Helping gEnerations Identify Risks (Heirs) to Health

项目摘要 预防性和紧急医疗保健对确保儿童健康至关重要，但许多儿童得不到 足够的照顾。研究表明，与儿童接受医疗保健相关的因素是健康 保险范围和/或通常的护理来源以及父母因素，如健康状况和健康状况 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，粮食供应）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，以改善儿童接受建议的保健服务的情况。亲本 和/或SDH因素与儿童接受推荐的护理最密切相关的主要是 未知此外，这些不同因素之间的途径也没有明确界定。 此外，必须了解父母对什么会阻止接受建议的看法。 以及他们认为初级保健可以做些什么来进行干预。如果没有这些信息， 无法设计出有效的干预措施来改善儿童获得推荐的保健服务的情况。因此，我们认为， 本研究的目的是检查父母因素之间的关系（即，获得医疗保健的负担 疾病），SDH，以及儿童接受推荐的医疗保健。我们将使用综合门诊 来自OCHIN（不是首字母缩略词）社区健康网络的初级保健电子健康记录（EHR）数据 中心来自18个州的> 200万患者（n= 354，915名儿童）。此外，我们将采访约30-40名 父母了解促进或阻碍儿童接受建议的照料的因素。具体 目标是：目标1。确定与儿童健康最密切相关的父母医疗保健和健康因素 获得和利用推荐的医疗保健。目标二。探讨SDH对家庭的影响 医疗保健的获取和利用。目标3。发现获得儿童权利的其他障碍和促进因素 建议的医疗保健，并评估父母的信念，初级保健如何可以帮助他们克服 这些障碍。我们将采用顺序混合方法方法来迭代地从定性学习， 访谈并根据重要的定性见解进行额外的定量分析。目标1和2 确定基于EHR的父母保健和健康因素以及与儿童最密切相关的SDH 接受推荐的护理，而目标3探讨了“现实生活中”的父母对什么有助于或阻碍 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。 拟议的工作将是第一个了解父母医疗保健和健康的复杂关系 因素和SDH和儿童接受推荐的医疗保健，并确定障碍， 我相信初级保健可以干预。这项形成性的工作将推动潜在的干预措施，以改善 孩子们推荐的护理收据。我们将利用独特的数据资源， 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.