Reducing Socioeconomic Disparities in Health at Pediatric Visits

减少儿科就诊时健康的社会经济差异

• 批准号: 8773551
• 负责人: Arvin Garg
• 金额: $ 39.22万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-10 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8773551
• 关键词: Address; Adult; Affect; Age; Area; Award; Biological; Birth; Boston; Caring; Child; Child Development; Child health care; Childhood; Chronic; Chronic stress; Clinical; Communities; Computerized Medical Record; Data; Disadvantaged; Disease; Education; Effectiveness; Employment; Evaluation; Exposure to; Face; Family; Federally Qualified Health Center; Frequencies; Goals; Health; Healthy People 2020; Heating; High-Income Populations; Hospitalization; Household; Housing; Immunization; Integrated Delivery of Health Care; Intervention; Life; Life Cycle Stages; Light; Link; Low income; Measures; Minority; Minority Groups; Mission; Modeling; Obesity; Outcome; Parents; Pathway interactions; Patients; Physiological; Population; Positioning Attribute; Poverty; Primary Health Care; Process; Productivity; Provider; Public Health; Randomized; Research; Resources; Site; Societies; Stress; Supervision; System; Time; Visit; Work; arm; base; biological adaptation to stress; chronic care model; cohort; community based service; early childhood; effectiveness trial; efficacy trial; ethnic minority population; experience; food security; health care service utilization; health disparity; health equity; health information technology; improved; innovation; insight; interest; meetings; outreach; pediatrician; peer; pragmatic trial; public health relevance; racial and ethnic; screening; social health determinants; socioeconomics

DESCRIPTION (provided by applicant): Socioeconomically disadvantaged populations experience multiple health disparities. Life course research suggests that these disparities begin in childhood with the biological embedding of adult disease as a result of exposure to "toxic stress," defined as prolonged exposure to adversity. Pediatric primary care-particularly at Federally Qualified Health Centers (FQHCs)-provides a unique public health opportunity to address this stress given the near universal reach of child health care and the frequency of visits in early childhood. Our prior work has focused on developing and examining the efficacy of a pediatric-based intervention model, "WE CARE", on addressing families' unmet material needs-a potent toxic stress for low-income children. Specifically, WE CARE addresses six key material needs-food security, employment, parental education, housing stability, household heat, and childcare-by systematically screening and referring families to available community-based resources at pediatric visits. Preliminary data from our R00 study suggests the model is efficacious in increasing provider referrals and parental receipt of community-based services in the child's first year of life; however, a subset of referred parents did not contact any resources We now propose a large-scale, multi-site randomized effectiveness trial, along with an implementation evaluation, at eight FQHCs, in which the WE CARE strategy is augmented by embedding screening/referral processes within existing clinical systems and by utilizing peer-led patient navigation. The proposed study's specific aims are to: 1) determine the effectiveness of the augmented WE CARE model on provider referrals and family receipt of community-based resources; 2) determine the model's impact on low-income children's utilization of health care services and child development and explore its impact on the onset of a chronic health condition-obesity; and 3) gain insight into the context and implementation of the model in order to enhance its dissemination and implementation potential at FQHCs nationally. We hypothesize that the augmented WE CARE model will increase provider referrals and family receipt of community resources. Based primarily on the life course and cumulative pathways models, along with our R00 results, we hypothesize that this pediatric- based model will reduce exposure to unmet material needs resulting in less chronic stress and improved health trajectories in the first three years of life. We expect to follow a cohort of over 1,400 low-incom, predominantly minority, children (>700 per treatment arm) from birth to age 3. Our proposal is innovative because it applies a new interventional approach-addressing social determinants of health systematically at low-income children's pediatric visits-to reducing lifelong socioeconomic disparities in health. This proposal has significant public health implications for the delivery of primary care to low-income children and addresses a NIMHD priority area. Our long-term goal is dissemination and implementation of a pediatric care model focused on addressing the social determinants of health at the national level through FQHCs.

描述（由申请人提供）：社会经济弱势群体面临多种健康差异。生命历程研究表明，这些差异始于童年时期，由于暴露于“有毒压力”（定义为长期处于逆境中）而导致成人疾病的生物嵌入。儿科初级保健——尤其是联邦合格健康中心 (FQHC)——提供了独特的公共卫生机会来解决这种压力，因为儿童保健几乎已普及到儿童早期就诊的频率很高。我们之前的工作重点是开发和检验基于儿科的干预模式“WE CARE”的有效性，以解决家庭未满足的物质需求——对低收入儿童来说是一种潜在的有毒压力。具体来说，“WE CARE”通过系统地筛选家庭并在儿科就诊时向家庭推荐可用的社区资源，解决六种关键的物质需求——粮食安全、就业、父母教育、住房稳定、家庭取暖和儿童保育。我们 R00 研究的初步数据表明，该模型可以有效增加提供者转介和家长在孩子出生后第一年接受基于社区的服务；然而，一部分被转介的家长没有联系任何资源。我们现在提议在八个 FQHC 进行一项大规模、多地点随机有效性试验以及实施评估，其中通过在现有临床系统中嵌入筛选/转诊流程以及利用同行主导的患者导航来增强“WE CARE”策略。拟议研究的具体目标是： 1) 确定增强的 WE CARE 模型在提供者转介和家庭接收社区资源方面的有效性； 2）确定该模型对低收入儿童利用医疗保健服务和儿童发展的影响，并探讨其对慢性健康状况肥胖的影响； 3) 深入了解该模型的背景和实施情况，以增强其在全国 FQHC 的传播和实施潜力。我们假设增强的 WE CARE 模式将增加提供者的转介和家庭对社区资源的接收。主要基于生命历程和累积路径模型以及我们的 R00 结果，我们假设这种基于儿科的模型将减少未满足的物质需求，从而减少生命前三年的慢性压力并改善健康轨迹。我们期望对超过 1,400 名低收入儿童（主要是少数族裔）（每个治疗组超过 700 名）从出生到 3 岁的儿童进行追踪。我们的建议具有创新性，因为它应用了一种新的干预方法——在低收入儿童的儿科就诊中系统地解决健康的社会决定因素——以减少终生的健康社会经济差异。该提案对于向低收入儿童提供初级保健具有重大的公共卫生影响，并涉及 NIMHD 优先领域。我们的长期目标是传播和实施儿科护理模式，重点是通过 FQHC 在国家层面解决健康的社会决定因素。