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Paul KJ, Virudachalam S, Montoya-Williams D, Lorch S. Associations between food insecurity and low birth weight severity in a national sample. J Perinatol 2024:10.1038/s41372-024-02094-z. [PMID: 39232084 DOI: 10.1038/s41372-024-02094-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 06/07/2024] [Accepted: 08/12/2024] [Indexed: 09/06/2024]
Affiliation(s)
- Kathryn Joanna Paul
- Division of Neonatology, The University of North Carolina, Chapel Hill, NC, USA.
| | - Senbagam Virudachalam
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, NC, USA
- PolicyLab, CHOP, Philadelphia, PA, USA
- Clinical Futures, CHOP, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Diana Montoya-Williams
- PolicyLab, CHOP, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Scott Lorch
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
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2
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Kanak MM, Stewart AM, Chang L, Fleegler EW. Health-Related Social Risks Versus Needs in a Pediatric Emergency Department. Am J Prev Med 2024; 67:291-295. [PMID: 38555031 DOI: 10.1016/j.amepre.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Health-related social problems may be conceptualized as the presence of either a social risk (i.e., food insecurity as defined by a screening tool) or a social need (i.e., desire for referral to a food program). Identification of social risks may not correlate with patients' desire to receive help. This study aimed to identify and compare patients and families with social risks versus social needs in a pediatric emergency department. METHODS This was a planned secondary analysis conducted in 2023 of a previously published prospective intervention study, which screened and referred caregivers and adult patients for health-related social problems in an urban tertiary pediatric emergency department between May 2019 and October 2020. Participants completed a screening tool for social risks and self-identified social needs by selecting desired assistance from a list of social service categories. Participants' social risk screening results were compared with their selection of resources for social needs across demographic and socioeconomic characteristics and the number of positive social risks using chi-squared or Fisher's exact tests. RESULTS Of 258 participants, 42.2% (109) screened positive for any social risk, and 38.0% (98) self-selected a social need. Of those, only 59.2% (77/130) both screened positive and self-selected a need. Among those who screened positive for a social risk, several demographic and socioeconomic factors including race, ethnicity, and income were significantly different between those interested versus not interested in assistance. CONCLUSIONS Both social risks and self-identified social needs should be considered within social care interventions in the pediatric healthcare setting.
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Affiliation(s)
- Mia M Kanak
- Division of Emergency Medicine and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, California.
| | - Amanda M Stewart
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia
| | - Lawrence Chang
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Petts RA, Baskin T, Basiru T, Ippolito S, Rothwell-Termotto H, Shahidullah JD. Health-Related Social Needs Screening and Referral in Pediatric Primary Care: A Systematic Review. J Pediatr Health Care 2024:S0891-5245(24)00142-1. [PMID: 39023460 DOI: 10.1016/j.pedhc.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 05/30/2024] [Accepted: 05/30/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION This study aimed to review approaches to health-related social needs (HRSN) screening and referral in pediatric primary care. METHOD PsycINFO, PubMed, and Google Scholar databases were searched to include peer-reviewed studies conducted in the U.S. over the last 30 years that reported HRSN screening and/or referral outcomes in primary care up to age 18. Studies included multiple HRSN domains and a variety of study designs. Data were summarized descriptively. RESULTS 20 studies met inclusion criteria. A variety of screening targets and modalities were employed in addition to referral support methods. Positive screens among the domains reported varied depending on the screening process and sample. DISCUSSION This review highlights a range of patient-centered innovations for HRSN screening and referral that may be adaptable to a range of local needs and capacities. Ongoing rigorous evaluation of these models is needed.
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Colon M, Goodman JM. Screening tools for employment in clinical healthcare delivery systems: a content analysis. BMC Health Serv Res 2024; 24:720. [PMID: 38862954 PMCID: PMC11167741 DOI: 10.1186/s12913-024-10976-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/10/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND The relationship between work and health is complex and bidirectional, where work can have both health-harming and health-enhancing effects. Though employment is recognized as a social determinant of health, and clinical healthcare delivery systems are increasingly using screening tools to ask patients about social needs, little research has explored the extent to which employment-related social risk is captured in these screening tools. This study aimed to identify and characterize employment- and work-related questions in social risk screening tools that have been implemented in clinical healthcare delivery systems. METHODS We conducted a qualitative content analysis of employment-related items in screening tools that have been implemented in clinical healthcare service delivery systems. Three content areas guided data extraction and analysis: Setting, Domain, and Level of Contextualization. RESULTS Screening tools that asked employment-related questions were implemented in settings that were diverse in the populations served and the scope of care provided. The intent of employment-related items focused on four domains: Social Risk Factor, Social Need, Employment Exposure, and Legal Need. Most questions were found to have a low Level of Contextualization and were largely focused on identifying an individual's employment status. CONCLUSIONS Several existing screening tools include measures of employment-related social risk, but these items do not have a clear purpose and range widely depending on the setting in which they are implemented. In order to maximize the utility of these tools, clinical healthcare delivery systems should carefully consider what domain(s) they aim to capture and how they anticipate using the screening tools to address social determinants of health.
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Affiliation(s)
- Mina Colon
- OHSU-PSU School of Public Health, Portland, OR, USA.
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5
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Baker S, Gallegos D, Rebuli MA, Taylor AJ, Mahoney R. Food Insecurity Screening in High-Income Countries, Tool Validity, and Implementation: A Scoping Review. Nutrients 2024; 16:1684. [PMID: 38892619 PMCID: PMC11174716 DOI: 10.3390/nu16111684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/17/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
Household food insecurity has significant negative implications across the lifespan. While routine screening is recommended, particularly in healthcare, guidelines are lacking on selection of screening tools and best-practice implementation across different contexts in non-stigmatizing ways. The objective of this scoping review was to synthesize evidence on household food insecurity screening tools, including psychometrics, implementation in a range of settings, and experiences of carrying out screening or being screened. Four electronic databases were searched for studies in English published from 1990 until June 2023. A total of 58 papers were included, 21 of which focused on tool development and validation, and 37 papers described implementation and perceptions of screening. Most papers were from the USA and described screening in healthcare settings. There was a lack of evidence regarding screening in settings utilized by Indigenous people. The two-item Hunger Vital Sign emerged as the most used and most valid tool across settings. While there is minimal discomfort associated with screening, screening rates in practice are still low. Barriers and facilitators of screening were identified at the setting, system, provider, and recipient level and were mapped onto the COM-B model of behavior change. This review identifies practical strategies to optimize screening and disclosure.
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Affiliation(s)
- Sabine Baker
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, South Brisbane, QLD 4101, Australia; (D.G.); (A.J.T.)
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Danielle Gallegos
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, South Brisbane, QLD 4101, Australia; (D.G.); (A.J.T.)
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | | | - Amanda J. Taylor
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, South Brisbane, QLD 4101, Australia; (D.G.); (A.J.T.)
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Ray Mahoney
- Australian e-Health Research Centre, CSIRO Health and Biosecurity, Herston, QLD 4029, Australia;
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Lingam R, Hu N, Cecil E, Forman J, Newham J, Satherley RM, Bori MS, Cousens S, Fox-Rushby J, Wolfe I. Changing contexts of child health: an assessment of unmet physical, psychological and social needs of children with common chronic childhood illness. Arch Dis Child 2024; 109:488-496. [PMID: 38383134 DOI: 10.1136/archdischild-2023-326766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/31/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND We assessed the biopsychosocial needs and key health drivers among children living with a common chronic illness, as baseline for a cluster randomised controlled trial of a child health system strengthening intervention. METHODS Cross-sectional data were analysed from a large population sample of children from South London with asthma, eczema or constipation, as exemplar tracer conditions of a new integrated care service. Descriptive and regression analyses, accounting for sociodemographic factors, investigated social needs, psychosocial outcomes and quality of life associated with poor symptom control. RESULTS Among 7779 children, 4371 children (56%) had at least one uncontrolled physical health condition. Across the three domains of physical health, mental health and social needs, 77.5% of children (n=4304 of 5554) aged 4-15 years had at least one unmet need, while 16.3% of children had three unmet needs. Children from the most socioeconomically disadvantaged quintile had a 20% increased risk of at least one poorly controlled physical condition (risk ratio (RR)=1.20, 95% CI: 1.11 to 1.31, p<0.001) compared with those from the least disadvantaged quintile. There was an 85% increased risk of clinically important mental health needs among children with uncontrolled asthma (RR=1.85, 95% CI: 1.65 to 2.07, p<0.001), 57% for active constipation (RR=1.57, 95% CI: 1.12 to 2.20, p<0.01) and 39% for uncontrolled eczema (RR=1.39, 95% CI: 1.24 to 1.56, p<0.001). Health-related quality of life was associated with poor symptom control. CONCLUSIONS There is a large burden of unmet biopsychosocial needs among children with chronic illness, signalling an urgent need for prevention, early intervention and integrated biopsychosocial care.
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Affiliation(s)
- Raghu Lingam
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Women & Children's Health, King's College London, London, UK
| | - Nan Hu
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Elizabeth Cecil
- Department of Women & Children's Health, King's College London, London, UK
| | - Julia Forman
- Department of Women & Children's Health, King's College London, London, UK
| | - James Newham
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | | | - Marina Soley Bori
- Department of Population Health Sciences, King's College London, London, UK
| | | | - Julia Fox-Rushby
- Department of Population Health Sciences, King's College London, London, UK
| | - Ingrid Wolfe
- Department of Women & Children's Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Cooper ZW, Mowbray O, Johnson L. Social determinants of health and diabetes: using a nationally representative sample to determine which social determinant of health model best predicts diabetes risk. Clin Diabetes Endocrinol 2024; 10:4. [PMID: 38402223 PMCID: PMC10894485 DOI: 10.1186/s40842-023-00162-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/12/2023] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVES Social determinants of health (SDOH) research demonstrates poverty, access to healthcare, discrimination, and environmental factors influence health outcomes. Several models are commonly used to assess SDOH, yet there is limited understanding of how these models differ regarding their ability to predict the influence of social determinants on diabetes risk. This study compares the utility of four SDOH models for predicting diabetes disparities. STUDY DESIGN We utilized The National Longitudinal Study of Adolescent to Adulthood (Add Health) to compare SDOH models and their ability to predict risk of diabetes and obesity. METHODS Previous literature has identified the World Health Organization (WHO), Healthy People, County Health Rankings, and Kaiser Family Foundation as the conventional SDOH models. We used these models to operationalize SDOH using the Add Health dataset. Add Health data were used to perform logistic regressions for HbA1c and linear regressions for body mass index (BMI). RESULTS The Kaiser model accounted for the largest proportion of variance (19%) in BMI. Race/ethnicity was a consistent factor predicting BMI across models. Regarding HbA1c, the Kaiser model also accounted for the largest proportion of variance (17%). Race/ethnicity and wealth was a consistent factor predicting HbA1c across models. CONCLUSION Policy and practice interventions should consider these factors when screening for and addressing the effects of SDOH on diabetes risk. Specific SDOH models can be constructed for diabetes based on which determinants have the largest predictive value.
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Affiliation(s)
- Zach W Cooper
- University of Georgia School of Social Work, 279 Williams Street, Athens, GA, 30602, Georgia.
| | - Orion Mowbray
- University of Georgia School of Social Work, 279 Williams Street, Athens, GA, 30602, Georgia
| | - Leslie Johnson
- Department of Family and Preventative Medicine, School of Medicine, Emory University, Atlanta, Georgia
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De Marchis EH, Fleegler EW, Cohen AJ, Tung EL, Clark CR, Ommerborn MJ, Lindau ST, Pantell M, Hessler D, Gottlieb LM. Screening for Financial Hardship: Comparing Patient Survey Responses Using Two Different Screening Tools. J Gen Intern Med 2024; 39:120-127. [PMID: 37770732 PMCID: PMC10817866 DOI: 10.1007/s11606-023-08437-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Healthcare delivery organizations are increasingly screening patients for social risks using tools that vary in content and length. OBJECTIVES To compare two screening tools both containing questions related to financial hardship. DESIGN Cross-sectional survey. PARTICIPANTS Convenience sample of adult patients (n = 471) in three primary care clinics. MAIN MEASURES Participants randomly assigned to self-complete either: (1) a screening tool developed by the Centers for Medicare & Medicaid Services (CMS) consisting of six questions on financial hardship (housing stability, housing quality, food security, transportation security, utilities security); or (2) social and behavioral risk measures recommended by the National Academy of Medicine (NAM), including one question on financial hardship (financial strain). We compared patient acceptability of screening, positive screening rates for financial hardship, patient interest in assistance, and self-rated health. RESULTS Ninety-one percent of eligible/interested patients completed the relevant survey questions to be included in the study (N = 471/516). Patient acceptability was high for both tools, though more participants reported screening was appropriate when answering the CMS versus NAM questions (87% vs. 79%, p = 0.02). Of respondents completing the CMS tool, 57% (132/232) reported at least one type of financial hardship; on the NAM survey, 52% (125/239) reported financial hardship (p = 0.36). Nearly twice as many respondents indicated interest in assistance related to financial hardship after completing items on the CMS tool than on the NAM question (39% vs. 21%, p < 0.01). CONCLUSIONS Patients reported high acceptability of both social risk assessment tools. While rates of positive screens for financial hardship were similar across the two measures, more patients indicated interest in assistance after answering questions about financial hardship on the CMS tool. This might be because the screening questions on the CMS tool help patients to appreciate the types of assistance related to financial hardship that may be available after screening. Future research should assess the validity and comparative validity of individual measures and measure sets. Tool selection should be based on setting and population served, screening goals, and resources available.
