Achieving Pediatric Health Equity by Responding to Identified Sociomedical risks with Effective Unified Purpose –Co-design and Evaluation of the RISEUP System

项目摘要 儿童健康成果方面的公平差距至少部分是由于没有充分解决儿童健康的社会决定因素。 健康，定义为“人们出生、生活、学习、工作、娱乐、崇拜和年龄的条件”。患者 家庭需求与有毒住房、进入障碍和社会经济剥夺等决定因素有关 损害健康，并将注意力从完成随访、药物填充和其他服务上转移开来， 促进最佳健康和福祉结果的恶习。社会决定因素未得到充分解决， 健康差距的持续存在。因此，能够有效监测 风险，然后整合对医疗和社会需求的积极响应，将更有可能实现 更好更公平的结果因此，本项目的目标是共同设计和评估"应对 识别社会医学风险与有效的统一目的"系统（RISEUP），以最好地满足医疗 儿童及其社区的社会需求。核心假设是，一个综合系统共同- 与医疗保健，人类服务，基于支付者的利益相关者和儿科患者的父母一起设计，将 通过提高对情况的认识和提供信息， 针对共同根源的跨部门行动。这一假设将通过三个具体的测试 目的：1）确定三种慢性儿科疾病（哮喘， 1型糖尿病和镰状细胞病）; 2）共同设计一个反应系统， 实施共享理论和解决医疗社会风险的项目;以及3）评估医疗-社会风险的影响。 利用RISEUP建立关于患者和人口一级健康结果的社会监测和反应系统 在高发病率，高贫困社区的哮喘，糖尿病和镰状细胞病儿童的护理。 拟议研究的贡献是共同设计和评估RISEUP，这种监测和响应 系统与医疗保健，人类服务和基于支付者的利益相关者以及儿科的父母合作， Ric患者这项研究是重要的，因为医疗和社会数据一起将提供AHRQ- 优先考虑儿童和社区的360度视角，使我们更接近贫困的根源 健康这一建议在监测差距的根源以及共同设计和评估方面具有创新性 综合协调的反应系统。以人为本的协同设计加速了这种数据集成 和基于人口的质量改善，为随后的规模和传播带来了巨大的希望。预计 成果包括一个潜在的变革性模板，用于医疗保健和人类服务系统的协作， 有效地监测和应对差异。事实上，RISEUP将通过促进预防， 解决社会决定因素和公平改善儿童成果的积极办法， BLE和AHRQ优先考虑的人群。

PROJECT SUMMARY Equity gaps in child health outcomes result, at least in part, from insufficiently addressed social determinants of health, defined as “the conditions in which people are born, live, learn, work, play, worship, and age.” Patient and family needs related to determinants like toxic housing, access barriers, and socioeconomic deprivation undermine health and shift attention away from completion of follow-up visits, medication fills, and other ser- vices that promote optimal health and well-being outcomes. Insufficiently addressed social determinants ex- plain much of the persistence in health disparities. As a result, healthcare systems that effectively monitor for risks and then integrate proactive responses to both medical and social needs will be more likely to achieve better, equitable outcomes. Thus, the objective of this project is to co-design and evaluate the “Responding to Identified Sociomedical risks with Effective Unified Purpose” System (RISEUP) to best meet both the medical and social needs of children and their communities. The central hypothesis is that an integrated system co- designed with healthcare-, human service-, payer-based stakeholders, and parents of pediatric patients, will promote better, more equitable outcomes across conditions by enhancing situation awareness and informing cross-sector actions directed at common root causes. This hypothesis will be tested through three specific aims: 1) Identify common root causes of health equity gaps across three chronic pediatric conditions (asthma, type 1 diabetes, and sickle cell disease) using an integrated monitoring system; 2) Co-design a response sys- tem to operationalize shared theory and address medical-social risks; and 3) Evaluate the effects of a medical- social monitoring and response system on patient- and population-level health outcomes, employing RISEUP in the care of children with asthma, diabetes, and sickle cell living in high-morbidity, high-poverty communities. The contribution of the proposed research is to co-design and evaluate RISEUP, this monitoring and response system in partnership with healthcare-, human service-, and payer-based stakeholders, and parents of pediat- ric patients. This research is significant because both medical and social data together would provide AHRQ- prioritized 360-degree views of children and communities, getting us closer to those factors at the root of poor health. This proposal is innovative in its monitoring of disparities’ root causes and the co-design and evaluation of integrated, coordinated response systems. Such data integration, accelerated by human-centered co-design and population-based quality improvement, holds great promise for subsequent scale and spread. Expected outcomes include a potentially transformative template for healthcare and human service systems to collabora- tively monitor and respond to disparities. Indeed, RISEUP will positively affect children by facilitating a preven- tive approach to addressing the social determinants and equitably improving outcomes for children, a vulnera- ble and AHRQ-prioritized population.