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Design Thinking Workshop: Strengthening Community-Based Dissemination & Implementation Research in Colorado
Tuesday, October 25, 2022, 1:30 PM - 4:30 PM MST
Category: Committee Event

Design Thinking Workshop: Strengthening Community-Based Dissemination & Implementation Research in Colorado
October 25, 2022
1:30-4:30pm
Anschutz Health Science Building P12-2004 Breakout Room & Zoom

Dissemination & Implementation (D&I) research has made notable progress in expanding the use of evidence-based practices in clinical healthcare settings such as physician practices, hospitals, and nursing home settings. CU and Colorado are national and international leaders in this space.

 

Social determinants of health (SDOH) such as housing instability, food insecurity, social isolation, and economic deprivation are major drivers of disease and injury burden and health inequities, yet healthcare providers often lack the opportunities and resources needed to intervene effectively on these determinants. Evidence-based SDOH interventions exist, largely outside of the healthcare sector (e.g. housing, education, child development, corrections), but resources and support are often lacking to implement these interventions at scale. This suggests a need for expanded D&I research in non-clinical, community-based settings where SDOH interventions can be developed and delivered most effectively. Similarly, this suggests a need for D&I research focused on collaboration between clinical and community-based settings to implement SDOH interventions. 

 

In recent years, many organizations within the medical care sector have begun to develop strategies for identifying and addressing SDOH among their patient populations, with the goals of improving patient health outcomes and reducing healthcare costs. Research regarding the effectiveness and impact of these types of multi-sector initiatives remains limited and mixed to date. Several recent evidence reviews have found that among more than 200 published studies on this topic, most studies have significant limitations in research design, analysis and reporting that prevent clear conclusions from being drawn about the effectiveness and cost-effectiveness of the initiatives.

 

One of the most rigorous SDOH community intervention studies conducted in the field to date—a randomized controlled trial of the Camden Coalition “hot-spotting” and navigation model—found no evidence of impact on the primary outcome of hospital readmission rates. One reason identified for this disappointing result is the model’s limited ability to enhance the availability and quality of social services in the community at large.

 

Another large and rigorous randomized SDOH community intervention study, still underway in 28 communities, focuses on the $140 million federal Accountable Health Communities demonstration program to help medical providers screen patients for unmet social needs and link these patients to community services using tailored navigation (including 2 sites in Colorado). Only 14% of the patients who completed a full year of navigation had any of their social needs documented as resolved, while 33% of patients were lost to follow up. For another 31% of patients, the program could not determine the patient’s status regarding linkage to services and resolution of needs with available data.  Factors contributing to these disappointing results included large caseloads, difficulties with data exchange, lack of transportation, and insufficient community resources. These problems all relate to implementation challenges and failures and require D&I research to address them.


Contact: [email protected]