Table1_Adaptation of a social risk screening and referral initiative across clinical populations, settings, and contexts in the Department of Veterans Affairs Health System.docx

Identifying and addressing social risks and social needs in healthcare settings is an important step towards achieving health equity. Assessing Circumstances and Offering Resources for Needs (ACORN) is a Department of Veterans Affairs (VA) social risk screening and referral model that aims to systematically identify and address social needs. Since initial piloting in 2018, our team has collaborated with clinical and operations partners to implement ACORN across multiple VA clinical settings while adapting and tailoring the initiative to meet the needs of different populations, specialties, and individuals administering screening. Given ACORN's complexity as a growing initiative with multiple partners and frequent real-time modifications within a large national healthcare system, we recognized a need to systematically document the rationale and process of adaptations over time. We looked to three implementation frameworks—RE-AIM, the Adaptome, and FRAME—to describe the rationale for adaptations, the nature of and context within which adaptations were made, and the details of each adaptation. In this manuscript, we uniquely interweave these three frameworks to document adaptations to ACORN across diverse VA clinical settings, with a focus on how adaptations support the promotion of heath equity in the Veteran population.

在医疗场景中识别并应对社会风险与社会需求，是实现健康公平（health equity）的关键路径。需求情形评估与资源供给模型（Assessing Circumstances and Offering Resources for Needs, ACORN）是美国退伍军人事务部（Department of Veterans Affairs, VA）推出的社会风险筛查与转介模型，旨在系统性识别并解决社会需求问题。自2018年首次试点以来，我们的团队与临床及运营合作伙伴携手，在多家退伍军人事务部临床场景中推广ACORN，并针对不同人群、专科领域及筛查实施人员的需求，对该项目进行调整与定制。鉴于ACORN作为一项不断发展的项目，涉及多方协作且在大型国家级医疗体系内需频繁开展实时调整，其复杂性颇高，我们意识到需要对其随时间推移所产生的各项调整的依据与流程进行系统性记录。我们选用了三项实施框架——RE-AIM、Adaptome及FRAME——来阐释调整的依据、调整发生的本质与背景，以及每项调整的具体细节。在本研究论文中，我们创新性地整合这三项框架，对不同退伍军人事务部临床场景下ACORN的各项调整进行记录，并重点探讨这些调整如何助力退伍军人群体的健康公平实现。