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Affiliation(s)
- Emilia H De Marchis
- Department of Family & Community Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Alicia J Cohen
- VA Providence Healthcare System, Providence, RI, USA
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Elizabeth L Tung
- Department of General Internal Medicine, University of Chicago, Chicago, IL, USA
| | - Cheryl R Clark
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital Harvard Medical School, Boston, MA, USA
| | - Mark J Ommerborn
- Center for Community Health and Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Stacy Tessler Lindau
- Departments of Ob/Gyn and Medicine-Geriatrics, University of Chicago, Chicago, IL, USA
| | - Matt Pantell
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Danielle Hessler
- Department of Family & Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Laura M Gottlieb
- Department of Family & Community Medicine, University of California, San Francisco, San Francisco, CA, USA
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Moheize S, Hsu M, Matiz LA, Peretz P, Medina K, Esteves A, Meyer D, Maletz B, Pineda L, Berger-Jenkins E. The Role of an Early Childhood Community Health Worker in Addressing Psycho-Social Needs in the Perinatal and Early Childhood Period. J Prim Care Community Health 2024; 15:21501319241234478. [PMID: 38444152 PMCID: PMC10916458 DOI: 10.1177/21501319241234478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/21/2024] [Accepted: 01/24/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE Addressing family psychosocial and mental health needs in the perinatal and early childhood period has a significant impact on long-term maternal and child health and is key to achieving health equity. We aimed to (1) describe and evaluate the role of an Early Childhood Community Health Worker (EC-CHW) to address psychosocial needs and improve psychosocial well-being for families in the perinatal period, and (2) examine factors associated with completion of goals. METHODS An EC-CHW program was modeled after an existing hospital CHW program for children with special healthcare needs and chronic disease. An evaluation was conducted using repeated measures to assess improvements in psychosocial outcomes such as family stress and protective factors after participating in the EC-CHW program. Linear regression was also used to assess factors associated with completion of goals. RESULTS Over a 21-month period (January 2019-September 2020), 161 families were referred to the EC-CHW. The most common reasons for referral included social needs and navigating systems for child developmental and behavioral concerns. There were high rates of family engagement in services (87%). After 6 months, families demonstrated statistically significant improvements in protective factors including positive parenting knowledge and social support. Only 1 key predictor variable, maternal depression, showed significant associations with completion of goals in the multivariable analysis. CONCLUSIONS This study demonstrated the need for, and potential impact of an EC-CHW in addressing psychosocial and mental health needs in the perinatal period, and in a primary care setting. Impacts on protective factors are promising.
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Affiliation(s)
- Sahar Moheize
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Mandy Hsu
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Luz Adriana Matiz
- Columbia University Irving Medical Center, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | | | | | - Amanda Esteves
- Columbia University Irving Medical Center, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Dodi Meyer
- Columbia University Irving Medical Center, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Beth Maletz
- NewYork-Presbyterian Hospital, New York, NY, USA
- Columbia University School of Nursing, New York, NY, USA
| | - Lucie Pineda
- Greater Harlem Healthy Start at the Northern Manhattan Perinatal Partnership, New York, NY, USA
| | - Evelyn Berger-Jenkins
- Columbia University Irving Medical Center, New York, NY, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
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Wilkerson K, De Marchis E, Rudd N, Williams JC, Pantell M, Ackerman SL, Amerson EH, Chang AY. Patient Perspectives on Social Risk Screening and Documentation in a Dermatology Clinic. JAMA Dermatol 2023; 159:1346-1358. [PMID: 37878278 PMCID: PMC10600715 DOI: 10.1001/jamadermatol.2023.3887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/20/2023] [Indexed: 10/26/2023]
Abstract
Importance Providing person-centered dermatologic care includes consideration of social risk factors, such as housing instability and unreliable transportation, that may affect clinical management. Patients' perspectives on social risk screening and documentation in dermatology clinics have not yet been evaluated. Objective To understand patients' perspectives on social risk screening and documentation in a dermatology clinic. Design, Setting, and Participants This mixed-methods study used a survey and semistructured interviews and was conducted in a general dermatology clinic at a large urban public hospital. Patients at the clinic were eligible to complete the survey if they were 18 years or older; able to speak and read English, Spanish, or Cantonese; and comfortable using a computer tablet. Survey participants who preferred to use English were eligible for interviews. The survey included social risk screening questions, measures of acceptability, and questions on social risk factors associated with patient acceptability. Semistructured interviews were conducted to explore attitudes and beliefs about social risk screening and documentation. Survey and interview findings were integrated during data analysis through development of themes and joint display. Data were analyzed from December 2021 to April 2023. Main Outcomes and Measures There were 2 outcome measures of acceptability: appropriateness of screening in a dermatology clinic and comfort with documentation of social risk in the electronic health record (EHR). Results A total of 135 participants (including 73 males [54.1%]) answered both measures of acceptability in the survey. Of these participants, 116 (85.9%) reported that social risk screening in their dermatology clinic was very or somewhat appropriate and 85 (63.0%) reported being completely or somewhat comfortable with having their social risks documented in the EHR. Themes that were developed from surveys and interviews were the (1) role of interpersonal factors in willingness to disclose social risks, (2) implications of institutional trust for willingness to disclose and comfort with documentation, and (3) relevance of screening in a dermatology clinic. Conclusions and Relevance Results of this study showed that most participants found social risk screening to be appropriate in a dermatology clinic, although a smaller proportion of participants were comfortable with EHR documentation of their social risks. Optimizing patients' trust in their physicians and the medical system, while addressing privacy and discrimination concerns, may help facilitate disclosure of social risks.
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Affiliation(s)
- Kamina Wilkerson
- University of California, San Francisco School of Medicine, San Francisco
| | - Emilia De Marchis
- Department of Family and Community Medicine, University of California, San Francisco School of Medicine, San Francisco
| | - Nora Rudd
- University of California, San Francisco School of Medicine, San Francisco
| | | | - Matt Pantell
- Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco
| | - Sara L. Ackerman
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco
| | - Erin H. Amerson
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco
- Department of Dermatology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Aileen Y. Chang
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco
- Department of Dermatology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
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11
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Hatef E, Kitchen C, Pandya C, Kharrazi H. Assessing Patient and Community-Level Social Factors; The Synergistic Effect of Social Needs and Social Determinants of Health on Healthcare Utilization at a Multilevel Academic Healthcare System. J Med Syst 2023; 47:95. [PMID: 37656284 DOI: 10.1007/s10916-023-01990-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023]
Abstract
We investigated the role of both individual-level social needs and community-level social determinants of health (SDOH) in explaining emergency department (ED) utilization rates. We also assessed the potential synergies between the two levels of analysis and their combined effect on patterns of ED visits. We extracted electronic health record (EHR) data between July 2016 and June 2020 for 1,308,598 unique Maryland residents who received care at Johns Hopkins Health System, of which 28,937 (2.2%) patients had at least one documented social need. There was a negative correlation between median household income in a neighborhood with having a social need such as financial resource strain, food insecurity, and residential instability (correlation coefficient: -0.05, -0.01, and - 0.06, p = 0, respectively). In a multilevel model with random effects after adjusting for other factors, living in a more disadvantaged neighborhood was found to be significantly associated with ED utilization statewide and within Baltimore City (OR: 1.005, 95% CI: 1.003-1.007 and 1.020, 95% CI: 1.017-1.022, respectively). However, individual-level social needs appeared to enhance the statewide effect of living in a more disadvantaged neighborhood with the OR for the interaction term between social needs and SDOH being larger, and more positive, than SDOH alone (OR: 1.012, 95% CI: 1.011-1.014). No such moderation was found in Baltimore City. To our knowledge, this study is one of the first attempts by a major academic healthcare system to assess the combined impact of patient-level social needs in association with community-level SDOH on healthcare utilization and can serve as a baseline for future studies using EHR data linked to population-level data to assess such synergistic association.
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Affiliation(s)
- Elham Hatef
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 502, Baltimore, MD, 21205, USA.
| | - Christopher Kitchen
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 502, Baltimore, MD, 21205, USA
| | - Chintan Pandya
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 502, Baltimore, MD, 21205, USA
| | - Hadi Kharrazi
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 502, Baltimore, MD, 21205, USA
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Akande M, Paquette ET, Magee P, Perry-Eaddy MA, Fink EL, Slain KN. Screening for Social Determinants of Health in the Pediatric Intensive Care Unit: Recommendations for Clinicians. Crit Care Clin 2023; 39:341-355. [PMID: 36898778 PMCID: PMC10332174 DOI: 10.1016/j.ccc.2022.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Social determinants of health (SDoH) play a significant role in the health and well-being of children in the United States. Disparities in the risk and outcomes of critical illness have been extensively documented but are yet to be fully explored through the lens of SDoH. In this review, we provide justification for routine SDoH screening as a critical first step toward understanding the causes of, and effectively addressing health disparities affecting critically ill children. Second, we summarize important aspects of SDoH screening that need to be considered before implementing this practice in the pediatric critical care setting.
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Affiliation(s)
- Manzilat Akande
- Section of Critical Care, Department of Pediatrics, Oklahoma University Health Sciences Center, OU Children's Physicians Building, 1200 Children's Avenue, Oklahoma City, OK 73104, USA.
| | - Erin T Paquette
- Division of Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East, Chicago Avenue, Box 73, Chicago, IL 60611, USA
| | - Paula Magee
- Division of Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East, Chicago Avenue, Box 73, Chicago, IL 60611, USA
| | - Mallory A Perry-Eaddy
- University of Connecticut School of Nursing, 231 Glenbrook Rd, U-4026, Storrs, CT 06269, USA; Department of Pediatrics, University of Connecticut School of Medicine, 200 Academic Way, Farmington, CT 06032, USA
| | - Ericka L Fink
- Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 2nd floor, Pittsburgh, PA 15206, USA
| | - Katherine N Slain
- Division of Pediatric Critical Care Medicine, University Hospitals Rainbow Babies & Children's Hospital, 11100 Euclid Avenue, RBC 6010 Cleveland, OH 44106, USA; Department of Pediatrics, Case Western Reserve University School of Medicine, 9501 Euclid Avenue, Cleveland, OH 44106, USA
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13
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Cordova-Ramos EG, Jain C, Torrice V, McGean M, Buitron de la Vega P, Burke J, Stickney D, Vinci RJ, Drainoni ML, Parker MG. Implementing Social Risk Screening and Referral to Resources in the NICU. Pediatrics 2023; 151:e2022058975. [PMID: 36919445 PMCID: PMC10797529 DOI: 10.1542/peds.2022-058975] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVE Social risk screening is recommended by the American Academy of Pediatrics, but this practice is underutilized in NICUs. To address this gap in social care, we aimed to increase rates of: (1) systematic social risk screening and (2) connection with community resources, each to ≥50% over a 14-month period. METHODS We conducted a quality improvement initiative from November 2020 to January 2022. We adapted a screening tool and used Plan-Do-Study-Act cycles to integrate screening and referral to resources into clinical workflow. Primary outcome measures included the percentage of (1) families screened and (2) connection with resources. We examined screening by maternal race/ethnicity and primary language. Process measures were (1) time from admission to screening and (2) percentage of referrals provided to families reporting unmet needs and requesting assistance. We used statistical process control to assess change over time and χ2 tests to compare screening by race/ethnicity and language. RESULTS The rates of systematic screening increased from 0% to 49%. Among 103 families screened, 84% had ≥1, and 64% had ≥2 unmet needs, with a total of 221 needs reported. Education, employment, transportation, and food were the most common needs. Screening rates did not vary by race/ethnicity or language. Among families requesting assistance, 98% received referrals. The iterative improvement of a written resource guide and community partnerships led to increased rates of connection with resources from 21% to 52%. CONCLUSION Leveraging existing staff, our social risk screening and referral intervention built the capacity to address the high burden of unmet needs among NICU families.
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Affiliation(s)
- Erika G. Cordova-Ramos
- Boston Medical Center, Department of Pediatrics
- Evans Center for Implementation and Improvement Sciences (CIIS), Department of Medicine, Boston University School of Medicine
| | | | | | | | - Pablo Buitron de la Vega
- Boston University School of Medicine
- Boston Medical Center, Department of General Internal Medicine
| | | | | | | | - Mari-Lynn Drainoni
- Evans Center for Implementation and Improvement Sciences (CIIS), Department of Medicine, Boston University School of Medicine
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine
- Department of Health Law, Policy and Management, Boston University School of Public Health
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14
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Wong-See H, Calik A, Ostojic K, Raman S, Woolfenden S. Clinical Pathways for the Identification and Referral for Social Needs: A Systematic Review. Pediatrics 2023; 151:190636. [PMID: 36751899 DOI: 10.1542/peds.2022-056837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 02/09/2023] Open
Abstract
CONTEXT Recognition of the importance of the social determinants of child health has prompted increased interest in clinical pathways that identify and refer for social needs. OBJECTIVE The aim of this systematic review was to determine the effectiveness of interventions that identify and refer for social needs for families with children aged 0 to 18 years attending outpatient community and ambulatory healthcare services. DATA SOURCES We searched the following databases: Medline, Embase, PsychINFO, CINAHL, Emcare, EBMR. STUDY SELECTION Studies were included if children and their families underwent a process of identification and referral for social needs in outpatient community and ambulatory healthcare services. DATA EXTRACTION Initial searches identified 5490 titles, from which 18 studies (73 707 families and children) were finally retained. RESULTS Intervention pathways were grouped into 3 categories based on whether identification and referral for social needs was conducted with only targeted community resources, a navigator, or with clinician training. The majority of studies reported positive outcomes; with an increase in social needs identification, an increase in referrals following identification, or a reduction in social needs. Child health outcome results were inconsistent. LIMITATIONS The search terms used may have provided bias toward countries in which these terms are in use. The heterogeneity of outcome measures between included studies meant a meta-analysis was not possible. CONCLUSIONS Despite evidence that clinical pathways for children and families help reduce social needs, evidence for improvements in child health is insufficient. Further studies from diverse settings are needed to inform clinical practice to optimize child health outcomes.
