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Johnson L, Liss DT, Carcamo P, Goel MS, Magner BG, Yang TY, Llaneza J. Implementing and Enhancing Social and Economic Needs Screening at a Federally Qualified Health Center. J Gen Intern Med 2024; 39:128-132. [PMID: 37715098 PMCID: PMC10817872 DOI: 10.1007/s11606-023-08404-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/29/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Programs to screen for social and economic needs (SENs) are challenging to implement. AIM To describe implementation of an SEN screening program for patients obtaining care at a federally qualified health center (FQHC). SETTING Large Chicago-area FQHC where many patients are Hispanic/Latino and insured through Medicaid. PROGRAM DESCRIPTION In the program's phase 1 (beginning April 2020), a prescreening question asked about patients' interest in receiving community resources; staff then called interested patients. After several refinements (e.g., increased staffing, tailored reductions in screening frequency) to address challenges such as a large screening backlog, program phase 2 began in February 2021. In phase 2, a second prescreening question asked about patients' preferred modality to learn about community resources (text/email versus phone calls). PROGRAM EVALUATION During phase 1, 8925 of 29,861 patients (30%) expressed interest in community resources. Only 40% of interested patients were successfully contacted and screened. In phase 2, 5781 of 21,737 patients (27%) expressed interest in resources; 84% of interested patients were successfully contacted by either text/email (43%) or phone (41%). DISCUSSION Under one-third of patients obtaining care at an FQHC expressed interest in community resources for SENs. After program refinements, rates of follow-up with interested patients substantially increased.
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Affiliation(s)
| | - David T Liss
- AllianceChicago, Chicago, IL, USA
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Mita Sanghavi Goel
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Vargas MC, Pineda GJ, Talamantes V, Toledo MJL, Owen A, Carcamo P, Gibbert W, Ackermann RT, Kandula NR, Cameron KA, Siddique J, Williams GC, O'Brien MJ. Design and rationale of behavioral nudges for diabetes prevention (BEGIN): A pragmatic, cluster randomized trial of text messaging and a decision aid intervention for primary care patients with prediabetes. Contemp Clin Trials 2023; 130:107216. [PMID: 37169219 DOI: 10.1016/j.cct.2023.107216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/24/2023] [Accepted: 05/03/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Among 96 million U.S. adults with prediabetes, adoption of evidence-based treatment to prevent diabetes remains low. Primary care represents an essential venue for preventing diabetes, yet providers in this setting have limited time to address prevention. This highlights the need for low-touch interventions that promote diabetes prevention and are not delivered by primary care providers. Text messaging and decision aids displaying disease risk and treatment information have improved outcomes in prior research. However, these approaches have not been definitively studied for managing prediabetes. METHODS The Behavioral Nudges for Diabetes Prevention (BEGIN) trial is a pragmatic, cluster randomized trial testing the effectiveness of text messaging about diabetes prevention and a prediabetes decision aid. These interventions are being studied in 8 primary care clinics using a 2 × 2 factorial design, in which pairs of clinics are randomized in a 1:1:1:1 ratio to receive usual care, text messaging alone, prediabetes decision aid alone, or both interventions. A total of 656 patients are recruited to participate, receive the study interventions, and contribute data at baseline and 12 months. The primary outcome is 12-month weight change, and the secondary outcome is adoption of evidence-based treatment to prevent diabetes. Change in hemoglobin A1c is an exploratory outcome that will be assessed among participants with available values. CONCLUSION Findings from the BEGIN trial will provide evidence about the effectiveness of two novel, low-touch interventions focused on diabetes prevention in primary care, where patients are diagnosed with prediabetes and there is little prior research. TRIAL REGISTRY NCT04869917.
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Affiliation(s)
- Maria C Vargas
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Drive, 10th floor, Chicago, IL 60611, USA; Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Drive, 6th floor, Chicago, IL 60611, USA
| | - Gracia J Pineda
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Drive, 10th floor, Chicago, IL 60611, USA; Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Drive, 6th floor, Chicago, IL 60611, USA
| | - Vanessa Talamantes
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Drive, 10th floor, Chicago, IL 60611, USA; Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Drive, 6th floor, Chicago, IL 60611, USA
| | - Maria Jose Leiva Toledo
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Drive, 10th floor, Chicago, IL 60611, USA; Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Drive, 6th floor, Chicago, IL 60611, USA
| | - Andrew Owen
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Drive, 10th floor, Chicago, IL 60611, USA; Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Drive, 6th floor, Chicago, IL 60611, USA
| | - Paula Carcamo
- Erie Family Health Centers, 1701 W. Superior Street, Chicago, IL 60622, USA
| | - Wesley Gibbert
- Erie Family Health Centers, 1701 W. Superior Street, Chicago, IL 60622, USA; Department of Family and Community Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lakeshore Drive, 14th floor, Chicago, IL 60611, USA
| | - Ronald T Ackermann
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Drive, 10th floor, Chicago, IL 60611, USA; Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Drive, 6th floor, Chicago, IL 60611, USA
| | - Namratha R Kandula
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Drive, 10th floor, Chicago, IL 60611, USA; Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Drive, 6th floor, Chicago, IL 60611, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lakeshore Drive, 14th floor, Chicago, IL 60611, USA
| | - Kenzie A Cameron
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Drive, 10th floor, Chicago, IL 60611, USA; Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Drive, 6th floor, Chicago, IL 60611, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lakeshore Drive, 14th floor, Chicago, IL 60611, USA
| | - Juned Siddique
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lakeshore Drive, 14th floor, Chicago, IL 60611, USA
| | - Geoffrey C Williams
- Division of Cardiology, Department of Medicine, University of Michigan Medical School, 24 Frank Lloyd Wright Dr., Suite 1300, Ann Arbor, MI 48106, USA
| | - Matthew J O'Brien
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Drive, 10th floor, Chicago, IL 60611, USA; Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lakeshore Drive, 6th floor, Chicago, IL 60611, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lakeshore Drive, 14th floor, Chicago, IL 60611, USA.
