Implementation of EMR-Integrated Referrals to Link Clinical and Community Services to Reduce Health Inequity

Background

The rural southeast, known as “the stroke belt,” is home to 2.6 million African Americans and has the highest prevalence of cardiovascular diseases (CVD) in the US. CVD vulnerability for AAs in the rural southeast is amplified by unmet health-related social needs (HSRN). Thus, to support best practices for CVD prevention in childhood through adulthood, health care providers need high-quality information about community-based resources to support self-management of CVD risk to share with patients, which is what CommunityRx-CVD (CRx-CVD) achieves through an electronic referral technology that automatically connects patients with resources in the area.

Objective

Through this study, we hope to learn how to better support clinics in rural settings to implement new resource referral technology systems and to improve the self-management and health outcomes associated with cardiovascular diseases among patients..

Study Team/Roles

*listed alphabetically by last name in each section

Principal Investigators

• Giselle Corbie, MD, MSc [UNC]
• Gaurav Dave, MD, DrPH, MPH [UNC]
• Stacy Lindau, MD, MA [UChicago]
• Mary Wolfe, Ph.D. [UNC]

Co-Investigators

• Dana Carthron, PhD, RN [NCCU]
• Crystal Cené, MD [UNC]
• Brian Ellerby [OIC]
• Leah Frerichs, PhD [UNC]
• Kristen Hassmiller-Lich, PhD, MHSA [UNC]
• Stephanie Hoover, PhD [UNC]
• Feng-Chang Lin, PhD [UNC]
• Emily Pfaff, MS [UNC]
• Chris Shea, PhD [UNC]

Staff

• Emily Abramsohn, MPH [UChicago]
• Malcolm Bevel [UNC]
• Maura Drewry, MPH [UNC]
• Amelia DeFosset, MPH [UNC]
• Mellissa Grana [UChicago]
• Gabrielle Harris, PhD, MSN, RN [UNC]
• Marisol De Ornelas, MSPH [UChicago]

Partnerships

• University of Chicago
• OIC of Rocky Mount
• NowPow
• MAPSCorps
• Carolina Family Health Centers
• Duke University
• North Carolina Central University

Conference Presentations

• “Electronically Integrated Community Resource Referral Systems in the United States: A Systematic Review.” 2022 Society of General Internal Medicine (SGIM) Annual Meeting, Orlando, FL, April 2022.

• “CommunityRx- Cardiovascular Disease: An EMR-based Technology Solution to Address Health Related Social Risks and Improve Cardiometabolic Health in Rural Communities.” 2022 Society of General Internal Medicine (SGIM) Annual Meeting, Orlando, FL, April 2022.

Contact Info

Study Coordinator, Maura Drewry, MPH
Email: maura_drewry@med.unc.edu