Family-Centered Community Health Worker Support for Children with Chronic Conditions and Unmet Social Needs

项目总结/摘要 解决慢性病儿童的护理协调需求和未得到满足的社会需求是一个高度- 这是美国医疗保健系统的首要目标。许多患有慢性病的儿童生活贫困， 与未得到满足的社会需求有关，如粮食不安全和住房不稳定，这可能限制他们的就业。 获得医疗服务，导致健康状况不佳。他们的护理人员必须在复杂的医疗保健和 系统和复杂的社会服务系统，以获得资源，他们的孩子需要保持健康。在我 初步研究，我发现，51%的照顾者的儿童住院多种慢性疾病， 报告有未满足的社会需求，这些照顾者表示希望纵向照顾 协调支持和帮助，解决他们出院后的社会需求。另外，我发现 照顾协调负担不成比例地影响低收入，黑人和西班牙裔儿童， 与放弃的医疗保健有关，使儿童健康结果的不平等永久化。促进卫生公平 并为患有慢性病的低收入儿童提供高质量的医疗保健， 迫切需要有效的以家庭为中心的干预措施，解决护理协调需求和社会 需求以患者为中心的目标的个体化管理（IMPaCT）是一种标准化的，基于理论的， 社区卫生工作者（CHW）领导的方法，以解决护理协调需求和社会需求， 患有多种慢性病的低收入成年人。干预措施建立在CHW的生活经验基础上， 他们的专业知识和独特的能力，作为卫生系统和社区之间的桥梁。影响 包括三个关键组成部分：（1）制定详细的，以患者为中心的护理计划，（2）纵向 支持的重点是满足医疗和社会需求，以及（3）与所需后续护理的联系。在 在成人中进行的多项随机对照试验中，发现IMPaCT可改善患者报告的 护理，同时减少急性护理使用。该应用程序的目标是针对、开发和测试儿科 调整IMPaCT，以满足住院儿童的护理协调需求和社会需求， 多种慢性疾病我的具体目标是1）确定与减少有关的社会需求 获得预防性护理的机会，并增加复杂慢性病住院儿童的急性护理使用 条件，2）为患有复杂慢性病的儿科患者制定适应性IMPaCT干预措施 和未得到满足的社会需求，以及3）确定可行性和可接受性，并评估初步疗效， 儿科IMPaCT干预。本工作与特别强调通知（SEN）：NOT-HS-21-014相关： 卫生服务研究，以促进健康公平，鉴于其重点是适应和实施一个 以证据为基础的干预措施，以促进保健服务系统内的公平， 多种慢性病患者，以及将健康的社会决定因素和社会需求纳入 医疗保健服务。

PROJECT SUMMARY/ABSTRACT Addressing both care coordination needs and unmet social needs for children with chronic conditions is a high- priority goal for the United States health care system. Many children with chronic conditions live in poverty and have associated unmet social needs, such as food insecurity and housing instability, which can limit their access to care and lead to poor health outcomes. Their caregivers must navigate both complex health care systems and complex social service systems to access resources their children need to stay healthy. In my preliminary studies, I found that 51% of caregivers of children hospitalized with multiple chronic conditions reported having unmet social needs, and these caregivers expressed a desire for longitudinal care coordination support and assistance addressing their social needs after hospital discharge. In addition, I found that care coordination burdens disproportionately impact low-income, Black, and Hispanic children and are associated with forgone health care, perpetuating inequities in child health outcomes. To promote health equity and increase access to high quality medical care for low-income children with chronic conditions, there is an urgent need for effective family-centered interventions addressing both care coordination needs and social needs. Individualized Management for Patient-Centered Targets (IMPaCT) is a standardized, theory-based, community health worker (CHW)-led approach to addressing care coordination needs and social needs for low-income adults with multiple chronic conditions. The intervention builds on CHW's lived experience and expertise and their unique ability to serve as a bridge between health systems and communities. IMPaCT includes three key components: (1) development of a detailed, patient-centered care plan, (2) longitudinal support focused on addressing medical and social needs, and (3) connection with needed follow-up care. In multiple randomized controlled trials in adults, IMPaCT has been found to improve patient-reported quality of care while reducing acute care utilization. The goal of this application is to target, develop, and test a pediatric adaptation of IMPaCT targeting both care coordination needs and social needs for hospitalized children with multiple chronic conditions. My specific aims are to 1) Identify social needs that are associated with decreased access to preventive care and increased acute care use among hospitalized children with complex chronic conditions, 2) develop an adapted IMPaCT intervention for pediatric patients with complex chronic conditions and unmet social needs, and 3) determine feasibility and acceptability and assess preliminary efficacy of the pediatric IMPaCT intervention. This work is relevant to Special Emphasis Notice (SEN): NOT-HS-21-014: Health Services Research to Advance Health Equity, given its focus on adapting and implementing an evidence-based intervention to advance equity within healthcare delivery systems, care delivery for persons with multiple chronic conditions, and integration of social determinants of health and social needs care within healthcare delivery.