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Affiliation(s)
- Harmonie Wong-See
- Community Paediatrics, Sydney Local Health District, Croydon, New South Wales, Australia
| | - Anna Calik
- Liverpool Public Health Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | | | - Shanti Raman
- Community Paediatrics, Sydney Local Health District, Croydon, New South Wales, Australia.,Community Paediatrics, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Susan Woolfenden
- Community Paediatrics, Sydney Local Health District, Croydon, New South Wales, Australia.,Community Paediatrics, Sydney Local Health District, Croydon, New South Wales.,Australia Population Child Health Research Group, Discipline of Paediatrics, University of New South Wales, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, University of Sydney
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15
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Kanak MM, Fleegler EW, Chang L, Curt AM, Burdick KJ, Monuteaux MC, Deane M, Warrington P, Stewart AM. Mobile Social Screening and Referral Intervention in a Pediatric Emergency Department. Acad Pediatr 2023; 23:93-101. [PMID: 36075518 DOI: 10.1016/j.acap.2022.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/15/2022] [Accepted: 08/28/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Many families in pediatric emergency departments (PED) have unmet social needs, which may be detected and addressed with the use of a digital social needs intervention. Our objective was to characterize the feasibility and effectiveness of utilizing personal phones or a PED tablet for screening and referral to social services. METHODS We conducted a prospective single-arm intervention study using a convenience sample of caregivers and adult patients in an urban PED between May 2019 and October 2020. Participants chose either their personal phone or a PED-provided tablet to use an app, "HelpSteps." Participants self-selected need(s) then referrals to service agencies. Participants completed a 1-month follow-up. Clinicians were surveyed about screening and impact on visit. RESULTS Of 266 participants enrolled, 55% of participants elected to use their personal phone. Of all participants, 67% self-selected at least 1 health-related social need; 34% selected 3 or more. The top 3 "most important" needs were housing (14%), education (12%), and fitness (12%). At one month follow-up, 44% of participants reported their top need was "completely" or "somewhat" solved. For 95% of encounters, clinicians reported the intervention did not increase length of stay. CONCLUSIONS A mobile social needs intervention was feasible and effective at identifying and referring participants in the PED setting. While more than half of participants used their personal phones, several smartphone owners cited barriers and elected to use a tablet. Overall, participants found the app easy to use, appropriate for the PED, and the intervention had minimal impact on clinical flow.
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Affiliation(s)
- Mia M Kanak
- Children's Hospital Los Angeles (MM Kanak), Division of Emergency Medicine and Transport Medicine, Los Angeles, Calif.
| | - Eric W Fleegler
- Boston Children's Hospital (EW Fleegler, L Chang, MC Monuteaux, M Deane, and AM Stewart), Division of Emergency Medicine, Boston, Mass; Harvard Medical School (EW Fleegler, L Chang, AM Curt, MC Monuteaux, and A M Stewart), Boston, Mass
| | - Lawrence Chang
- Boston Children's Hospital (EW Fleegler, L Chang, MC Monuteaux, M Deane, and AM Stewart), Division of Emergency Medicine, Boston, Mass; Harvard Medical School (EW Fleegler, L Chang, AM Curt, MC Monuteaux, and A M Stewart), Boston, Mass
| | - Alexa M Curt
- Harvard Medical School (EW Fleegler, L Chang, AM Curt, MC Monuteaux, and A M Stewart), Boston, Mass
| | - Kendall J Burdick
- University of Massachusetts Medical School (KJ Burdick), Worcester, Mass
| | - Michael C Monuteaux
- Boston Children's Hospital (EW Fleegler, L Chang, MC Monuteaux, M Deane, and AM Stewart), Division of Emergency Medicine, Boston, Mass; Harvard Medical School (EW Fleegler, L Chang, AM Curt, MC Monuteaux, and A M Stewart), Boston, Mass
| | - Melissa Deane
- Boston Children's Hospital (EW Fleegler, L Chang, MC Monuteaux, M Deane, and AM Stewart), Division of Emergency Medicine, Boston, Mass
| | | | - Amanda M Stewart
- Boston Children's Hospital (EW Fleegler, L Chang, MC Monuteaux, M Deane, and AM Stewart), Division of Emergency Medicine, Boston, Mass; Harvard Medical School (EW Fleegler, L Chang, AM Curt, MC Monuteaux, and A M Stewart), Boston, Mass
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16
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Arbour M, Fico P, Floyd B, Morton S, Hampton P, Murphy Sims J, Atwood S, Sege R. Sustaining and scaling a clinic-based approach to address health-related social needs. FRONTIERS IN HEALTH SERVICES 2023; 3:1040992. [PMID: 36926501 PMCID: PMC10012656 DOI: 10.3389/frhs.2023.1040992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/25/2023] [Indexed: 02/19/2023]
Abstract
Objective Scaling evidence-based interventions (EBIs) from pilot phase remains a pressing challenge in efforts to address health-related social needs (HRSN) and improve population health. This study describes an innovative approach to sustaining and further spreading DULCE (Developmental Understanding and Legal Collaboration for Everyone), a universal EBI that supports pediatric clinics to implement the American Academy of Pediatrics' Bright Futures™ guidelines for infants' well-child visits (WCVs) and introduces a new quality measure of families' HRSN resource use. Methods Between August 2018 and December 2019, seven teams in four communities in three states implemented DULCE: four teams that had been implementing DULCE since 2016 and three new teams. Teams received monthly data reports and individualized continuous quality improvement (CQI) coaching for six months, followed by lighter-touch support via quarterly group calls (peer-to-peer learning and coaching). Run charts were used to study outcome (percent of infants that received all WCVs on time) and process measures (percent of families screened for HRSN and connected to resources). Results Integrating three new sites was associated with an initial regression of outcome: 41% of infants received all WCVs on time, followed by improvement to 48%. Process performance was sustained or improved: among 989 participating families, 84% (831) received 1-month WCVs on time; 96% (946) were screened for seven HRSN, 54% (508) had HRSN, and 87% (444) used HRSN resources. Conclusion An innovative, lighter-touch CQI approach to a second phase of scale-up resulted in sustainment or improvements in most processes and outcomes. Outcomes-oriented CQI measures (family receipt of resources) are an important addition to more traditional process-oriented indicators.
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Affiliation(s)
- MaryCatherine Arbour
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Placidina Fico
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Baraka Floyd
- Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | | | - Patsy Hampton
- Center for the Study of Social Policy, Washington, D.C., United States
| | - Jennifer Murphy Sims
- Early Intervention Services, UCSF Benioff Children's Hospital, Oakland, CA, United States
| | - Sidney Atwood
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Robert Sege
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States
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17
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Germán M, Alonzo JK, Williams IM, Bushar J, Levine SM, Cuno KC, Umylny P, Briggs RD. Early Childhood Referrals by HealthySteps and Community Health Workers. Clin Pediatr (Phila) 2022; 62:321-328. [PMID: 36113109 DOI: 10.1177/00099228221120706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study explored how a community health worker (CHW) within a primary care team with a HealthySteps (HS) Specialist impacted referrals to social determinant of health resources for families with children aged birth to 5 years. Medical charts with documentation of HS comprehensive services between January and June 2018 were reviewed at 3 primary care clinics: 2 with an HS Specialist (HSS Only) and 1 with an HS Specialist and CHW (HSS + CHW). Eighty-six referrals were identified, 78 of which had documented outcomes. Outcomes were categorized as successful, unsuccessful, and not documented. The HSS + CHW group had a higher rate of successful referrals (96%) than the HSS Only group (74%). Statistical analysis (χ2 = 8.37, P = .004) revealed a significant association between the referral outcome and having a CHW on a primary care team with an HS Specialist. Therefore, primary care practices should consider adapting their HS model to include CHWs.
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Affiliation(s)
- Miguelina Germán
- Pediatric Behavioral Health Services, Montefiore Medical Group, Albert Einstein College of Medicine, Montefiore Medical Center, Yonkers, NY, USA
| | - Jayxa K Alonzo
- Pediatric Behavioral Health Services, Montefiore Medical Group, Albert Einstein College of Medicine, Montefiore Medical Center, Yonkers, NY, USA
| | - I Mihiri Williams
- Pediatric Behavioral Health Services, Montefiore Medical Group, Albert Einstein College of Medicine, Montefiore Medical Center, Yonkers, NY, USA
| | | | - Sydney M Levine
- Pediatric Behavioral Health Services, Montefiore Medical Group, Albert Einstein College of Medicine, Montefiore Medical Center, Yonkers, NY, USA
| | - Kate C Cuno
- Maimonides Children's Hospital, Brooklyn, NY, USA
| | - Polina Umylny
- Pediatric Behavioral Health Services, Montefiore Medical Group, Albert Einstein College of Medicine, Montefiore Medical Center, Yonkers, NY, USA
| | - Rahil D Briggs
- Pediatric Behavioral Health Services, Montefiore Medical Group, Albert Einstein College of Medicine, Montefiore Medical Center, Yonkers, NY, USA.,ZERO TO THREE, Washington, DC, USA
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18
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Liberman DB, Pham PK, Semple-Hess JE. Social Emergency Medicine: Capitalizing on the Pediatric Emergency Department Visit to Screen and Connect Patients and Families to Community Resources. Acad Pediatr 2022; 22:1049-1056. [PMID: 34995821 DOI: 10.1016/j.acap.2021.12.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/20/2021] [Accepted: 12/26/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To describe the social needs of families screened by the Community Health Advocates Team (CHAT) Desk, situated within a pediatric emergency department (PED); and to evaluate the effectiveness of this help desk in connecting families to community resources. METHODS Trained undergraduates, onsite in the PED 30 hours/week during daytime and evening hours, weekdays and weekends, screened a convenience sample of families of patients in the PED for social needs, and provided information on available community resources. Families were offered a follow-up phone call several weeks after their PED visit to assess program satisfaction and success, and identify remaining social needs. RESULTS Between January 2019 and March 2020, CHAT Desk screened and assisted 682 families. CHAT routinely provided resources about free outdoor recreational activities for families, but after that, the most commonly provided informational resources pertained to: health care (n = 200), housing (n = 143), and food (n = 137). Of families who completed the follow-up phone call (n = 294), almost half (n = 134, 46%) reported being able to contact at least one of the resources; 100 reported that the resource was able to assist them, and 99 families planned to continue using the resource. When asked about satisfaction, 93% (n = 274) reported being very satisfied or somewhat satisfied with CHAT; 94% (n = 276) said they would recommend it to others. CONCLUSIONS The PED of a busy tertiary care children's hospital is an opportune location to screen families for social needs, and provide them with information on requested community resources.
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Affiliation(s)
- Danica B Liberman
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles (DB Liberman, PK Pham, and JE Semple-Hess), Los Angeles, Calif; Department of Pediatrics, Keck School of Medicine, University of Southern California (DB Liberman and JE Semple-Hess), Los Angeles, Calif; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (DB Liberman), Los Angeles, Calif.
| | - Phung K Pham
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles (DB Liberman, PK Pham, and JE Semple-Hess), Los Angeles, Calif; Division of Behavioral and Organizational Sciences, Claremont Graduate University of the Claremont Colleges (PK Pham), Claremont, Calif
| | - Janet E Semple-Hess
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles (DB Liberman, PK Pham, and JE Semple-Hess), Los Angeles, Calif; Department of Pediatrics, Keck School of Medicine, University of Southern California (DB Liberman and JE Semple-Hess), Los Angeles, Calif
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19
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Anderst A, Hunter K, Andersen M, Walker N, Coombes J, Raman S, Moore M, Ryan L, Jersky M, Mackenzie A, Stephensen J, Williams C, Timbery L, Doyle K, Lingam R, Zwi K, Sheppard-Law S, Erskine C, Clapham K, Woolfenden S. Screening and social prescribing in healthcare and social services to address housing issues among children and families: a systematic review. BMJ Open 2022; 12:e054338. [PMID: 35487725 PMCID: PMC9058796 DOI: 10.1136/bmjopen-2021-054338] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Housing is a social determinant of health that impacts the health and well-being of children and families. Screening and referral to address social determinants of health in clinical and social service settings has been proposed to support families with housing problems. This study aims to identify housing screening questions asked of families in healthcare and social services, determine validated screening tools and extract information about recommendations for action after screening for housing issues. METHODS The electronic databases MEDLINE, PsycINFO, EMBASE, Ovid Emcare, Scopus and CINAHL were searched from 2009 to 2021. Inclusion criteria were peer-reviewed literature that included questions about housing being asked of children or young people aged 0-18 years and their families accessing any healthcare or social service. We extracted data on the housing questions asked, source of housing questions, validity and descriptions of actions to address housing issues. RESULTS Forty-nine peer-reviewed papers met the inclusion criteria. The housing questions in social screening tools vary widely. There are no standard housing-related questions that clinical and social service providers ask families. Fourteen screening tools were validated. An action was embedded as part of social screening activities in 27 of 42 studies. Actions for identified housing problems included provision of a community-based or clinic-based resource guide, and social prescribing included referral to a social worker, care coordinator or care navigation service, community health worker, social service agency, referral to a housing and child welfare demonstration project or provided intensive case management and wraparound services. CONCLUSION This review provides a catalogue of housing questions that can be asked of families in the clinical and/or social service setting, and potential subsequent actions.
