Helping gEnerations Identify Risks (Heirs) to Health

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Project Summary Preventive and acute healthcare are essential to ensure child health, yet, many children do not receive adequate care. Research shows the factors associated with receipt of healthcare for children are having health insurance coverage and/or a usual source of care and parental factors such as health conditions and health insurance coverage. Additionally, social determinants of health (SDH) (e.g., neighborhood social deprivation, poverty rate, food availability) are likely another burden on families' healthcare utilization, therefore, it is important to take them into account to improve children's receipt of recommended healthcare. The parental and/or SDH factors most strongly associated with children's receipt of recommended care are largely unknown. Further, the pathways between and among these different factors are not clearly defined. Additionally, it is essential to understand parents' perspectives on what prevents receipt of recommended healthcare for their children and what they believe primary care can do to intervene. Without this information, effective interventions to improve children's receipt of recommended healthcare cannot be devised. Therefore, this study aims to examine the relationships between parental factors (i.e., receipt of healthcare, burden of disease), SDH, and children's receipt of recommended healthcare. We will use comprehensive, outpatient primary care electronic health record (EHR) data from OCHIN's (not an acronym) network of community health centers on >2 million patients (n=354,915 children) from 18 states. In addition, we will interview about 30-40 parents to understand the factors facilitating or hindering children's receipt of recommended care. The specific aims are: Aim 1. Identify the parental healthcare and health factors most strongly associated with children's access to and utilization of recommended healthcare. Aim 2. Explore the influence of SDH on family healthcare access and utilization. Aim 3. Discover additional barriers and facilitators of accessing children's recommended healthcare and assess parental beliefs about how primary care could help them overcome these barriers. We will employ a sequential mixed-methods approach to iteratively learn from the qualitative interviews and conduct additional quantitative analyses based on important qualitative insights. Aims 1 and 2 identify EHR-based parental healthcare and health factors and SDH most strongly associated with children's receipt of recommended care, while Aim 3 explores “real-life” parent perceptions of what helps or hinders receipt of recommended care and identifies the barriers that parents believe primary care can intervene on. The proposed work will be the first to understand the complex relationship of parental healthcare and health factors and SDH and children's receipt of recommended healthcare and to identify the barriers that parents believe primary care can intervene on. This formative work will propel potential interventions to improve children's recommended care receipt. We will capitalize on unique data resources that provide information about healthcare and health of vulnerable families.