Methods. We used multiple data sources from the three HCS in descriptive analyses: (a) ~371 parent contact records documenting enrollment rates from two strategies (pediatrician’s in-person referral to GGC v. letter/email referral), (b) cross-site comparisons of EHR data about adolescent substance use and mental health, and (c) team meeting notes weighing statistical and pragmatic implications of different implementation strategies.
Results: Early results indicated that pediatricians referred half of eligible parents to GGC. About one quarter enrolled once reached by telephone, exceeding rates found in community trials, particularly following in-person referral. Intractable gaps in EHR data about substance use and mental health led us to create a behavioral health survey to evaluate GGC effectiveness. We developed an innovative, hierarchical statistical model of our partially cross-nested design to avoid bias, increased Type I error, and problems with statistical inference.
Conclusions: HCS-based pragmatic trials that generate strong scientific evidence are feasible and can support prevention program uptake and sustainability. Preliminary data from GGC4H suggest that parent enrollment was enhanced by pediatrician referral, but pediatricians may need support to refer consistently. Expanding EHR data on key adolescent prevention outcomes would facilitate pragmatic evaluation.