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Affiliation(s)
- Ania Anderst
- Aboriginal and Torres Strait Islander Health Program, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Kate Hunter
- Aboriginal and Torres Strait Islander Health Program, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Melanie Andersen
- Aboriginal and Torres Strait Islander Health Program, The George Institute for Global Health, Newtown, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Natasha Walker
- Aboriginal and Torres Strait Islander Health Program, The George Institute for Global Health, Newtown, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Julieann Coombes
- Aboriginal and Torres Strait Islander Health Program, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Shanti Raman
- Community Paediatrics, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Melinda Moore
- Sydney Children's Hospitals Network (Randwick Campus), Sydney, New South Wales, Australia
| | - Lola Ryan
- Child, Youth and Family Services, Population and Community Health, South Eastern Sydney Local Health District, Kogarah, New South Wales, Australia
| | - Michelle Jersky
- Sydney Children's Hospitals Network (Randwick Campus), Sydney, New South Wales, Australia
| | - Amy Mackenzie
- Sydney Children's Hospitals Network (Randwick Campus), Sydney, New South Wales, Australia
| | - Jennifer Stephensen
- Sydney Children's Hospitals Network (Randwick Campus), Sydney, New South Wales, Australia
| | - Carina Williams
- Youth Health Services, Community Health, NSW Health, Sydney, New South Wales, Australia
| | - Lee Timbery
- Sydney Children's Hospitals Network (Randwick Campus), Sydney, New South Wales, Australia
| | - Kerrie Doyle
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Raghu Lingam
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Karen Zwi
- Sydney Children's Hospitals Network (Randwick Campus), Sydney, New South Wales, Australia
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Suzanne Sheppard-Law
- Faculty of Health, School of Nursing and Midwifery, University of Technology Sydney, Broadway, New South Wales, Australia
| | | | - Kathleen Clapham
- Ngarruwan Ngadju First Peoples Health and Wellbeing Research Centre, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Susan Woolfenden
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Community Paediatrics Research Group, Institute for Women, Children and Families, Sydney Local Health District, Sydney, New South Wales, Australia
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20
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Rucker AC, Watson A, Badolato G, Boyle M, Hendrix C, Jarvis L, Patel SJ, Goyal MK. Predictors of Elevated Social Risk in Pediatric Emergency Department Patients and Families. Pediatr Emerg Care 2022; 38:e910-e917. [PMID: 34225329 DOI: 10.1097/pec.0000000000002489] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to identify predictors of high unmet social needs among pediatric emergency department (ED) patients. We hypothesized that obesity, frequent nonurgent visits, reported food insecurity, or an at-risk chief complaint (CC) would predict elevated social risk. METHODS We administered a tablet-based survey assessing unmet social needs in 13 domains to caregivers of patients aged 0 to 17 years presenting to an urban pediatric ED. Responses were used to tabulate a social risk score (SRS). We performed multivariable logistic regression to measure associations between a high SRS (≥3) and obesity, frequent nonurgent visits, food insecurity, or an at-risk CC (physical abuse, sexual abuse, assault, mammalian bites, reproductive/sexual health complaints, intoxication, ingestion/poisoning, psychiatric/behavioral complaints, or any complaint triaged as "least urgent"). RESULTS Five hundred seventy caregivers completed the survey. Eighty-one percent reported at least one unmet social need, and 33% identified ≥3 social needs. Caregivers of patients with an at-risk CC had twice the odds of a high SRS (adjusted odds ratio [aOR], 1.8; 95% confidence interval [CI], 1.0-3.3). Caregivers of patients reporting food insecurity had 4 times the odds of a high SRS (aOR, 4.3; 95% CI, 2.5-7.3). Neither obesity (aOR, 1.5; 95% CI, 0.9-2.6) nor frequent nonurgent visits (aOR, 0.9; 95% CI, 0.4-1.9) were predictive of a high SRS. CONCLUSIONS Unmet social needs are prevalent among caregivers of pediatric ED patients, supporting universal screening in this population. Patients with an at-risk CC or reported food insecurity might benefit from proactive intervention. Future studies should examine optimal methods for ED-based interventions that address social determinants of health.
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Affiliation(s)
| | - Ar'Reon Watson
- Department of Psychiatry, Center for Child and Human Development, Georgetown University, Washington, DC
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21
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Donnelly KA, Rucker A, Boyle MD, Fornari MJ, Badolato GM, Goyal MK. Experiencing Bullying Is Associated With Firearm Access, Weapon Carriage, Depression, Marijuana Use, and Justice Involvement in Adolescents. Pediatr Emerg Care 2022; 38:e918-e923. [PMID: 34116552 DOI: 10.1097/pec.0000000000002473] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of this study were to assess whether bullying experience among youths is associated with firearm access and to evaluate assault perpetration risk factors between bullied and nonbullied adolescents. METHODS This was a secondary analysis of a cross-sectional survey designed to measure self-reported social determinants of health and behavioral health risks among adolescents (13-21 years) in a pediatric emergency department between July 2017 and August 2019. Participants were included in this subanalysis if they responded to a survey item that assessed bullying. Multivariable logistic regression was used to measure the association of firearm access, weapon carriage, and assault perpetration factors (violence, mental health, substance abuse, and justice involvement) with bullying after adjustment for sex, race/ethnicity, and insurance status. RESULTS Of the 369 participants meeting inclusion criteria, 147 adolescents (40.5%) reported experiencing bullying. Bullied teenagers had higher odds of a gun in the home (adjusted odds ratio [aOR], 3.0; 95% confidence interval [CI], 1.2-7.8]), weapon carriage (aOR, 5.6; 95% CI, 1.6-18.8), witnessing an assault (aOR, 3.0; 95% CI, 1.6-5.6), negative experience with law enforcement (aOR, 4.5; 95% CI, 2.2-9.2), mental health diagnosis (aOR, 3.9; 95% CI, 2.3-6.7), and marijuana use (aOR, 2.7; 95% CI, 1.1-7.0]). CONCLUSIONS More than 1 in 3 adolescents presenting to the emergency department report having ever experienced bullying. Bullied teenagers have a higher likelihood of firearm access, weapon carriage, and violent injury perpetration risk factors compared with nonbullied youths. Further studies are needed to understand the relationship between bullying and assault perpetration.
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Affiliation(s)
- Katie A Donnelly
- From the Department of Emergency Medicine, Children's National Hospital, Washington, DC
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McDougall JA, Jaffe SA, Guest DD, Sussman AL. The Balance Between Food and Medical Care: Experiences of Food Insecurity Among Cancer Survivors and Informal Caregivers. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022; 17:380-396. [PMID: 35757157 PMCID: PMC9216194 DOI: 10.1080/19320248.2021.1892295] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Defined as an inability to acquire enough food because of insufficient money or other resources, the prevalence of food insecurity is markedly higher among cancer survivors than the general population. The objective of this qualitative study was to understand and characterize the experience of food insecurity from the perspective of cancer survivors' and their informal caregivers using qualitative interviews. Barriers to healthy eating, behaviors and strategies in times of food shortage, and unmet educational needs shaped the experience of food insecurity. These experiences and insights for addressing food insecurity in oncology practice have broad implications for future interventions.
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Affiliation(s)
- Jean A. McDougall
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM,Department of Internal Medicine, University of New Mexico, Albuquerque, NM
| | | | - Dolores D. Guest
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM,Department of Internal Medicine, University of New Mexico, Albuquerque, NM
| | - Andrew L. Sussman
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM,Department of Community and Family Medicine, University of New Mexico, Albuquerque, NM
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23
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Bernhardt C, King C. Telehealth and food insecurity screenings: challenges and lessons learned. Mhealth 2022; 8:10. [PMID: 35178441 PMCID: PMC8800207 DOI: 10.21037/mhealth-21-31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/02/2021] [Indexed: 11/06/2022] Open
Abstract
Food insecurity remains a persistent problem in the United States and affected 35.2 million Americans in 2019. In the wake of COVID-19, food insecurity has increased in many communities. Given that food insecurity exacerbates poor health or health conditions, screening of food insecurity within medical settings is frequently identified within the literature as an important first step in effectively addressing this social concern and improving the health outcomes of patients. However, health care providers often do not screen for food insecurity for a variety of reasons. In this article review, we discuss the challenges associated with incorporating food insecurity screenings within the medical model and how the COVID-19 pandemic has exacerbated these challenges. Specifically, the COVID-19 pandemic has substantially increased the delivery of health care services via telehealth, making screening for food insecurity even more difficult via remote videoconferencing. We examine the strengths and weaknesses of telehealth and their implications for food insecurity screenings. We discuss how these implications might inform future research regarding the use of telehealth as a means of screening patients for social determinants of health in the COVID-19 era. Given that the use of telehealth is not expected to back to pre-pandemic levels, it is important to understand how to best screen for social determinants of health via videoconferencing.
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Affiliation(s)
| | - Christian King
- School of Global Health Management and Informatics, University of Central Florida, Orlando, FL, USA
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24
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Matson PA, Bakhai N, Solomon BS, Flessa S, Ramos J, Hammond CJ, Adger H. Understanding caregiver acceptance of screening for family substance use in pediatric clinics serving economically disadvantaged children. Subst Abus 2022; 43:282-288. [PMID: 34214411 PMCID: PMC9901192 DOI: 10.1080/08897077.2021.1941510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Children of parents with substance use disorders are at greater risk for mental and physical health co-morbidities. Despite guidelines, pediatricians rarely screen for substance use in the family/household, citing fear of offending parents. The objectives of this study were to examine (1) caregiver acceptance of pediatricians screening for family/household substance use during well-child visits, (2) prevalence of family/household substance use, and (3) the association between family/household substance use and trust in their child's pediatrician. Methods: This cross-sectional study surveyed adult caregivers presenting a child for medical care at two urban pediatric outpatient clinics using a brief anonymous computer-based survey. The primary outcome measured the acceptability of pediatrician screening for family/household substance use. Substance use and concerns about use in the family/household were also assessed. Results: Adult caregivers (n = 271) surveyed were mean age 35 years, 73% mothers, 90% African American, and 85% on Medicaid. Over half (51%) of caregivers reported substance use by someone in the family/household, most commonly cigarettes (38%), followed by alcohol (19%) and marijuana (10%). Sixty-one percent of caregivers who reported family substance use expressed concern about the use of this substance. The majority (87%) agreed it is appropriate for pediatricians to ask caregivers about family/household substance use. No differences were found between caregivers who did and did not report substance use in their family/household. Caregivers with concerning substance use in their family/household were less likely to trust their pediatrician [OR = 0.21, 95%CI: 0.05, 0.85] Conclusions: Caregivers endorsed acceptance of universal screening for substance use, including illicit substances, and substance use disorders in the family/household during well-child visits. Pediatricians are trusted professionals with expertise in communicating with parents to maximize the health of their patients; assessing family history of substance use and substance use disorders is a natural extension of their role.
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Affiliation(s)
| | | | | | - Sarah Flessa
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Hoover Adger
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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25
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Eder M, Henninger M, Durbin S, Iacocca MO, Martin A, Gottlieb LM, Lin JS. Screening and Interventions for Social Risk Factors: Technical Brief to Support the US Preventive Services Task Force. JAMA 2021; 326:1416-1428. [PMID: 34468710 DOI: 10.1001/jama.2021.12825] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Evidence-based guidance is limited on how clinicians should screen for social risk factors and which interventions related to these risk factors improve health outcomes. OBJECTIVE To describe research on screening and interventions for social risk factors to inform US Preventive Services Task Force considerations of the implications for its portfolio of recommendations. DATA SOURCES Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Sociological Abstracts, and Social Services Abstracts (through 2018); Social Interventions Research and Evaluation Network evidence library (January 2019 through May 2021); surveillance through May 21, 2021; interviews with 17 key informants. STUDY SELECTION Individual-level and health care system-level interventions with a link to the health care system that addressed at least 1 of 7 social risk domains: housing instability, food insecurity, transportation difficulties, utility needs, interpersonal safety, education, and financial strain. DATA EXTRACTION AND SYNTHESIS One investigator abstracted data from studies and a second investigator evaluated data abstractions for completeness and accuracy; key informant interviews were recorded, transcribed, summarized, and integrated with evidence from the literature; narrative synthesis with supporting tables and figures. MAIN OUTCOMES AND MEASURES Validity of multidomain social risk screening tools; all outcomes reported for social risk-related interventions; challenges or unintended consequences of screening and interventions. RESULTS Many multidomain social risk screening tools have been developed, but they vary widely in their assessment of social risk and few have been validated. This technical brief identified 106 social risk intervention studies (N = 5 978 596). Of the interventions studied, 73 (69%; n = 127 598) addressed multiple social risk domains. The most frequently addressed domains were food insecurity (67/106 studies [63%], n = 141 797), financial strain (52/106 studies [49%], n = 111 962), and housing instability (63/106 studies [59%], n = 5 881 222). Food insecurity, housing instability, and transportation difficulties were identified by key informants as the most important social risk factors to identify in health care. Thirty-eight studies (36%, n = 5 850 669) used an observational design with no comparator, and 19 studies (18%, n = 15 205) were randomized clinical trials. Health care utilization measures were the most commonly reported outcomes in the 68 studies with a comparator (38 studies [56%], n = 111 102). The literature and key informants described many perceived or potential challenges to implementation of social risk screening and interventions in health care. CONCLUSIONS AND RELEVANCE Many interventions to address food insecurity, financial strain, and housing instability have been studied, but more randomized clinical trials that report health outcomes from social risk screening and intervention are needed to guide widespread implementation in health care.
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Affiliation(s)
- Michelle Eder
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Michelle Henninger
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Shauna Durbin
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento
| | - Megan O Iacocca
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Allea Martin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Laura M Gottlieb
- Department of Family and Community Medicine, University of California, San Francisco
| | - Jennifer S Lin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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26
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Sokol RL, Mehdipanah R, Bess K, Mohammed L, Miller AL. When Families Do Not Request Help: Assessing a Social Determinants of Health Screening Tool in Practice. J Pediatr Health Care 2021; 35:471-478. [PMID: 34116869 DOI: 10.1016/j.pedhc.2021.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Using pediatric social determinants of health screening data from a large medical system, we explored social needs dislosures and identified which needs were associated with resource connection requests. METHOD Data came from records of outpatient pediatric patients (0-18 years) seen between October 2018 and March 2020 (39,251 encounters). We assessed percent of encounters where families (1) indicated a social need, and (2) requested a resource connection. We conducted multivariable logistic regression to identify which needs were associated with resource connection requests. RESULTS Among all encounters, 8% indicated a need and 2% requested a resource connection. Among families indicating a need, needs associated with resource requests included: housing (odds ratio [OR], 3.49 [2.42-5.03]), employment (OR, 3.15 [2.21-4.50]), food (OR, 1.89 [1.41-2.52]), and transportation (OR, 1.82 [1.30-2.56]). DISCUSSION Families seldom requested resource connections to address social needs. Better understanding families' interests in receiving assistance is an important next step in pediatric social determinants of health screening system development.