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O'Brien MJ, Vargas MC, Lopez A, Feliciano Y, Gregory DL, Carcamo P, Mohr L, Mohanty N, Padilla R, Ackermann RT, Persell SD, Feinglass J. Development of a novel clinical decision support tool for diabetes prevention and feasibility of its implementation in primary care. Prev Med Rep 2022; 29:101979. [PMID: 36161117 PMCID: PMC9501986 DOI: 10.1016/j.pmedr.2022.101979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 11/12/2022] Open
Abstract
Clinical decision support may represent a strategy for promoting diabetes prevention in primary care. We developed a novel clinical decision support tool with input from primary care providers. This clinician-facing tool was associated with improvements in processes of prediabetes care. Exploratory analyses found small, but nonsignificant weight loss associated with its use.
Prediabetes impacts 88 million U.S. adults, yet uptake of evidence-based treatment with intensive lifestyle interventions and metformin remains exceedingly low. After incorporating feedback from 15 primary care providers collected during semi-structured interviews, we developed a novel Prediabetes Clinical Decision Support (PreDM CDS) from August 2019 to February 2020. This tool included order options enabling prediabetes management in a single location within the electronic health record. We conducted a retrospective observational study examining the feasibility of implementing this tool at Erie Family Health Centers, a large community health center, examining its use and related outcomes among patients for whom it was used vs not. Overall, 7,424 eligible patients were seen during the implementation period (February 2020 to August 2021), and the PreDM CDS was used for 108 (1.5 %). Using the PreDM CDS was associated with higher rates of hemoglobin A1c orders (70.4 % vs 22.2 %; p < 0.001), lifestyle counseling (38.0 % vs 7.8 %; p < 0.001), and metformin prescription orders (5.6 % vs 2.6 %; p = 0.06). Exploratory analyses revealed small, nonsignificant weight loss among patients for whom the PreDM CDS was used. This study demonstrates the feasibility of developing and implementing the PreDM CDS in primary care. Its low use was likely related to not imposing an interruptive ‘pop-up’ alert, as well as major changes in workflows and clinical priorities during the Covid-19 pandemic. Use of the tool was associated with improved process outcomes. Future efforts with the PreDM CDS should follow standard CDS implementation processes that were not possible due to the Covid-19 pandemic.
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Affiliation(s)
- Matthew J O'Brien
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 10 Floor, Chicago, IL 60611, United States.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 6 Floor, Chicago, IL 60611, United States.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine. 680 N. Lakeshore Drive, 14 Floor, Chicago, IL 60611, United States
| | - Maria C Vargas
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 10 Floor, Chicago, IL 60611, United States.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 6 Floor, Chicago, IL 60611, United States
| | - Azucena Lopez
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 10 Floor, Chicago, IL 60611, United States.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 6 Floor, Chicago, IL 60611, United States
| | - Yury Feliciano
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 10 Floor, Chicago, IL 60611, United States.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 6 Floor, Chicago, IL 60611, United States
| | - Dyanna L Gregory
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 10 Floor, Chicago, IL 60611, United States
| | - Paula Carcamo
- Erie Family Health Centers. 1701 W. Superior Street, Chicago, IL 60622, United States
| | - Loretta Mohr
- Erie Family Health Centers. 1701 W. Superior Street, Chicago, IL 60622, United States
| | - Nivedita Mohanty
- Erie Family Health Centers. 1701 W. Superior Street, Chicago, IL 60622, United States.,AllianceChicago. 225 W. Illinois Street, 5 Floor, Chicago, IL 60654, United States
| | - Roxane Padilla
- AllianceChicago. 225 W. Illinois Street, 5 Floor, Chicago, IL 60654, United States
| | - Ronald T Ackermann
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 10 Floor, Chicago, IL 60611, United States.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 6 Floor, Chicago, IL 60611, United States
| | - Stephen D Persell
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 10 Floor, Chicago, IL 60611, United States.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 6 Floor, Chicago, IL 60611, United States
| | - Joseph Feinglass
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 10 Floor, Chicago, IL 60611, United States.,Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine. 750 N. Lakeshore Drive, 6 Floor, Chicago, IL 60611, United States
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