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Project ACHIEVE (Achieving Patient-Centered Care and Optimized Health In Care Transitions by Evaluating the Value of Evidence).Patients in the U.S. suffer harm too often as they move between sites of health care, and their caregivers ex perience significant burden. Poorly managed patient care transitions can lead to worsening symptoms, adverse effects from medications, unaddressed test results, and excess re-hospitalizations and emergency visits. Project ACHIEVE is a collaboration among patients, family caregivers, and nationally recognized leaders in health care transitions and research to evaluate the effectiveness of current efforts at improving care transitions. Funded by the Patient Centered Outcome Research Institute (PCORI), the ACHIEVE team aims to develop recommendations on best practices for patient-centered care transitions and guidance for dissemination.
1. Identify the transitional care outcomes and components that matter most to patients and caregivers.
2. Determine which evidence-based transitional care (TC) strategies or clusters most effectively yield patient and caregiver desired outcomes overall and among diverse patient and caregiver populations in different types of care settings and communities.
3. Identify barriers and facilitators to the implementation of specific TC strategies or clusters of TC strategies for different types of care settings and communities.
4. Develop recommendations for dissemination and implementation of the findings on the best evidence regarding how to achieve optimal TC services and outcomes for patients, caregivers and providers.
Project BOOST®—The Project BOOST® Mentored Implementation Program is a yearlong initiative wherein hospitals receive expert mentoring and peer support to aid in improving the care of patients as they transition from hospital to home. BOOST mentors help hospital teams to map current processes and create and implement action plans for organizational change. BOOST provides a suite of evidence-based clinical interventions that can be easily adapted and integrated into each unique hospital environment.
Tracking and Evaluation Core of UK's Center for Clinical and Translational Science—CHSR is implementing a comprehensive evaluation plan to engage CCTS leadership, researchers, and staff in examining progress and impact in the field of translational science. Using internal resources and expertise gleaned from our ongoing work in the areas of healthcare transformation, community outreach and engagement, and quality improvement and evaluation, our CCTS T&E plan employs validated methods designed to accomplish tracking and performance monitoring, continuous quality improvement, process and implementation evaluation, and assessment of outcomes and impact indicators.
Kentucky Consortium for Accountable Health Communities (KC-AHC)—Funded by the Centers for Medicare & Medicaid Services, CHSR has established the KC-AHC to address the health-related social needs of vulnerable patients across the Commonwealth. KC-AHC will implement and test an Alignment model, which seeks to determine whether providing a combination of tailored community service referrals and patient navigation services assistance, as well as clinical and community partner alignment, will yield improvement in patient outcomes, health care utilization and costs. One component of this project is an online registry of resources to help address health-related social needs (CARE KY: Community Asset Registry for the Empowerment of Kentucky).
RISE: Examining Social Influences on Syringe Exchange Uptake Among Rural PWID at Risk for HIV—The National Institutes of Health (NIH) awarded the CHSR funding to study the adoption of syringe exchange programs in rural communities in the Appalachian region of Kentucky. Rates of opioid use disorder and injection drug use have risen significantly in Kentucky, especially in rural communities. The two-year National Institute on Drug Abuse-funded study is designed to reach vulnerable injection drug users in Clark, Knox, and Pike counties to understand the multi-level barriers to access syringe exchange programs and to identify priority intervention targets and strategies to increase uptake.
1) Examine the uptake of syringe exchange programs (SEPs) in three Appalachian county Health Departments (Clark, Knox and Pike) by conducting structured interviews with 350 people who inject drugs (PWID) (175 SEP utilizers and 175 non-utilizers) to identify and compare the key differences between utilizers and non-utilizers in social ecological domains, including
- intrapersonal (e.g., HIV /HCV knowledge, rural identity),
- interpersonal (e.g., kinship, peer norms, social isolation);
- institutional (e.g., justice system involvement, law enforcement activity);
- community (e.g., community stigma, geographic distance); and
- public policy factors (e.g., SEP policies and practices such as privacy/anonymity, hours, locations, distribution model, secondary exchange) that influence SEP uptake and utilization; and,
2) Identify priority intervention targets and develop strategies to enhance uptake of SEPs among rural PWID, by conducting in-depth qualitative interviews with a strategically selected sample of PWID from Aim 1, as well as key health departments directors and SEP staff, local substance treatment providers, law enforcement, and other community stakeholders, to assess multi-level barriers to SEP utilization, acceptability and feasibility of complementary intervention strategies, and to develop recommendations for intervention priorities and practice changes to improve SEP uptake.
Project MISSION (Developing a multicomponent, Multilevel Implementation Strategy for Syncope OptImalCare thrOugh eNgagement)—Syncope is a complex presenting symptom that requires thoughtful and efficient evaluation to determine the etiology of a patient’s loss of consciousness. Prevalence rates of syncope have been reported as high as 41%, with recurrent syncope occurring in 13.5%. A common symptom, approximately 1% to 3% of all emergency department (ED) visits (as many ED visits as atrial fibrillation) and up to 6% of all hospital admissions are due to syncope.The proposed study will identify barriers and facilitators for implementation of an evidence-based, high value approach to diagnosis and management of patients presenting with syncope. The research team will develop a multi-level, multi-component implementation strategy for evidence-based syncope evaluation and management and plan for a subsequent hybrid effectiveness-implementation trial, guided by the Consolidated Framework for Implementation Research (CFIR).
Social Network Analysis and Social Support Intervention for Rural Dwelling Older Adults with T2DM—
Aim 2—Use mixed methods to evaluate the impact of social support on T2DM self-care and clinical outcomes and evaluate social networks in rural dwelling older adults with T2DM.
Aim 3—Test the feasibility and preliminary effectiveness of a 6-week intervention administered by community health workers with the support of members of older adults’ individual social network.