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27
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Fritz CQ, Thomas J, Gambino J, Torok M, Brittan MS. Prevalence of Social Risks on Inpatient Screening and Their Impact on Pediatric Care Use. Hosp Pediatr 2021; 10:859-866. [PMID: 32967923 DOI: 10.1542/hpeds.2020-0094] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Screening for social determinants of health in the inpatient setting is uncommon. However, social risk factors documented in billing and electronic medical record data are associated with increased pediatric care use. We sought to describe (1) the epidemiology of social risks and referral acceptance and (2) association between social risks identified through routine inpatient screening and care use. METHODS Parents of children ages 0 to 18 admitted to a general pediatric floor at an academic children's hospital completed a psychosocial screening survey from October 2017 to June 2019. The survey covered the following domains: finances, housing, food security, medications, and benefits. Patient characteristics and care use outcomes were abstracted from the electronic medical record and compared by using Pearson's χ2 or the Wilcoxon rank test and logistic regression analyses. RESULTS Of 374 screened families, 141 (38%) had a positive screen result, of whom 78 (55%) reported >1 need and 64 (45%) accepted a community resource. In bivariate analyses, patients with a positive screen result had higher 30-day readmission (10% vs 5%; P = .05), lower median household income ($62 321 vs $71 460; P < .01), lower parental education (P < .01), public insurance (57% vs 43%; P < .01), lived in a 1-parent household (30 vs 12%; P < .01), and had a complex chronic condition (35% vs 23%; P = .01) compared with those with a negative screen result. There was no difference in care reuse by screening status in adjusted analyses. CONCLUSIONS Social risks are common in the pediatric inpatient setting. Children with medical complexity offer a good target for initial screening efforts.
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Affiliation(s)
- Cristin Q Fritz
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee; .,Department of Pediatrics, School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Jacob Thomas
- Adult and Child Consortium for Health Outcomes Research and Delivery Science and
| | | | - Michelle Torok
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - Mark S Brittan
- Adult and Child Consortium for Health Outcomes Research and Delivery Science and.,Children's Hospital Colorado, Aurora, Colorado; and.,Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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28
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Ruiz Escobar E, Pathak S, Blanchard CM. Screening and Referral Care Delivery Services and Unmet Health-Related Social Needs: A Systematic Review. Prev Chronic Dis 2021; 18:E78. [PMID: 34387188 PMCID: PMC8388203 DOI: 10.5888/pcd18.200569] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Introduction Unmet health-related social needs contribute to high patient morbidity and poor population health. A potential solution to improve population health includes the adoption of care delivery models that alleviate unmet needs through screening, referral, and tracking of patients in health care settings, yet the overall impact of such models has remained unexplored. This review addresses an existing gap in the literature regarding the effectiveness of these models and assesses their overall impact on outcomes related to experience of care, population health, and costs. Methods In March 2020, we searched for peer-reviewed articles published in PubMed over the past 10 years. Studies were included if they 1) used a screening tool for identifying unmet health-related social needs in a health care setting, 2) referred patients with positive screens to appropriate resources for addressing identified unmet health-related social needs, and 3) reported any outcomes related to patient experience of care, population health, or cost. Results Of 1,821 articles identified, 35 met the inclusion criteria. All but 1 study demonstrated a tendency toward high risk of bias. Improved outcomes related to experience of care (eg, change in social needs, patient satisfaction, n = 34), population health (eg, diet quality, blood cholesterol levels, n = 7), and cost (eg, program costs, cost-effectiveness, n = 3) were reported. In some studies (n = 5), improved outcomes were found among participants who received direct referrals or additional assistance with indirect referrals compared with those who received indirect referrals only. Conclusion Effective collaborations between health care organizations and community-based organizations are essential to facilitate necessary patient connection to resources for addressing their unmet needs. Although evidence indicated a positive influence of screening and referral programs on outcomes related to experience of care and population health, no definitive conclusions can be made on overall impact because of the potentially high risk of bias in the included studies.
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Affiliation(s)
- Emily Ruiz Escobar
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Shweta Pathak
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina.,UNC Eshelman School of Pharmacy, Center for Medication Optimization, 2400 Kerr Hall, 301 Pharmacy Ln, Chapel Hill, NC 27599-7574.
| | - Carrie M Blanchard
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina
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29
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De Marchis EH, Ettinger de Cuba SA, Chang L, Sheward RS, Doran KM, Gottlieb LM, Cohen AJ, Fleegler EW, Sandel MT. Screening Discordance and Characteristics of Patients With Housing-Related Social Risks. Am J Prev Med 2021; 61:e1-e12. [PMID: 33785274 DOI: 10.1016/j.amepre.2021.01.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/10/2021] [Accepted: 01/26/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Healthcare systems are increasingly interested in identifying patients' housing-related risks, but minimal information exists to inform screening question selection. The primary study aim is to evaluate discordance among 5 housing-related screening questions used in health care. METHODS This was a cross-sectional multisite survey of social risks used in a convenience sample of adults seeking care for themselves or their child at 7 primary care clinics and 4 emergency departments across 9 states (2018-2019). Housing-related risks were measured using 2 questions from the Accountable Health Communities screening tool (current/anticipated housing instability, current housing quality problems) and 3 from the Children's HealthWatch recommended housing instability screening measures (prior 12-month: rent/mortgage strain, number of moves, current/recent homelessness). The 2-sided Fisher's exact tests analyzed housing-related risks and participant characteristics; logistic regression explored associations with reported health (2019-2020). RESULTS Of 835 participants, 52% screened positive for ≥1 housing-related risk (n=430). Comparing the tools, 32.8% (n=274) screened discordant: 11.9% (n=99) screened positive by Children's HealthWatch questions but negative by Accountable Health Communities, and 21.0% (n=175) screened positive by the Accountable Health Communities tool but negative by Children's HealthWatch (p<0.001). Worse health was associated with screening positive for current/anticipated housing instability (AOR=0.56, 95% CI=0.32, 0.96) or current/recent homelessness (AOR=0.57, 95% CI=0.34, 0.96). CONCLUSIONS The 5 housing questions captured different housing-related risks, contributed to different health consequences, and were relevant to different subpopulations. Before implementing housing-related screening initiatives, health systems should understand how specific measures surface distinct housing-related barriers. Measure selection should depend on program goals and intervention resources.
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Affiliation(s)
- Emilia H De Marchis
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | | | - Lawrence Chang
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Richard S Sheward
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Kelly M Doran
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, New York; Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, New York
| | - Laura M Gottlieb
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
| | - Alicia J Cohen
- Providence VA Medical Center, Providence, Rhode Island; Department of Family Medicine, Brown Alpert Medical School, Brown University, Providence, Rhode Island; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Megan T Sandel
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
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30
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Messmer E, Brochier A, Joseph M, Tripodis Y, Garg A. Impact of an On-Site Versus Remote Patient Navigator on Pediatricians' Referrals and Families' Receipt of Resources for Unmet Social Needs. J Prim Care Community Health 2021; 11:2150132720924252. [PMID: 32449443 PMCID: PMC7249580 DOI: 10.1177/2150132720924252] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: Patient navigation is increasingly being used by pediatric health care delivery systems to address patients' unmet social needs. However, it is not known whether navigators working remotely can be as effective at linking families to community resources as on-site navigators. The aim of this study was to assess whether a patient navigator located on-site versus remotely is more likely to receive referrals from clinicians, successfully follow-up with patients, and assist families with enrollment in social needs resources. Methods: A patient navigator worked on-site and remotely as she divided her time between 4 federally qualified health centers (FQHCs) from May 2015 to June 2019. We conducted a 1-sample test of proportion comparing the proportion of on-site referrals made with the proportion of the week spent in each FQHC. To assess the impact of on-site versus remote referrals on number of contacts with a family, we conducted a 2-sample t test. We used chi-square testing to assess the effect of on-site versus remote status on resource enrollment. Results: Of the referrals (N = 414) made to the patient navigator, the majority were made through the electronic health record (83%) versus in person (17%) (P < .0001). When the navigator was on-site, significantly more referrals were made than expected (45% vs 29%, P < .0001). Between remote and on-site referral groups, there was no significant difference in number of contact points (1.0 vs 1.1 points, P = .32) or in the proportion of families who received a resource (4.6% vs 5.1%, P = .31). Conclusion: Our results indicate that clinicians were significantly more likely to refer families to patient navigation if the navigator was on-site. The likelihood of having contact with the navigator and enrolling in a resource, however, did not differ between families referred when the patient navigator was on-site compared with remote.
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Affiliation(s)
- Emily Messmer
- Boston University School of Public Health, Boston, MA, USA
| | | | | | | | - Arvin Garg
- Boston Medical Center, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
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31
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Webb J. Social aspects of chronic transfusions: addressing social determinants of health, health literacy, and quality of life. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2020; 2020:175-183. [PMID: 33275666 PMCID: PMC7727521 DOI: 10.1182/hematology.2020000104] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Chronic monthly transfusions are a lifesaving preventative therapy for many patients with sickle cell disease; however, the burden of this therapy for patients and families is high. In the United States, there is overlap in the population affected by sickle cell disease and those with the greatest burden of social needs. Hematology providers caring for patients with SCD have an opportunity to screen for and mitigate social determinants of health, especially in those receiving chronic transfusion therapy given the frequent interactions with the healthcare system and increased demand on already potentially limited resources. Given the complexity of the treatment and medication regimens, providers caring for patients receiving chronic transfusions should implement universal strategies to minimize the impact of low health literacy, as this therapy imposes a significant demand on the health literacy skills of a family. Despite the social and literacy burden of this intervention, it is reassuring that quality of life is preserved as patients with SCD on chronic transfusion therapy often report higher health related quality of life than their peers receiving other disease modifying therapies.
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Hastert TA, McDougall JA, Strayhorn SM, Nair M, Beebe-Dimmer JL, Schwartz AG. Social needs and health-related quality of life among African American cancer survivors: Results from the Detroit Research on Cancer Survivors study. Cancer 2020; 127:467-475. [PMID: 33225460 DOI: 10.1002/cncr.33286] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Social needs may affect cancer survivors' health-related quality of life (HRQOL) above and beyond sociodemographic and cancer-related factors. The purpose of this study was to estimate associations between social needs and HRQOL. METHODS Results included data from 1754 participants in the Detroit Research on Cancer Survivors cohort, a population-based study of African American survivors of breast, colorectal, lung, and prostate cancer. Social needs included items related to food insecurity, utility shutoffs, housing instability, not getting health care because of cost or a lack of transportation, and perceptions of neighborhood safety. HRQOL was measured with the validated Functional Assessment of Cancer Therapy-General (FACT-G). Linear regression models controlled for demographic, socioeconomic, and cancer-related factors. RESULTS More than one-third of the survivors (36.3%) reported social needs including 17.1% of survivors reported 2 or more. The prevalence of social needs ranged from 14.8% for food insecurity to 8.9% for utility shutoffs. FACT-G score differences associated with social needs were -12.2 (95% confidence interval [CI] to -15.2 to -9.3) for not getting care because of a lack of transportation, -11.3 (95% CI, -14.2 to -8.4) for housing instability, -10.1 (95% CI, -12.7 to -7.4) for food insecurity, -9.8 (95% CI, -12.7 to -6.9) for feeling unsafe in the neighborhood, -8.6 (95% CI, -11.7 to -5.4) for utility shutoffs, and -6.7 (95% CI, -9.2 to -4.1) for not getting care because of cost. CONCLUSIONS Social needs were common in this cohort of African American cancer survivors and were associated with clinically significant differences in HRQOL. Clinical oncology care and survivorship care planning may present opportunities to screen for and address social needs to mitigate their impact on survivors' HRQOL.
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Affiliation(s)
- Theresa A Hastert
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.,Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Jean A McDougall
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Shaila M Strayhorn
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Mrudula Nair
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.,Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Jennifer L Beebe-Dimmer
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.,Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Ann G Schwartz
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.,Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
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Clark RE, Weinreb L, Flahive JM, Seifert RW. Infants Exposed To Homelessness: Health, Health Care Use, And Health Spending From Birth To Age Six. Health Aff (Millwood) 2020; 38:721-728. [PMID: 31059358 DOI: 10.1377/hlthaff.2019.00090] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Homeless infants are known to have poor birth outcomes, but the longitudinal impact of homelessness on health, health care use, and health spending during the early years of life has received little attention. Linking Massachusetts emergency shelter enrollment records for the period 2008-15 with Medicaid claims, we compared 5,762 infants who experienced a homeless episode with a group of 5,553 infants matched on sex, race/ethnicity, location, and birth month. Infants born during a period of unstable housing resulting in homelessness had higher rates of low birthweight, respiratory problems, fever, and other common conditions; longer neonatal intensive care unit stays; more emergency department visits; and higher annual spending. Differences in most health conditions persisted for two to three years. Asthma diagnoses, emergency department visits, and spending were significantly higher through age six. While screening and access to health care can be improved for homeless infants, long-term solutions require a broader focus on housing and income.
