Computer-Supported Management of Medical-Legal Issues Impacting Child Health

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DESCRIPTION (provided by applicant): Poverty-induced hardships such as food insecurity, utility shut-offs and substandard housing all have the potential to negatively impact health. In th United States, there exist many laws and policies designed to address such issues, but access to legal aid, much like access to nutritious food, is often limited by social and economic disadvantage. A child's health status may be negatively affected when he or she does not receive the benefit of laws designed to address such disparities. This study has been designed to expand upon the medical- legal partnership concept and mitigate health disparities by creating an innovative system that dramatically increases the identification of medical-legal issues in pediatric clinics, improves the delivery of appropriate physician counseling and streamlines access to legal resources when legal remedies are needed. The specific aims of are to: (1) Expand and modify an existing computer-based decision support system, the Child Health Improvement through Computer Automation (CHICA) system, to assist pediatricians with the identification and management of four common medical-legal problems (homelessness, unsafe rental home conditions, inadequate access to necessary utilities and food insecurity) that have the potential to adversely impact child health; (2) Evaluate the effect of the CHICA medical-legal module on the identification and mitigation of medical-legal problems in four pediatric practices. Sub-aim 2(a): Evaluate rates of medical-legal issue identification. Sub-aim 2(b): Evaluate actions taken by physicians to mitigate identified medical-legal issues. Sub-aim 2(c): Evaluate actions taken by patient caregivers to mitigate identified medical-legal issues; (3) Evaluate physician and patient caregiver satisfaction with the CHICA medical-legal module. Sub-aim 3(a): Evaluate physician comfort with medical-legal issue identification and acceptance of the CHICA medical-legal module. Sub-aim 3(b): Evaluate patient caregiver perceptions about physicians' handling of medical-legal issues and the CHICA medical-legal module process; and (4) Evaluate the impact of the CHICA medical-legal module on healthcare utilization. We hypothesize that the streamlined process proposed herein will dramatically increase the rate of medical-legal issue identification; increase and improve the delivery of appropriate physician counseling and referral processes when medical-legal issues are identified; increase and improve the rate at which patient caregivers take positive steps to mitigate medical-legal issues when identified; increase physician comfort with medical-legal issue identification and counseling; and demonstrate decreased healthcare utilization based upon effective medical-legal issue resolution. This study is consistent with ARHQ's Health IT Portfolio research objectives pertaining to the support of patient-centered care and the exchange of electronic health information to improve the quality of care and empower. It is also consistent with AHRQ's Comparative Effectiveness Portfolio research objectives. PUBLIC HEALTH RELEVANCE: The proposed study has been designed to mitigate health disparities by creating an innovative system that dramatically increases the identification of medical-legal issues in pediatric clinics, improves the delivery of appropriate physician counseling and streamlines access to legal resources when legal remedies are needed. The proposed study is relevant to public health because poverty-induced hardships such as food insecurity, utility shut-offs and substandard housing all have the potential to negatively impact health. A child's health status may be negatively affected when he or she does not receive the benefit of laws designed to address such disparities.