Computer-Supported Management of Medical-Legal Issues Impacting Child Health

描述(由申请人提供)：贫困导致的困难，如粮食不安全、公用事业关闭和住房不达标，都有可能对健康产生负面影响。在美国，有许多旨在解决这类问题的法律和政策，但获得法律援助的机会，就像获得营养食品一样，往往受到社会和经济劣势的限制。如果儿童得不到旨在解决这种差距的法律的好处，他或她的健康状况可能会受到负面影响。这项研究旨在扩大医疗-法律伙伴关系的概念，并通过创建一个创新的系统来缓解健康差距，该系统大大增加了儿科诊所对医疗-法律问题的识别，改善了适当医生咨询的提供，并在需要法律补救时简化了对法律资源的获取。其具体目标是：(1)扩大和修改现有的基于计算机的决策支持系统--通过计算机自动化改善儿童健康系统，以协助儿科医生确定和管理四个可能对儿童健康产生不利影响的常见医疗法律问题(无家可归、租房条件不安全、不能获得必要的公用事业和食品不安全)；(2)评估医疗法律模块在确定和减轻四种儿科实践中的医疗法律问题方面的效果。分目标2(A)：评价医疗-法律问题的辨识率。分目标2(B)：评估医生为减轻已查明的医疗法律问题而采取的行动。分目标2(C)：评估病人照顾者为减轻已查明的医疗法律问题而采取的行动；(3) 评估医生和患者护理人员对CHICA医疗法律模块的满意度。分目标3(A)：通过确定和接受CHICA医疗法律模块，评估医生的舒适度。分目标3(B)：评估患者照顾者对医生处理医疗法律问题和CHICA医疗法律模块流程的看法；以及(4)评估CHICA医疗法律模块对医疗保健利用的影响。我们假设，本文建议的简化流程将显著提高医疗法律问题的识别率；在发现医疗法律问题时，增加和改善适当的医生咨询和转诊流程；增加和改善患者护理人员在发现医疗法律问题时采取积极措施缓解医疗法律问题的比率；增加医生对医疗法律问题识别和咨询的舒适度；以及基于有效的医疗法律问题解决方案，证明降低了医疗保健利用率。这项研究与ARHQ的健康信息技术组合研究目标一致，这些目标涉及支持以患者为中心的护理和交换电子健康信息，以提高护理质量和赋权。这也符合AHRQ的比较有效性组合研究目标。 公共卫生相关性：拟议的研究旨在通过创建一个创新的系统来缓解健康差距，该系统大大增加了对儿科诊所医疗法律问题的识别，改善了适当医生咨询的提供，并在需要法律补救时简化了对法律资源的获取。这项拟议的研究与公共卫生有关，因为贫困导致的困难，如粮食不安全、公用事业关闭和住房不达标，都有可能对健康产生负面影响。如果儿童得不到旨在解决这种差距的法律的好处，他或她的健康状况可能会受到负面影响。

DESCRIPTION (provided by applicant): Poverty-induced hardships such as food insecurity, utility shut-offs and substandard housing all have the potential to negatively impact health. In th United States, there exist many laws and policies designed to address such issues, but access to legal aid, much like access to nutritious food, is often limited by social and economic disadvantage. A child's health status may be negatively affected when he or she does not receive the benefit of laws designed to address such disparities. This study has been designed to expand upon the medical- legal partnership concept and mitigate health disparities by creating an innovative system that dramatically increases the identification of medical-legal issues in pediatric clinics, improves the delivery of appropriate physician counseling and streamlines access to legal resources when legal remedies are needed. The specific aims of are to: (1) Expand and modify an existing computer-based decision support system, the Child Health Improvement through Computer Automation (CHICA) system, to assist pediatricians with the identification and management of four common medical-legal problems (homelessness, unsafe rental home conditions, inadequate access to necessary utilities and food insecurity) that have the potential to adversely impact child health; (2) Evaluate the effect of the CHICA medical-legal module on the identification and mitigation of medical-legal problems in four pediatric practices. Sub-aim 2(a): Evaluate rates of medical-legal issue identification. Sub-aim 2(b): Evaluate actions taken by physicians to mitigate identified medical-legal issues. Sub-aim 2(c): Evaluate actions taken by patient caregivers to mitigate identified medical-legal issues; (3) Evaluate physician and patient caregiver satisfaction with the CHICA medical-legal module. Sub-aim 3(a): Evaluate physician comfort with medical-legal issue identification and acceptance of the CHICA medical-legal module. Sub-aim 3(b): Evaluate patient caregiver perceptions about physicians' handling of medical-legal issues and the CHICA medical-legal module process; and (4) Evaluate the impact of the CHICA medical-legal module on healthcare utilization. We hypothesize that the streamlined process proposed herein will dramatically increase the rate of medical-legal issue identification; increase and improve the delivery of appropriate physician counseling and referral processes when medical-legal issues are identified; increase and improve the rate at which patient caregivers take positive steps to mitigate medical-legal issues when identified; increase physician comfort with medical-legal issue identification and counseling; and demonstrate decreased healthcare utilization based upon effective medical-legal issue resolution. This study is consistent with ARHQ's Health IT Portfolio research objectives pertaining to the support of patient-centered care and the exchange of electronic health information to improve the quality of care and empower. It is also consistent with AHRQ's Comparative Effectiveness Portfolio research objectives. PUBLIC HEALTH RELEVANCE: The proposed study has been designed to mitigate health disparities by creating an innovative system that dramatically increases the identification of medical-legal issues in pediatric clinics, improves the delivery of appropriate physician counseling and streamlines access to legal resources when legal remedies are needed. The proposed study is relevant to public health because poverty-induced hardships such as food insecurity, utility shut-offs and substandard housing all have the potential to negatively impact health. A child's health status may be negatively affected when he or she does not receive the benefit of laws designed to address such disparities.