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Affiliation(s)
- Robin E Clark
- Robin E. Clark ( ) is a professor of family medicine and community health and of population and quantitative health sciences, University of Massachusetts Medical School in Worcester
| | - Linda Weinreb
- Linda Weinreb is a professor of family medicine and community health, University of Massachusetts Medical School, and vice president and medical director for Medicaid at Fallon Health, in Worcester
| | - Julie M Flahive
- Julie M. Flahive is a biostatistician in the Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School in Worcester
| | - Robert W Seifert
- Robert W. Seifert is executive director of the Center for Health Law and Policy, University of Massachusetts Medical School in Shrewsbury
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Abstract
EXECUTIVE SUMMARY A growing literature regarding the health consequences of social risks, such as substandard housing and food insecurity, combined with increased adoption of risk-based payment models have contributed to a wave of healthcare sector initiatives focused on the social determinants of health. Yet decisions about how and when to address adverse social conditions are frequently guided by limited information about potential interventions and a lack of data on their effectiveness. We describe four complementary strategies that healthcare leaders can pursue to intervene on social adversity, split between patient care and community-level approaches. Patient care strategies rely on data about patients' social risks to adapt medical care or improve patients' social circumstances directly. Community-level strategies focus on improving the broader health and well-being of the local population through a mix of direct investments in communities and collaboration through multisector partnerships. Each approach presents unique incentives and challenges, and healthcare systems wanting to address social adversity may adopt one or more. Understanding the range of potential choices may help healthcare leaders make more informed choices in response to patient needs and changing payment and policy initiatives.
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Atkins M, Castro I, Sharifi M, Perkins M, O'Connor G, Sandel M, Taveras EM, Fiechtner L. Unmet Social Needs and Adherence to Pediatric Weight Management Interventions: Massachusetts, 2017-2019. Am J Public Health 2020; 110:S251-S257. [PMID: 32663093 DOI: 10.2105/ajph.2020.305772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine effects of unmet social needs on adherence to pediatric weight management intervention (PWMI).Methods. We examined individual associations of positive screens for parental stress, parental depression, food insecurity, and housing insecurity with intervention adherence, and associations of 0, 1 or 2, and 3 or 4 unmet social needs with adherence, among children enrolled in a 2017-2019 comparative effectiveness trial for 2 high-intensity PWMIs in Massachusetts. Models were adjusted for child age, body mass index (BMI), parent BMI, and intervention arm.Results. Families with versus without housing insecurity received a mean of 5.3 (SD = 8.0) versus 8.3 (SD = 10.9) contact hours (P < .01). There were no statistically significant differences in adherence for families reporting other unmet social needs. Children with 3 to 4 unmet social needs versus without received a mean of 5.2 (SD = 8.1) versus 9.2 (SD = 11.8) contact hours (P < .01). In fully adjusted models, those with housing insecurity attended a mean difference of -3.14 (95% confidence interval [CI] = -5.41, -0.88) hours versus those without. Those with 3 or 4 unmet social needs attended -3.74 (95% CI = -6.64, -0.84) hours less than those with none.Conclusions. Adherence to PWMIs was lower among children with housing insecurity and in families with 3 or 4 unmet social needs. Addressing social needs should be a priority of PWMIs to improve intervention adherence and reduce disparities in childhood obesity.Trial Registration: ClinicalTrials.gov identifier: NCT03012126.
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Affiliation(s)
- Micaela Atkins
- Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
| | - Ines Castro
- Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
| | - Mona Sharifi
- Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
| | - Meghan Perkins
- Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
| | - Giselle O'Connor
- Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
| | - Megan Sandel
- Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
| | - Elsie M Taveras
- Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
| | - Lauren Fiechtner
- Micaela Atkins, Ines Castro, Meghan Perkins, Giselle O'Connor, and Man Luo are with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Mona Sharifi is with Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Megan Sandel is with Division of General Academic Pediatrics, Boston Medical Center, Boston. Lauren Fiechtner is with Department of Pediatrics, Division of General Academic Pediatrics and Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children. Elsie M. Taveras is with Department of Pediatrics, Division of General Academic Pediatrics, MassGeneral Hospital for Children, and Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
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Gottlieb LM, Adler NE, Wing H, Velazquez D, Keeton V, Romero A, Hernandez M, Munoz Vera A, Urrutia Caceres E, Arevalo C, Herrera P, Bernal Suarez M, Hessler D. Effects of In-Person Assistance vs Personalized Written Resources About Social Services on Household Social Risks and Child and Caregiver Health: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e200701. [PMID: 32154888 PMCID: PMC7064877 DOI: 10.1001/jamanetworkopen.2020.0701] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
IMPORTANCE Social and economic contexts shape children's short- and long-term health. Efforts to address contextual risk factors are increasingly incorporated into pediatric health care. OBJECTIVE To compare the effectiveness of 2 social risk-related interventions. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial included English- and/or Spanish-speaking caregiver-child dyads recruited from a pediatric urgent care clinic nested in a large, urban, safety-net hospital. Study recruitment, enrollment, and follow-up were conducted from July 18, 2016, to March 8, 2019. Data analysis was conducted from January 1, 2019, to January 20, 2020. INTERVENTIONS Following standardized social risk assessment, caregivers were randomly assigned to receive either written information regarding relevant government and community social services resources or comparable written information plus in-person assistance and follow-up focused on service access. MAIN OUTCOMES AND MEASURES Caregiver-reported number of social risk factors and child health 6 months after enrollment. RESULTS Among 611 caregiver-child dyads enrolled in the study, 302 dyads were randomized to the written resources group and 309 dyads were randomized to the written resources plus in-person assistance group. The mean (SD) age of children was 6.1 (5.0) years; 483 children (79.1%) were Hispanic; and 315 children (51.6%) were girls. There were no significant differences between groups in the effects of the interventions. In post hoc secondary analyses, the number of reported social risks decreased from baseline to 6-month follow-up in both groups: caregivers who received written resources alone reported a mean (SE) of 1.28 (0.19) fewer risks at follow-up, while those receiving written resources plus in-person assistance reported 1.74 (0.21) fewer risks at follow-up (both P < .001). In both groups, there were small but statistically significant improvements from baseline to follow-up in child health (mean [SE] change: written resources, 0.37 [0.07]; written resources plus in-person assistance, 0.24 [0.07]; both P < .001). CONCLUSIONS AND RELEVANCE This randomized clinical trial compared 2 approaches to addressing social risks in a pediatric urgent care setting and found no statistically significant differences in the social risk and child and caregiver health effects of providing written resources at the point of care with vs without in-person longitudinal navigation services. Caregivers in both groups reported fewer social risks and improved child and caregiver health 6 months after the intervention. These findings deepen understanding of effective doses of social risk-related interventions. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02746393.
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Affiliation(s)
- Laura M. Gottlieb
- Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco
| | - Nancy E. Adler
- Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco
| | - Holly Wing
- Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco
| | - Denisse Velazquez
- Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco
| | - Victoria Keeton
- School of Nursing, Department of Family Health Care Nursing, University of California, San Francisco
| | - Abigail Romero
- Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco
| | - Maricarmen Hernandez
- Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco
| | - Andrea Munoz Vera
- Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco
- San Francisco State University, San Francisco, California
| | - Elizabeth Urrutia Caceres
- Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco
| | | | - Philip Herrera
- Department of Family and Community Medicine, University of California, San Francisco
- Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | - Mara Bernal Suarez
- Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco
- Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco
| | - Danielle Hessler
- Department of Family and Community Medicine, University of California, San Francisco
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Palakshappa D, Goodpasture M, Albertini L, Brown CL, Montez K, Skelton JA. Written Versus Verbal Food Insecurity Screening in One Primary Care Clinic. Acad Pediatr 2020; 20:203-207. [PMID: 31629943 PMCID: PMC7036321 DOI: 10.1016/j.acap.2019.10.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/10/2019] [Accepted: 10/12/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Clinics are increasingly interested in identifying food insecurity (FI), but there are limited data on how to implement FI screening. Our objective was to determine the difference in FI disclosure rates by parents/guardians screened by a written questionnaire compared to verbally. METHODS The study occurred in 1 pediatric primary care clinic in which we screened for FI using the 2-item Hunger Vital Sign. We used interrupted time series to evaluate the effect of changing from the clinician verbal screening to a written questionnaire. Screening results were extracted for all well-child visits from 4/2017 to 10/2018 for children age 0 to 18 years. The outcome was the proportion who screened positive for FI 9 months before and 9 months after the implementation of the written questionnaire. We estimated the difference in the level and trend of positive screens using ordinary least squares regression using Newey-West standard errors and adjusting for autocorrelation. RESULTS In 7996 well-child visits, 1141 patients (14.3%) screened positive. In bivariate analysis, there was a significant difference in the FI disclosure rates between patients screened by written questionnaire compared to verbally (16.3% vs 10.4%, P < .001). In interrupted time series, changing to the written questionnaire was associated with a significant increase in FI disclosure rates (β = .04, 95% confidence interval: 0.01, 0.07; P = .02). There was no significant change in the trend in disclosure rates. DISCUSSION Multiple barriers exist to effectively implementing FI screening in clinical care. Changing from a verbal to a written questionnaire resulted in an immediate and significant increase in the number of parents/guardians who reported FI.
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Affiliation(s)
- Deepak Palakshappa
- Department of Internal Medicine, Wake Forest School of Medicine (D Palakshappa), Winston-Salem, NC; Department of Pediatrics, Wake Forest School of Medicine (D Palakshappa, M Goodpasture, L Albertini, CL. Brown, K Montez, and JA Skelton), Winston-Salem, NC; Public Health Sciences, Wake Forest School of Medicine (D Palakshappa, CL Brown, and JA Skelton), Winston-Salem, NC.
| | - Meggan Goodpasture
- Department of Pediatrics, Wake Forest School of Medicine (D Palakshappa, M Goodpasture, L Albertini, CL. Brown, K Montez, and JA Skelton), Winston-Salem, NC
| | - Laurie Albertini
- Department of Pediatrics, Wake Forest School of Medicine (D Palakshappa, M Goodpasture, L Albertini, CL. Brown, K Montez, and JA Skelton), Winston-Salem, NC
| | - Callie L Brown
- Department of Pediatrics, Wake Forest School of Medicine (D Palakshappa, M Goodpasture, L Albertini, CL. Brown, K Montez, and JA Skelton), Winston-Salem, NC; Public Health Sciences, Wake Forest School of Medicine (D Palakshappa, CL Brown, and JA Skelton), Winston-Salem, NC
| | - Kimberly Montez
- Department of Pediatrics, Wake Forest School of Medicine (D Palakshappa, M Goodpasture, L Albertini, CL. Brown, K Montez, and JA Skelton), Winston-Salem, NC
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest School of Medicine (D Palakshappa, M Goodpasture, L Albertini, CL. Brown, K Montez, and JA Skelton), Winston-Salem, NC; Public Health Sciences, Wake Forest School of Medicine (D Palakshappa, CL Brown, and JA Skelton), Winston-Salem, NC
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Tung EL, Abramsohn EM, Boyd K, Makelarski JA, Beiser DG, Chou C, Huang ES, Ozik J, Kaligotla C, Lindau ST. Impact of a Low-Intensity Resource Referral Intervention on Patients' Knowledge, Beliefs, and Use of Community Resources: Results from the CommunityRx Trial. J Gen Intern Med 2020; 35:815-823. [PMID: 31749028 PMCID: PMC7080911 DOI: 10.1007/s11606-019-05530-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 10/28/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Connecting patients to community-based resources is now a cornerstone of modern healthcare that supports self-management of health. The mechanisms that link resource information to behavior change, however, remain poorly understood. OBJECTIVE To evaluate the impact of CommunityRx, an automated, low-intensity resource referral intervention, on patients' knowledge, beliefs, and use of community resources. DESIGN Real-world controlled clinical trial at an urban academic medical center in 2015-2016; participants were assigned by alternating week to receive the CommunityRx intervention or usual care. Surveys were administered at baseline, 1 week, 1 month, and 3 months. PARTICIPANTS Publicly insured adults, ages 45-74 years. INTERVENTION CommunityRx generated an automated, personalized list of resources, known as HealtheRx, near each participant's home using condition-specific, evidence-based algorithms. Algorithms used patient demographic and health characteristics documented in the electronic health record to identify relevant resources from a comprehensive, regularly updated database of health-related resources in the study area. MAIN MEASURES Using intent-to-treat analysis, we examined the impact of HealtheRx referrals on (1) knowledge of the most commonly referred resource types, including healthy eating classes, individual counseling, mortgage assistance, smoking cessation, stress management, and weight loss classes or groups, and (2) beliefs about having resources in the community to manage health. KEY RESULTS In a real-world controlled trial of 374 adults, intervention recipients improved knowledge (AOR = 2.15; 95% CI, 1.29-3.58) and beliefs (AOR = 1.68; 95% CI, 1.07-2.64) about common resources in the community to manage health, specifically gaining knowledge about smoking cessation (AOR = 2.76; 95% CI, 1.07-7.12) and weight loss resources (AOR = 2.26; 95% CI 1.05-4.84). Positive changes in both knowledge and beliefs about community resources were associated with higher resource use (P = 0.02). CONCLUSIONS In a middle-age and older population with high morbidity, a low-intensity health IT intervention to deliver resource referrals promoted behavior change by increasing knowledge and positive beliefs about community resources for self-management of health. NIH TRIAL REGISTRY NCT02435511.
