BACKGROUND: Bettering Asthma Care in Kids - Geographic Social Determinants Data to Understand Disparities

项目摘要/摘要 与非西班牙裔白人儿童相比，患有哮喘的拉丁裔儿童的哮喘预后更差。 在医学文献中，这些结果在多大程度上是由于有限的获取、未充分利用、 护理质量差，或社会和环境因素尚不清楚。对哮喘结果有更全面的了解 拉美裔儿童受到科学证据的阻碍，这些证据依赖于有限的 时间捕获，或容易受到回答偏差影响的主观调查。此外，一些健康方面的证据 服务文献表明，健康的社会决定因素(个人和社区层面的经济、 社会和环境因素)，包括西班牙裔亚群(墨西哥血统、波多黎各血统等) 影响哮喘护理和预后。然而，目前还不确定哪些社会决定因素是最强烈的 与拉丁裔儿童哮喘护理有关。 拟议的项目旨在填补关于哮喘护理性质的这些知识空白。 拉美裔儿童的差异以及健康的社会决定因素对这些差异的相对贡献， 通过利用包含数千个数据源的客观、纵向和健壮的链接 多个州的弱势儿童。我们将利用来自大型、全国性的 社区卫生中心网络，具有链接到社区级别的共享电子健康记录数据 健康数据的社会决定因素。此大型纵向数据集包含前所未有的数据链接 将使我们能够评估哮喘护理方面的差异，评估哪些社会决定因素影响使用率，以及 差异，并确定这些差异中的哪一个可能随着时间的推移而影响最大。我们还将专门 开发使用社区西班牙裔亚群信息的方法来估计 在我们诊所看到的患者(电子健康记录中通常不存在的信息)，以及如何 预防性服务的使用在这些群体中有所不同 了解健康的社会决定因素对拉美裔儿童哮喘护理的相对影响 将：1.做出更明智的政策决定，以改善对这一弱势群体的照顾；2.促进 医疗保健提供者和社区机构之间的战略伙伴关系准备介入社会 拉丁裔儿童生活中的因素，以及3.帮助临床提供者了解他们的病人在护理方面的障碍 利用，并进一步努力解决影响儿童利用卫生服务的障碍 为他们的哮喘推荐的医疗保健服务。

Project Summary/Abstract Latino children with asthma have worse outcomes from their asthma than non-Hispanic white children. In the medical literature, the degree to which these outcomes are the result of limited access, underutilization, poor quality of care, or social & environmental factors is unclear. A fuller understanding of asthma outcomes in Latino children is hampered by scientific evidence that has relied upon cross-sectional studies with a limited time capture, or subjective surveys vulnerable to response biases. Additionally, some evidence in the health services literature suggests that social determinants of health (individual- and community-level economic, social, and environmental factors), including Hispanic subgroup (Mexican ancestry, Puerto Rican ancestry, etc) affect asthma care and outcomes. It is uncertain, however, which social determinants are most strongly associated with Latino children's asthma care. The proposed project intends to fill these gaps in knowledge regarding the nature of asthma care disparities in Latino children and the relative contribution of social determinants of health to these disparities, by utilizing an objective, longitudinal, and robust linkage of data sources encompassing thousands of vulnerable children across multiple states. We will leverage a unique data resource from a large, national network of community health centers with shared electronic health record data that is linked to community-level social determinants of health data. This large, longitudinal dataset contains unprecedented data linkages which will let us assess disparities in asthma care, evaluate which social determinants affect utilization and disparities, and determine which of these may do so most significantly over time. We will also specifically develop methods to use community Hispanic subgroup information to estimate the individual subgroups of patient seen in our clinics (which is information not usually present in electronic health records), and how preventive service use differs among these groups Understanding the relative impact of social determinants of health on asthma care in Latino children will: 1. Enable more informed policy decisions to improve the care of this vulnerable population, 2. facilitate strategic partnerships between healthcare providers and community agencies poised to intervene in social factors in the lives of Latino children, and 3. help clinical providers understand their patients' barriers to care utilization, and further point-of-care efforts to address the barriers that influence children's utilization of recommended health care services for their asthma.