Implementing a Social Determinants of Health Screening and Referral Care Model in the Neonatal Intensive Care Unit

项目总结 健康的社会决定因素(SDOH)--人们出生、成长、工作、生活和年龄的条件-- 是造成健康差距的关键驱动因素。美国儿科学会，国家医学学会， 医疗补助和医疗保险服务中心等支付者建议将筛查纳入 不利的SDOH和产生转诊到作为中心的医疗保健提供系统内的社会服务 促进患者和人群健康的方法。虽然许多儿科门诊诊所现在正在实施 SDOH筛查，很少关注住院设置，这意味着错失了机会 推进健康公平。总体而言，10%的美国婴儿是早产的，而且他们的比例不成比例 由低收入和少数族裔母亲所生。多达四分之一的早产儿家庭有未满足的基本需求 需求，如住房或工作不安全，这是不利的SDOH。早产儿尤其是 由于他们成长所处的社会条件，容易受到早期生活规划的影响，并对 在多个器官系统中发挥作用。不幸的是，努力实施有效的干预措施来解决 早产儿出生后住院的新生儿重症监护病房(NICU)未满足的基本需求 几周到几个月都没有。该提案的目标是将已建立的SDOH模型 从门诊儿科环境进行筛查和转诊到NICU，从而最大限度地潜在 抵消不良SDOH对脆弱的母亲-早产儿夫妇的影响。我们的研究小组之前 开发和测试低接触SDOH筛查和转介干预，称为“我们关心”在 门诊儿科设置，并展示了其在增加接受社区资源方面的有效性。 我们现在建议在8个美国安全网NICU(我们关心的4个)中使用混合有效性实施集群RCT NICU和4个控制NICU)，使用实施研究的Proctor概念模型。我们会 将我们的关怀落实到4个NICU中，并纵向跟踪576名母亲-早产儿双胞胎(288名)的队列 每个研究组)，在NICU出院后12个月。在目标1中，我们将审查WE CARE的实施情况 进入NICU，评估其适当性、可行性、渗透率、公平性和可持续性。在目标2中，我们 将审查我们在NICU环境中对父母接受社区照顾的有效性和公平性 NICU出院后3个月内未满足的基本需求的资源。最后，在目标3中，我们将探讨 我们关心产妇的心理健康和早产儿的健康和发育。建议的低强度， 可扩展的我们关心的干预具有巨大的潜力，可以改变系统性社会需求的范式 从门诊到住院的筛查和转诊医疗服务系统，并解决不良的SDOH 在高度脆弱的儿科人群中处于生命的早期阶段，有可能改善儿童的 健康和发展轨迹以及产妇的心理健康和福祉。

PROJECT SUMMARY Social determinants of health (SDOH)—the conditions in which people are born, grow, work, live, and age— are key drivers of health disparities. The American Academy of Pediatrics, the National Academy of Medicine, and payers such as the Centers for Medicaid and Medicare Services recommend integrating screening for adverse SDOH and generating referrals to social services within the healthcare delivery system as a central way to promote patient and population health. While many pediatric outpatient practices are now implementing SDOH screening, little attention has been paid to the inpatient setting, representing a missed opportunity to advance health equity. Overall, ten percent of U.S. infants are born preterm and they are disproportionately born to low-income and minority mothers. Up to a quarter of families with preterm infants have unmet basic needs, such as housing or job insecurity, which represent adverse SDOH. Preterm infants are especially vulnerable to early-life programming by the social conditions that they grow up in, with sustained impacts on function across multiple organ systems. Unfortunately, efforts to implement effective interventions that address unmet basic needs in the neonatal intensive care unit (NICU) where preterm infants are hospitalized after birth for weeks to months are lacking. The goal of this proposal is to translate an established model of SDOH screening and referral from the outpatient pediatric setting to the NICU, thereby maximizing the potential to offset effects of adverse SDOH on vulnerable mother-preterm infant dyads. Our study team has previously developed and tested the low-touch SDOH screening and referral intervention called “WE CARE” in the outpatient pediatric setting and demonstrated its effectiveness on increasing receipt of community resources. We now propose a hybrid effectiveness-implementation cluster RCT in 8 U.S. safety-net NICUs (4 WE CARE NICUs and 4 control NICUs), using the Proctor Conceptual Model of Implementation Research. We will implement WE CARE into 4 NICUs and longitudinally follow a cohort of 576 mother-preterm infant dyads (288 per study arm) for 12 months after NICU discharge. In Aim 1, we will examine the implementation of WE CARE into the NICU, assessing its appropriateness, feasibility, penetration, equity, and sustainability. In Aim 2, we will examine the effectiveness and equity of WE CARE in the NICU setting on parental receipt of community resources for unmet basic needs 3-months post-NICU discharge. Finally, in Aim 3, we will explore the effect of WE CARE on maternal mental health and preterm infant health and development. The proposed low-intensity, scalable WE CARE intervention has tremendous potential to shift the paradigm of systematic social needs screening and referral from the outpatient to inpatient healthcare delivery system and address adverse SDOH at the earliest stages of life in a highly vulnerable pediatric population, with the potential to improve children’s health and developmental trajectories along with maternal mental health and well-being.