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Affiliation(s)
- Elizabeth L Tung
- Section of General Internal Medicine, University of Chicago, Chicago, IL, USA. .,Center for Health and the Social Sciences, University of Chicago, Chicago, IL, USA. .,Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, IL, USA.
| | - Emily M Abramsohn
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Kelly Boyd
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | | | - David G Beiser
- Section of Emergency Medicine, University of Chicago, Chicago, IL, USA.,Center for Healthcare Delivery Science and Innovation, University of Chicago, Chicago, IL, USA
| | - Chiahung Chou
- Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL, USA.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Elbert S Huang
- Section of General Internal Medicine, University of Chicago, Chicago, IL, USA.,Chicago Center for Diabetes Translation Research, University of Chicago, Chicago, IL, USA.,Center for Healthcare Delivery Science and Innovation, University of Chicago, Chicago, IL, USA
| | - Jonathan Ozik
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL, USA.,Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, IL, USA
| | - Chaitanya Kaligotla
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL, USA.,Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, IL, USA
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA.,Center for Healthcare Delivery Science and Innovation, University of Chicago, Chicago, IL, USA.,Department of Medicine-Geriatrics, University of Chicago, Chicago, IL, USA.,Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
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Lakshmanan A, Song AY, Flores-Fenlon N, Parti U, Vanderbilt DL, Friedlich PS, Williams R, Kipke M. Association of WIC Participation and Growth and Developmental Outcomes in High-Risk Infants. Clin Pediatr (Phila) 2020; 59:53-61. [PMID: 31672064 PMCID: PMC8345225 DOI: 10.1177/0009922819884583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The objective of this study was to describe the association of enrollment in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), the Supplemental Nutrition Assistance Program (SNAP), and infant growth and neurodevelopmental outcomes. Z scores and Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) and Vineland Adaptive/Behavior Scale-II (VABS-II) scores represented primary outcomes. We conducted bivariate analyses and linear regression. Children who were enrolled in WIC or WIC/SNAP had weight z scores U (95% confidence interval [CI]) that were 1.32 (0.42-2.21) or 1.19 (0.16-2.23) units higher. Enrollment in WIC or WIC/SNAP was associated with a higher score (95% CI) of 11.7 U (1.2-22.2 U) or 11.5 (0.1-22.9) for Bayley-III cognitive score and 10.1 U (1.9-19.1 U) or 10.3 (0.9-19.7) for the VABS-II composite score. These findings support increased advocacy for participation in WIC or WIC/SNAP for families with high-risk infants.
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Affiliation(s)
- Ashwini Lakshmanan
- Fetal and Neonatal Medicine, Division of Neonatology, Department of Pediatrics, Children’s Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States
| | - Ashley Y. Song
- Fetal and Neonatal Medicine, Division of Neonatology, Department of Pediatrics, Children’s Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Nicole Flores-Fenlon
- USC/LAC+USC Neonatal-Perinatal Medicine Fellowship Program, Division of Neonatology, LAC+USC Medical Center, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Urvashi Parti
- Fetal and Neonatal Medicine, Division of Neonatology, Department of Pediatrics, Children’s Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Douglas L. Vanderbilt
- Fetal and Neonatal Medicine, Division of Neonatology, Department of Pediatrics, Children’s Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States,Division of General Pediatrics, Children’s Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Philippe S. Friedlich
- Fetal and Neonatal Medicine, Division of Neonatology, Department of Pediatrics, Children’s Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Roberta Williams
- Division of Cardiology, Children’s Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Michele Kipke
- Saban Research Institute, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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De Marchis EH, Hessler D, Fichtenberg C, Adler N, Byhoff E, Cohen AJ, Doran KM, Ettinger de Cuba S, Fleegler EW, Lewis CC, Lindau ST, Tung EL, Huebschmann AG, Prather AA, Raven M, Gavin N, Jepson S, Johnson W, Ochoa E, Olson AL, Sandel M, Sheward RS, Gottlieb LM. Part I: A Quantitative Study of Social Risk Screening Acceptability in Patients and Caregivers. Am J Prev Med 2019; 57:S25-S37. [PMID: 31753277 PMCID: PMC7336892 DOI: 10.1016/j.amepre.2019.07.010] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Despite recent growth in healthcare delivery-based social risk screening, little is known about patient perspectives on these activities. This study evaluates patient and caregiver acceptability of social risk screening. METHODS This was a cross-sectional survey of 969 adult patients and adult caregivers of pediatric patients recruited from 6 primary care clinics and 4 emergency departments across 9 states. Survey items included the Center for Medicare and Medicaid Innovation Accountable Health Communities' social risk screening tool and questions about appropriateness of screening and comfort with including social risk data in electronic health records. Logistic regressions evaluated covariate associations with acceptability measures. Data collection occurred from July 2018 to February 2019; data analyses were conducted in February‒March 2019. RESULTS Screening was reported as appropriate by 79% of participants; 65% reported comfort including social risks in electronic health records. In adjusted models, higher perceived screening appropriateness was associated with previous exposure to healthcare-based social risk screening (AOR=1.82, 95% CI=1.16, 2.88), trust in clinicians (AOR=1.55, 95% CI=1.00, 2.40), and recruitment from a primary care setting (AOR=1.70, 95% CI=1.23, 2.38). Lower appropriateness was associated with previous experience of healthcare discrimination (AOR=0.66, 95% CI=0.45, 0.95). Higher comfort with electronic health record documentation was associated with previously receiving assistance with social risks in a healthcare setting (AOR=1.47, 95% CI=1.04, 2.07). CONCLUSIONS A strong majority of adult patients and caregivers of pediatric patients reported that social risk screening was appropriate. Most also felt comfortable including social risk data in electronic health records. Although multiple factors influenced acceptability, the effects were moderate to small. These findings suggest that lack of patient acceptability is unlikely to be a major implementation barrier. SUPPLEMENT INFORMATION This article is part of a supplement entitled Identifying and Intervening on Social Needs in Clinical Settings: Evidence and Evidence Gaps, which is sponsored by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services, Kaiser Permanente, and the Robert Wood Johnson Foundation.
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Affiliation(s)
- Emilia H De Marchis
- Department of Family & Community Medicine, University of California, San Francisco, San Francisco, California.
| | - Danielle Hessler
- Department of Family & Community Medicine, University of California, San Francisco, San Francisco, California
| | - Caroline Fichtenberg
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, San Francisco, California
| | - Nancy Adler
- Center for Health and Community, University of California, San Francisco, San Francisco, California
| | - Elena Byhoff
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Alicia J Cohen
- Providence VA Medical Center, Providence, Rhode Island; Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Kelly M Doran
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York
| | | | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois; Department of Medicine-Geriatrics, University of Chicago, Chicago, Illinois
| | - Elizabeth L Tung
- Section of General Internal Medicine, University of Chicago, Chicago, Illinois
| | - Amy G Huebschmann
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado; Center for Women's Health Research, University of Colorado School of Medicine, Aurora, Colorado
| | - Aric A Prather
- Department of Psychiatry, University of San Francisco, San Francisco, California
| | - Maria Raven
- Department of Emergency Medicine, University of San Francisco, San Francisco, California
| | - Nicholas Gavin
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Susan Jepson
- Upstream Health Innovations, Hennepin County Medical Center, Minneapolis, Minnesota
| | | | - Eduardo Ochoa
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ardis L Olson
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Megan Sandel
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | | | - Laura M Gottlieb
- Department of Family & Community Medicine, University of California, San Francisco, San Francisco, California
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Gottlieb LM, DeSalvo K, Adler NE. Healthcare Sector Activities to Identify and Intervene on Social Risk: An Introduction to the American Journal of Preventive Medicine Supplement. Am J Prev Med 2019; 57:S1-S5. [PMID: 31753275 DOI: 10.1016/j.amepre.2019.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Laura M Gottlieb
- Department of Family & Community Medicine, University of California, San Francisco, San Francisco, California.
| | - Karen DeSalvo
- Department of Internal Medicine, University of Texas at Austin, Austin, Texas; Department of Population Health, University of Texas at Austin, Austin Texas
| | - Nancy E Adler
- Center for Health and Community, University of California, San Francisco, San Francisco, California
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Langerman SD, Badolato GM, Rucker A, Jarvis L, Patel SJ, Goyal MK. Acceptability of Adolescent Social and Behavioral Health Screening in the Emergency Department. J Adolesc Health 2019; 65:543-548. [PMID: 31377163 PMCID: PMC6764595 DOI: 10.1016/j.jadohealth.2019.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/19/2019] [Accepted: 05/17/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE The American Academy of Pediatrics recommends routine screening for social and behavioral health risks (SBHR) in adolescents. Because adolescents who seek care in emergency departments (EDs) may have riskier behaviors than adolescents who access primary care, the ED may be a strategic additional setting for screening. We sought to identify acceptable domains for comprehensive SBHR screening in a pediatric ED. METHODS We conducted a cross-sectional survey to assess adolescent and caregiver acceptance of ED-based SBHR screening across multiple domains. Logistic regression was performed to identify factors associated with screening acceptance. McNemar's test was used to assess agreement within patient/caregiver dyads across domains. RESULTS Among our 516 study participants (347 adolescents and 169 caregivers), those who indicated that they "agree" or "strongly agree" that ED-based screening should be conducted were classified as finding screening acceptable. Acceptability rates ranged from 45.0% (firearm access) to 77.5% (suicidality) among adolescents and 61.5% (firearm access) to 84.0% (substance use) among caregivers. After adjusting for gender, race/ethnicity, and insurance status, adolescents were less accepting than caregivers of screening for: substance use (adjusted odds ratio [aOR]: .51; .31, .83; p < .01); violence (aOR: .63; .41, .97; p = .04); depression (aOR: .65; .42, .99; p = .04); human trafficking (aOR: .58; .39, .86; p < .01); and access to firearms (aOR: .47; .32, .70; p < .01). Shared agreement within adolescent/caregiver dyads ranged from 25.2% to 67.1%. CONCLUSIONS A majority of adolescents and caregivers agree that ED-based SBHR screening should be conducted across most domains. Caregivers generally had higher rates of screening acceptance than adolescents.
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Affiliation(s)
- Steven D Langerman
- Department of Pediatrics, The George Washington University, School of Medicine and Health Sciences, Washington, DC
| | - Gia M Badolato
- Department of Pediatrics, Children's National Health System, Washington, DC
| | - Alexandra Rucker
- Department of Pediatrics, The George Washington University, School of Medicine and Health Sciences, Washington, DC; Department of Pediatrics, Children's National Health System, Washington, DC
| | - Lenore Jarvis
- Department of Pediatrics, The George Washington University, School of Medicine and Health Sciences, Washington, DC; Department of Pediatrics, Children's National Health System, Washington, DC
| | - Shilpa J Patel
- Department of Pediatrics, The George Washington University, School of Medicine and Health Sciences, Washington, DC; Department of Pediatrics, Children's National Health System, Washington, DC
| | - Monika K Goyal
- Department of Pediatrics, The George Washington University, School of Medicine and Health Sciences, Washington, DC; Department of Pediatrics, Children's National Health System, Washington, DC.
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Sokol R, Austin A, Chandler C, Byrum E, Bousquette J, Lancaster C, Doss G, Dotson A, Urbaeva V, Singichetti B, Brevard K, Wright ST, Lanier P, Shanahan M. Screening Children for Social Determinants of Health: A Systematic Review. Pediatrics 2019; 144:peds.2019-1622. [PMID: 31548335 PMCID: PMC6996928 DOI: 10.1542/peds.2019-1622] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2019] [Indexed: 01/06/2023] Open
Abstract
CONTEXT Screening children for social determinants of health (SDOHs) has gained attention in recent years, but there is a deficit in understanding the present state of the science. OBJECTIVE To systematically review SDOH screening tools used with children, examine their psychometric properties, and evaluate how they detect early indicators of risk and inform care. DATA SOURCES Comprehensive electronic search of PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane Central Register of Controlled Trials, and Web of Science Core Collection. STUDY SELECTION Studies in which a tool that screened children for multiple SDOHs (defined according to Healthy People 2020) was developed, tested, and/or employed. DATA EXTRACTION Extraction domains included study characteristics, screening tool characteristics, SDOHs screened, and follow-up procedures. RESULTS The search returned 6274 studies. We retained 17 studies encompassing 11 screeners. Study samples were diverse with respect to biological sex and race and/or ethnicity. Screening was primarily conducted in clinical settings with a parent or caregiver being the primary informant for all screeners. Psychometric properties were assessed for only 3 screeners. The most common SDOH domains screened included the family context and economic stability. Authors of the majority of studies described referrals and/or interventions that followed screening to address identified SDOHs. LIMITATIONS Following the Healthy People 2020 SDOH definition may have excluded articles that other definitions would have captured. CONCLUSIONS The extent to which SDOH screening accurately assessed a child's SDOHs was largely unevaluated. Authors of future research should also evaluate if referrals and interventions after the screening effectively address SDOHs and improve child well-being.
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Affiliation(s)
- Rebeccah Sokol
- School of Public Health, University of Michigan, Ann Arbor, Michigan;
| | - Anna Austin
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Caroline Chandler
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elizabeth Byrum
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jessica Bousquette
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christiana Lancaster
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ginna Doss
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Andrea Dotson
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Venera Urbaeva
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Bhavna Singichetti
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kanisha Brevard
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sarah Towner Wright
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Paul Lanier
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Meghan Shanahan
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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De Marchis EH, Torres JM, Benesch T, Fichtenberg C, Allen IE, Whitaker EM, Gottlieb LM. Interventions Addressing Food Insecurity in Health Care Settings: A Systematic Review. Ann Fam Med 2019; 17:436-447. [PMID: 31501207 PMCID: PMC7032918 DOI: 10.1370/afm.2412] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/07/2019] [Accepted: 04/04/2019] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Based on the recognition that food insecurity (FI) is associated with poor health across the life course, many US health systems are actively exploring ways to help patients access food resources. This review synthesizes findings from studies examining the effects of health care-based interventions designed to reduce FI. METHODS We conducted a systematic review of peer-reviewed literature published from January 2000 through September 2018 that described health care- based FI interventions. Standardized mean differences (SMD) were calculated and pooled when appropriate. Study quality was rated using Grading Recommendations Assessment Development and Evaluation criteria. RESULTS Twenty-three studies met the inclusion criteria and examined a range of FI interventions and outcomes. Based on study design and sample size, 74% were rated low or very low quality. Studies of referral-based interventions reported moderate increases in patient food program referrals (SMD = 0.67, 95% CI, 0.36-0.98; SMD = 1.42, 95% CI, 0.76-2.08) and resource use (pooled SMD = 0.54, 95% CI, 0.31-0.78). Studies describing interventions providing food or vouchers reported mixed results for the actual change in fruit/vegetable intake, averaging to no impact when pooled (-0.03, 95% CI, -0.66 to 0.61). Few studies evaluated health or utilization outcomes; these generally reported small but positive effects. CONCLUSIONS Although a growing base of literature explores health care-based FI interventions, the low number and low quality of studies limit inferences about their effectiveness. More rigorous evaluation of FI interventions that includes health and utilization outcomes is needed to better understand roles for the health care sector in addressing FI.
