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

描述（由申请人提供）：贫困引起的困难，如粮食不安全，公用事业关闭和不合标准的住房都有可能对健康产生负面影响。在美国，有许多法律和政策旨在解决这些问题，但获得法律的援助，很像获得营养食品，往往是有限的社会和经济劣势。如果儿童得不到旨在解决这种差异的法律的好处，他或她的健康状况可能会受到不利影响。本研究旨在扩展医疗-法律的伙伴关系概念，并通过创建一个创新系统来减轻健康差异，该系统可显著增加儿科诊所中医疗-法律的问题的识别，改善适当的医生咨询的提供，并在需要法律的补救措施时简化法律的资源的获取。的具体目标是：（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（CHICA）系统，以帮助儿科医生识别和管理四个常见的医疗法律问题（无家可归、不安全的出租房屋条件、无法充分获得必要的公用设施和粮食不安全），有可能对儿童健康产生不利影响;（2）评估CHICA医疗法律模块在四个儿科实践中识别和缓解医疗法律问题的效果。次级目标2（a）：评估医疗-法律问题识别率。次级目标2（B）：评价医生为缓解已识别的医疗法律问题而采取的措施。次级目标2（c）：评价患者护理人员为缓解已确定的医疗-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。次级目标3（a）：评价医生对医疗法律问题的识别和CHICA医疗法律模块的接受程度。次级目标3（B）：评估病人照顾者对医生处理医疗法律问题和CHICA医疗法律模块过程的看法;（4）评估CHICA医疗法律模块对医疗保健利用的影响。我们假设，本文提出的简化过程将大大提高医疗法律问题识别率;当医疗法律问题被识别时，增加和改善适当的医生咨询和转诊过程的交付;增加和改善患者护理人员在识别时采取积极措施减轻医疗法律问题的速度;增加医生对医疗法律问题识别和咨询的舒适度;并证明基于有效的医疗法律问题解决方案的医疗保健利用率降低。这项研究与ARHQ的健康IT组合研究目标一致，该目标涉及支持以患者为中心的护理和电子健康信息的交换，以提高护理质量并增强权能。这也符合AHRQ的比较效果组合研究目标。

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.