.5%). During the pilot phase, 352 care team members, including hospitalists, residents, nurses, care managers, and physician therapists, have added the tool to their workflow. At the conclusion of the post-implementation phase, 467 care team members have added the tool to their workflow. In addition, providers assigned a discharge status to 84.9% of patients discharged during the pilot implementation period and 87.4% of patients discharged post-implementation. The most common barriers identified by providers were medical improvement (40.9%), placement (12.3%), subspecialty consults (9.6%), physical therapy (9.3%), and social work or care management (8.9%).

CONCLUSIONS

Typical solutions for improving discharge planning often rely on one-way communication mechanisms and static data entry into the EHR or in-person meetings for discharge rounds. We have designed a dynamic EHR discharge readiness tool, allowing the care team to communicate the status of patient discharge readiness and patient discharge needs in real-time across hospital settings. Survey and EHR data suggest that this electronic discharge readiness tool has been successfully adopted by providers and clinical staff. Frequent stakeholder engagement and iterative user-centered design was critical to the successful implementation of this tool.

Conducting Pragmatic Community-Based Autism Research

Posted on July 30, 2020August 4, 2020 by coprhcon

BACKGROUND

In 2014, the NIMH’s Autism Spectrum Disorder Pediatric, Early Detection, Engagement and Services (ASD PEDS) Network was formed to develop and test systems innovations that rapidly engage young children with ASD in diagnostic and treatment services1. Five studies across nine states were funded, each testing a different model of care (i.e., family navigation, enhanced community identification, enhanced primary care identification, online screening and identification with provider training, identification in Part C early intervention). The current paper represents an effort to learn from the collective experience of the five diverse ASD PEDS Network projects. Specifically, we evaluate where each study falls on the pragmatic (i.e., “real-world”) to explanatory (i.e., “ideal condition”) continuum in order to inform future implementation efforts and identify research priorities for early ASD identification and intervention services.

METHODS

The Pragmatic Explanatory Continuum Indicator Summary–2 (PRECIS-2) was used to assess the five ASD PEDS Network studies2. First, investigator teams from each study completed the Template for Intervention Description and Replication (TIDieR) checklist for their specific study3. Second, a group of independent reviewers with expertise in community ASD services and trial design (n=3) reviewed the checklists and rated each study on the nine PRECIS constructs (i.e., eligibility, recruitment, setting, organization, delivery, adherence, follow-up, outcomes, analysis) from 1 (most “explanatory”) to 5 (most “pragmatic”). Third, a modified Delphi approach was used to reach agreement for each study in each domain.

RESULTS

The domains rated as most pragmatic (i.e., most reflective of usual care) were those measuring the inclusiveness of data in the analyses (M= 5.0, SD=0) and the flexibility allowed in providers’ adherence to the intervention protocol (M=4.34, SD=1.19). Domains rated as most explanatory (i.e., least reflective of usual care) included the time and effort devoted to follow-up data collection (M=2.23, SD=0.66) and the resources and expertise needed to deliver the intervention (M=2.32, SD=0.81).

DISCUSSION

Overall, there was considerable variability across ASD PEDS Network studies and PRECIS-2 domains. The least pragmatic aspects of these studies were the settings in which they were conducted and the manner in which outcome data were collected, suggesting that these areas may pose particular challenges for community-based trials focused on early detection and service access for ASD. To achieve the goal of increasing pragmatic research trials and “real-world” applicability for ASD research, future research might benefit from using the PRECIS-2 during initial trial design, developing more pragmatic outcome measures, and improving methods for integration of research into “real-world” settings.