Study protocol: a pragmatic, stepped-wedge trial of tailored support for implementing social determinants of health docu
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STUDY PROTOCOL
Open Access
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 Gold1,2* , Arwen Bunce2, Erika Cottrell2,3, Miguel Marino3, Mary Middendorf2, Stuart Cowburn2, Dagan Wright2, Ned Mossman2, Katie Dambrun2, Byron J. Powell4, Inga Gruß1, Laura Gottlieb5, Marla Dearing2, Jason Scott1, Nadia Yosuf1 and Molly Krancari2
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. Trial registration: clinicaltrials.gov, NCT03607617, registration date: 7/31/2018—retrospectively registered Keywords: Social determinants of health, Electronic health records, Community health centers, Implementation, Implementation strategies
* Correspondence: [email protected] 1 Kaiser Permanente–Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA 2 OCHIN, Inc, 1881 SW Naito Pkwy, Portland, OR 97201, USA Full list of author information is available at the end of the article © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduc
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