Preparing to Address Social Determinants of Health (SDOH): Approaches to Clinic Transformation.

CONTEXT: Pennsylvanians' health is influenced by numerous social determinants of health (SDOH). Integrating SDOH data into electronic health records (EHRs) is critical to identifying health disparities, informing public health policies, and devising interventions. Nevertheless, challenges remain in its implementation within clinical settings. In 2018, the Pennsylvania Department of Health (PADOH) received the Centers for Disease Control and Prevention's DP18-1815 "Improving the Health of Americans Through Prevention and Management of Diabetes and Heart Disease and Stroke" grant to strengthen SDOH data integration in Pennsylvania practices. IMPLEMENTATION: Quality Insights was contracted by PADOH to provide training tailored to each practice's readiness, an International Classification of Diseases, Tenth Revision (ICD-10) guide for SDOH, Continuing Medical Education on SDOH topics, and introduced the PRAPARE toolkit to streamline SDOH data integration and address disparities. Dissemination efforts included a podcast highlighting success stories and lessons learned from practices. From 2019 to 2022, Quality Insights and the University of Pittsburgh Evaluation Institute for Public Health (Pitt evaluation team) executed a mixed-methods evaluation. FINDINGS: During 2019-2022, Quality Insights supported 100 Pennsylvania practices in integrating SDOH data into EHR systems. Before COVID-19, 82.8% actively collected SDOH data, predominantly using PRAPARE tool (62.7%) and SDOH ICD-10 codes (80.4%). Amidst COVID-19, these statistics shifted to 65.1%, 45.2%, and 42.7%, respectively. Notably, the pandemic highlighted the importance of SDOH assessment and catalyzed some practices' utilization of SDOH data. Progress was evident among practices, with additional contribution to other DP18-1815 objectives. The main challenge was the variable understanding, utilization, and capability of handling SDOH data across practices. Effective strategies involved adaptable EHR systems, persistent efforts by Quality Insights, and the presence of change champions within practices. DISCUSSION: The COVID-19 pandemic strained staffing in many practices, impeding SDOH data integration into EHRs. Addressing the diverse understanding and use of SDOH data requires standardized training and procedures. Customized support and sustained engagement by facilitating organizations are paramount in ensuring practices' efficient SDOH data collection and integration.

Program Factors Affecting Weight Loss and Mobility in Older Adults: Evidence From the Mobility and Vitality Lifestyle Program (MOVE UP).

Background. The Mobility and Vitality Lifestyle Program (MOVE UP) is a behavioral weight-management intervention for improving mobility among community-dwelling older adults. We examined program factors that affect implementation outcomes and participant-level health outcomes. Methods. The MOVE UP program was implemented in the greater Pittsburgh area from January 2015 to June 2019 to improve lower extremity performance in community-dwelling older adults who were overweight or obese. Thirty-two sessions were delivered over 13 months. All sessions were designed to be 1-hour in length, on-site, group-based, and led by trained and supported community health workers (CHWs). Participants completed weekly Lifestyle Logs for self-monitoring of body weight, diet, and physical activity. We evaluated the MOVE UP program using the RE-AIM framework, and collected quantitative data at baseline, 5-, 9-, and 13-months. Multilevel linear regression models assessed the impacts of program factors (site, CHW, and participant characteristics) on implementation outcomes and participant-level health outcomes. Results. Twenty-two CHWs delivered MOVE UP program to 303 participants in 26 cohorts. Participants were similar to the target source population in weight but differed in some demographic characteristics. The program was effective for weight loss and lower extremity function in both intervention and maintenance periods (Ps < .01), with an independent effect for Lifestyle Logs submission but not session attendance. Discussion. CHWs were able to deliver a multi-component weight loss intervention effectively in community settings. CHW and site characteristics had independent impacts on participants' adherence. Lifestyle Log submission may be a more potent measure of adherence in weight loss interventions than attendance.

Effectiveness of a behavioral lifestyle intervention on weight management and mobility improvement in older informal caregivers: a secondary data analysis.

BACKGROUND: Older informal caregivers are prone to sedentary behavior and obesity. With great caregiving burdens and frequent physical and mental distress, older informal caregivers may have low adherence and poor results in behavioral intervention for weight management. This study examined whether overweight or obese older informal caregivers could benefit from a behavioral weight management program as much as non-caregivers. METHODS: The Mobility and Vitality Lifestyle Program (MOVE UP) was a pre-post, community-based, 13-month lifestyle intervention study to help older adults improve physical function performance and lose weight. We identified a subset of informal caregivers (n = 29) and non-caregivers (n = 65) from the MOVE UP participants retrospectively. Changes in lower extremity function, weight, depressive symptoms, and self-efficacy from baseline were compared between caregivers and non-caregivers using paired t-tests and ANCOVA. RESULTS: Older informal caregivers had significantly lower session attendance rates than non-caregivers (67.7% vs 76.8%, P < 0.05), however, both informal caregivers and non-caregivers improved significantly in lower extremity function, weight loss, and self-efficacy in diet (Ps < 0.05). For each outcome, changes from baseline to the 13-month endpoint were the same among informal caregivers and non-caregivers. CONCLUSION: This study provides evidence that older informal caregivers can benefit from behavioral weight management interventions despite the challenge caregiving poses for effective self-care. Future behavioral intervention studies for older informal caregivers should adopt self-monitoring tools and extend the on-site delivery to home-based settings for higher adherence and greater flexibility. TRIAL REGISTRATION: Registered at clinicaltrials.gov (NCT02657239).

Developing Community-Based Mentorship: Supporting Health Science Training in Historically Marginalized Communities.

Community mentors can play a unique and critical role in developing and supporting graduate and health professional student learning in underresourced community-based settings. These mentors can benefit from extra preparation for a potentially unfamiliar role as teachers about complex social and structural challenges faced by the populations with which they work. Encouraging mentors to recognize and share their valuable expertise while developing their teaching skills can (1) improve mentors' abilities to work effectively with graduate-level and health science students from multiple disciplines, (2) bolster student learning about important historical social and structural determinants of participants' health, and (3) help students understand the broader context within which organizations serving vulnerable populations operate. As such, in one full-time, community-engaged, interdisciplinary practicum program, Bridging the Gaps-Pittsburgh, part of the multiinstitutional Bridging the Gaps Network, a half-day mentor workshop has been required for two decades for new community mentors to develop their capacity to be community-based teachers of largely graduate-level health science students. Additionally, program staff aim to support mentors and connect them to faculty and community resources in a variety of ways. Our model supports the argument that applied learning by health professional students in community settings can be significantly enhanced through building and supporting the capacity of community mentors to act as recognized teachers in areas of community expertise.