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

项目摘要 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- 是健康差距的主要驱动因素。美国儿科学会，美国国家医学院， 医疗补助和医疗保险服务中心等支付者建议整合筛查， 不利的SDOH和产生转介到社会服务的医疗保健提供系统作为一个中心 促进患者和人群健康。虽然许多儿科门诊实践现在正在实施 SDOH筛查，很少注意到住院设置，代表错过了机会， 促进健康公平。总体而言，10%的美国婴儿早产， 出生于低收入和少数民族母亲。多达四分之一的早产儿家庭的基本保健 需要，如住房或工作不安全，这是不利的SDOH。早产儿尤其 易受他们成长的社会条件的早期生活规划的影响， 在多个器官系统中发挥作用。不幸的是，执行有效干预措施， 新生儿重症监护室（NICU）中未满足的基本需求，早产儿出生后住院 几周到几个月都没有。本提案的目标是将SDOH的既定模型 从门诊儿科环境到NICU的筛查和转诊，从而最大限度地提高 不利的SDOH对脆弱的母亲-早产儿二对的抵消作用。我们的研究团队此前曾 开发并测试了低接触SDOH筛查和转诊干预称为"我们关心"， 门诊儿科设置，并证明其有效性，增加社区资源的接收。 我们现在提出了一个在8个美国安全网NICU（4 WE CARE）中进行的混合有效性-实施集群RCT NICU和4控制NICU），使用普罗克特概念模型的实施研究。我们将 在4个新生儿重症监护病房实施WE CARE，并纵向随访576例母婴配对（288 每个研究组）在NICU出院后12个月。在目标1中，我们将研究WE CARE的实施情况 进入新生儿重症监护室，评估其适当性，可行性，渗透性，公平性和可持续性。在目标2中， 将检查我们照顾的有效性和公平性，在新生儿重症监护室设置对父母接收社区 NICU出院后3个月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展。建议的低强度， 可扩展的WE CARE干预具有巨大的潜力，可以改变系统性社会需求的范式 筛查和转诊从门诊到住院的医疗保健提供系统，并解决不利的SDOH 在高度脆弱的儿科人群生命的最早阶段，有可能改善儿童的 健康和发展轨迹沿着孕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.