Helping gEnerations Identify Risks (Heirs) to Health

项目摘要 预防性和急性保健对确保儿童健康至关重要，然而，许多儿童得不到 足够的护理。研究表明，与儿童接受医疗保健相关的因素是健康 保险覆盖范围和/或通常的护理来源和父母因素，如健康状况和健康 保险范围。此外，健康的社会决定因素(SDH)(例如，邻里社会剥夺、 贫困率、食物可获得性)可能是家庭医疗保健利用的另一个负担，因此， 重要的是要考虑到这些因素，以改善儿童获得建议的医疗保健的情况。父母 和/或SDH因素在很大程度上与儿童接受推荐护理有关 未知。此外，这些不同因素之间的路径也没有明确界定。 此外，重要的是要了解父母对阻止接受推荐的因素的看法 为他们的孩子提供医疗保健，以及他们认为初级保健可以做些什么来干预。如果没有这些信息， 无法制定有效的干预措施来改善儿童接受推荐医疗保健的情况。因此， 本研究旨在考察父母因素(如接受医疗保健、家庭负担等)之间的关系 疾病)、SDH和儿童接受推荐的医疗保健。我们将使用综合性的、门诊的 来自OCHIN(非首字母缩写)社区卫生网络的初级保健电子健康记录(EHR)数据 中心是来自18个州的200万名患者(n=354,915名儿童)。此外，我们还将采访30-40人左右 让家长了解促进或阻碍儿童接受推荐护理的因素。具体的 目标是：目标1.确定父母的保健和健康因素与儿童的 获得和利用推荐的医疗保健。目的2.探讨SDH对家庭的影响 医疗服务的获取和利用。目标3.发现获取儿童信息的其他障碍和促进者 推荐医疗保健并评估父母对初级保健如何帮助他们克服 这些障碍。我们将使用顺序混合方法来迭代地学习定性的 访谈，并根据重要的定性见解进行额外的量化分析。目标1和目标2 确定基于EHR的父母保健和健康因素以及SDH与儿童最密切相关 接受推荐的护理，而Aim 3则探索父母对什么有助于或阻碍的“现实生活”看法 接受建议的护理，并确定父母认为初级保健可以干预的障碍。 这项拟议的工作将是第一次理解父母保健和健康的复杂关系 因素和SDH以及儿童接受推荐的医疗保健，并确定父母 相信初级保健可以干预。这项形成性工作将推动潜在的干预措施 儿童推荐护理收据。我们将利用提供信息的独特数据资源 关于弱势家庭的医疗保健和健康。

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.