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 Gold, Arwen Bunce, Erika Cottrell, Miguel Marino, Mary Middendorf, Stuart Cowburn, Dagan Wright, Ned Mossman, Katie Dambrun, Byron J Powell, Inga Gruß, Laura Gottlieb, Marla Dearing, Jason Scott, Nadia Yosuf, Molly Krancari, Rachel Gold, Arwen Bunce, Erika Cottrell, Miguel Marino, Mary Middendorf, Stuart Cowburn, Dagan Wright, Ned Mossman, Katie Dambrun, Byron J Powell, Inga Gruß, Laura Gottlieb, Marla Dearing, Jason Scott, Nadia Yosuf, Molly Krancari

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: Community health centers; Electronic health records; Implementation; Implementation strategies; Social determinants of health.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Kaiser Permanente Northwest Institutional Review Board.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Social determinants of health summary view
Fig. 2
Fig. 2
Decision tool: which patients does the clinic want to target for social determinants of health screening?
Fig. 3
Fig. 3
Social determinants of health workflow planning tool
Fig. 4
Fig. 4
Realist evaluation model—factors influencing intervention impact on outcomes [135, 136, 162]

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