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Affiliation(s)
- Emilia H De Marchis
- Department of Family & Community Medicine, University of California, San Francisco, California
| | - Jacqueline M Torres
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California
| | - Tara Benesch
- University of California, San Francisco, California.,University of California, Berkeley, California
| | - Caroline Fichtenberg
- Social Interventions Research and Evaluation Network, Center for Health & Community, University of California, San Francisco, California
| | - Isabel Elaine Allen
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California
| | - Evans M Whitaker
- UCSF Medical Library, University of California, San Francisco, California
| | - Laura M Gottlieb
- Social Interventions Research and Evaluation Network, Center for Health & Community, University of California, San Francisco, California
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Freund KM, Haas JS, Lemon SC, Burns White K, Casanova N, Dominici LS, Erban JK, Freedman RA, James TA, Ko NY, LeClair AM, Moy B, Parsons SK, Battaglia TA. Standardized activities for lay patient navigators in breast cancer care: Recommendations from a citywide implementation study. Cancer 2019; 125:4532-4540. [PMID: 31449680 DOI: 10.1002/cncr.32432] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/07/2019] [Accepted: 07/10/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND There is a need for guidelines on patient navigation activities to promote both the quality of patient navigation and the standards of reimbursement for these services because a lack of reimbursement is a major barrier to the implementation, maintenance, and sustainability of these programs. METHODS A broad community-based participatory research process was used to identify the needs of patients for navigation. A panel of stakeholders of clinical providers was convened to identify specific activities for navigators to address the needs of patients and providers with the explicit goal of reducing delays in the initiation of cancer treatment and improving adherence to the care plan. RESULTS Specific activities were identified that could be generalized to all patient navigation programs for care during active cancer management to address the needs of vulnerable communities. CONCLUSIONS Oncology programs that seek to implement lay patient navigation may benefit from the adoption of these activities for quality monitoring. Such activities are necessary as we consider reimbursement strategies for navigators without clinical training or licensure.
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Affiliation(s)
- Karen M Freund
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.,Division of Internal Medicine and Primary Care, Department of Medicine, Tufts Medical Center, Boston, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
| | - Jennifer S Haas
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephenie C Lemon
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Karen Burns White
- Initiative to Eliminate Cancer Disparities, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | - Nicole Casanova
- Section of General Internal Medicine, Center of Excellence in Women's Health, Boston University School of Medicine, Boston, Massachusetts
| | - Laura S Dominici
- Dana-Farber/Brigham and Women's Cancer Center, Brigham and Women's Faulkner Hospital, Boston, Massachusetts
| | - John K Erban
- Cancer Center and Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts
| | - Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ted A James
- Department of Surgery, BreastCare Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Naomi Y Ko
- Section of Hematology and Oncology, Department of Medicine, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
| | - Amy M LeClair
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Beverly Moy
- Division of Hematology/Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.,Cancer Center and Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts.,Reid R. Sacco AYA Cancer Program, Tufts University School of Medicine, Boston, Massachusetts
| | - Tracy A Battaglia
- Section of General Internal Medicine, Center of Excellence in Women's Health, Boston University School of Medicine, Boston, Massachusetts
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Pediatric Emergency Department and Primary Care Provider Attitudes on Assessing Childhood Adversity. Pediatr Emerg Care 2019; 35:527-532. [PMID: 29112109 DOI: 10.1097/pec.0000000000001220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to understand pediatric emergency department (ED) and primary care (PC) health care provider attitudes and beliefs regarding the intersection between childhood adversities and health care. METHODS We conducted in-depth, semistructured interviews in 2 settings (ED and PC) within an urban health care system. Purposive sampling was used to balance the sample among 3 health care provider roles. Interview questions were based on a modified health beliefs model exploring the "readiness to act" among providers. Interviews were recorded, transcribed, and coded. Interviews continued until theme saturation was reached. RESULTS Saturation was achieved after 26 ED and 19 PC interviews. Emergency department/primary care providers were similar in their perception of patient susceptibility to childhood adversity. Childhood mental health problems were the most frequently referenced adverse outcome, followed by poor childhood physical health. Adult health outcomes because of childhood adversity were rarely mentioned. Many providers felt that knowing about childhood adversity in the medical setting was important because it relates to provision of tangible resources. There were mixed opinions about whether or not pediatric health care providers should be identifying childhood adversities at all. CONCLUSIONS Although providers exhibited knowledge about childhood adversity, the perceived effect on health was only immediate and tangible. The effect of childhood adversity on lifelong health and the responsibility and potential accountability health systems have in addressing these important health determinants was not recognized by many respondents in our study. Addressing these provider perspectives will be a critical component of successful transformation toward more accountable health care delivery systems.
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47
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Lakshmanan A, Kubicek K, Williams R, Robles M, Vanderbilt DL, Mirzaian CB, Friedlich PS, Kipke M. Viewpoints from families for improving transition from NICU-to-home for infants with medical complexity at a safety net hospital: a qualitative study. BMC Pediatr 2019; 19:223. [PMID: 31277630 PMCID: PMC6610911 DOI: 10.1186/s12887-019-1604-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/27/2019] [Indexed: 12/31/2022] Open
Abstract
Background We have limited information on families’ experiences during transition and after discharge from the neonatal intensive care unit. Methods Open-ended semi-structured interviews were conducted with English or Spanish- speaking families enrolled in Medicaid in an urban high-risk infant follow up clinic at a safety-net center, which serves preterm and high-risk term infants. We generated salient themes using inductive-deductive thematic analysis. Results Twenty-one participants completed the study. The infant’s median (IQR) birth weight was 1750 (1305, 2641) grams; 71% were Hispanic and 10% were Black non-Hispanic; 62% reported living in a neighborhood with 3-4th quartile economic hardship. All were classified as having chronic disease per the Pediatric Medical Complexity Algorithm and 67% had medical complexity. A conceptual model was constructed and the analysis revealed major themes describing families’ challenges and ideas to support transition centered on the parent-child role and parent self-efficacy. The challenges were: (1) comparison to normal babies, (2) caregiver mental health, (3) need for information. Ideas to support transition included, (1) support systems, (2) interventions using mobile health technology (3) improved communication to the primary care provider and (4) information regarding financial assistance programs. Specific subthemes differed in frequency counts between infants with and without medical complexity. Conclusions Families often compare their preterm or high-risk infant to their peers and mothers feel great anxiety and stress. However, families often found hope and resilience in peer support and cited that in addition to information needs, interventions using mobile health technology and transition and financial systems could better support families after discharge. Electronic supplementary material The online version of this article (10.1186/s12887-019-1604-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ashwini Lakshmanan
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA. .,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. .,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA. .,USC Gehr Family Center for Health Systems Science, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Katrina Kubicek
- Division of Research on Children, Youth and Families, Children's Hospital Los Angeles, Los Angeles, USA
| | - Roberta Williams
- Division of Cardiology, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Marisela Robles
- Division of Research on Children, Youth and Families, Children's Hospital Los Angeles, Los Angeles, USA
| | - Douglas L Vanderbilt
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA.,Division of General Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christine B Mirzaian
- Division of General Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Philippe S Friedlich
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA
| | - Michele Kipke
- USC Gehr Family Center for Health Systems Science, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Flores-Fenlon N, Song AY, Yeh A, Gateau K, Vanderbilt DL, Kipke M, Friedlich P, Lakshmanan A. Smartphones and Text Messaging are Associated With Higher Parent Quality of Life Scores and Enrollment in Early Intervention After NICU Discharge. Clin Pediatr (Phila) 2019; 58:903-911. [PMID: 31088122 PMCID: PMC8362840 DOI: 10.1177/0009922819848080] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to evaluate the impact of access to communication technology on caregiver quality of life, neurodevelopmental, and medical outcomes (eg, rehospitalization, emergency room visits, or surgeries) in preterm infants, and enrollment in public assistance programs. In this cross-sectional study, we surveyed families of preterm infants in a high-risk infant-follow-up clinic. We estimated associations of access to various modes of communication technology with outcomes, adjusting for sociodemographic and infant characteristics using linear and unconditional logistic regression. Access to email, text messaging, and smartphones was associated with higher quality of life scores on the Multicultural Quality of Life Index, and email and smartphone access was significantly associated with increased enrollment in early intervention. Evaluating smartphone and email access on neonatal intensive care unit discharge is important when considering enrollment in community programs and caregiver quality of life.
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Affiliation(s)
- Nicole Flores-Fenlon
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Ashley Y. Song
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Amy Yeh
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Kameelah Gateau
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Douglas L. Vanderbilt
- Division of General Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michele Kipke
- Division of Research on Children, Youth and Families, Children's Hospital Los Angeles, Los Angeles, CA, USA,Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Philippe Friedlich
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ashwini Lakshmanan
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA,USC Gehr Family Center for Health Systems Science, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Seear M, Amed S, Dionne J, Yang C, Tourigny K, De Mello A, Hamilton Z, Garcia Espinosa B. In support of point-of-care social needs screening: The effects of five social determinants on the health of children with chronic diseases in British Columbia. Paediatr Child Health 2019; 24:200-208. [PMID: 31110462 DOI: 10.1093/pch/pxy090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Prior to introducing social needs screening into our subspecialty clinics, we first wanted to understand the health effects of the major social challenges facing children with chronic diseases in British Columbia. Methods Using a strict prospective methodology, avoiding use of health databases and proxy end points, we studied the effects of five social health determinants (distance from care, family income, gender, ethnicity, caregiver education), on health outcomes in three groups of children with chronic diseases: cystic fibrosis (CF), type 1 diabetes (T1D), chronic kidney disease (CKD). Social determinant data were collected at a face-to-face interview during a clinic visit. These were correlated with diagnosis-specific health outcomes, measured at the same visit. Main outcomes were: forced expired volume in 1 second (FEV1) (CF group), HbA1c (T1D group), estimated glomerular filtration rate (CKD group). Results We studied 270 children: 85 CF, 89 T1D and 96 CKD. In all three groups, children from families with annual income less than $45,000 had significantly worse health than those from families above this cut-off. Lower caregiver education was related to worse health in the CKD and T1D groups. We found no adverse health effects associated with distance from subspecialty care, patient ethnicity or gender. Conclusion Even in a prosperous province, family poverty and lack of caregiver education still impose measurable adverse effects on the health of children with chronic diseases. We hope these results help support the integration of social needs screening into routine multidisciplinary outpatient clinics. Early detection of social problems and targeted interventions will hopefully help to equalize health outcomes between children from different social groups.
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Affiliation(s)
- Michael Seear
- Division of Respirology, Department of Pediatrics, BC's Children's Hospital, Vancouver, British Columbia
| | - Shazhan Amed
- Division of Endocrinology, Department of Pediatrics, BC's Children's Hospital, Vancouver, British Columbia
| | - Janis Dionne
- Division of Nephrology, Department of Pediatrics, BC's Children's Hospital, Vancouver, British Columbia
| | - Connie Yang
- Division of Respirology, Department of Pediatrics, BC's Children's Hospital, Vancouver, British Columbia
| | - Katherine Tourigny
- Division of Respirology, Department of Pediatrics, BC's Children's Hospital, Vancouver, British Columbia
| | - Alanna De Mello
- Division of Nephrology, Department of Pediatrics, BC's Children's Hospital, Vancouver, British Columbia
| | - Zachary Hamilton
- Division of Respirology, Department of Pediatrics, BC's Children's Hospital, Vancouver, British Columbia
| | - Bernardo Garcia Espinosa
- Division of Respirology, Department of Pediatrics, BC's Children's Hospital, Vancouver, British Columbia
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Semple-Hess JE, Pham PK, Cohen SA, Liberman DB. Community Resource Needs Assessment Among Families Presenting to a Pediatric Emergency Department. Acad Pediatr 2019; 19:378-385. [PMID: 30471361 DOI: 10.1016/j.acap.2018.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 11/13/2018] [Accepted: 11/17/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To identify community resource needs among families presenting to a pediatric emergency department (PED). METHODS A convenience sample of English- and Spanish-speaking caregivers residing in Los Angeles County who presented to the PED of a large urban children's hospital were surveyed. The needs assessment survey assessed demographics, food insecurity, and previous and anticipated need for 12 common community resources. RESULTS Of 768 caregivers who completed the survey, 75% identified as Hispanic/Latinx. Across all survey participants, 83% used at least 1 resource in the past, and 67% anticipated needing at least 1 resource in the next 12 months. Low-cost/free health clinics were the most common resources used in the past and needed for the future. Caregivers with younger children tended to need baby formula/breastfeeding and women's health resources, whereas caregivers with older children tended to need safe housing, subsidized utilities, and counseling/therapy. Many families who needed resources in the past and for the future resided south of the children's hospital where median household income was relatively lower than in other areas of the county. A pattern of heightened use emerged among caregivers who primarily spoke Spanish. On average, caregivers reported feeling comfortable approaching hospital staff about community resources. CONCLUSIONS We found significant needs for community resources among families who presented to an urban PED. Needs were particularly salient among Spanish-speaking families and families living in close proximity to the children's hospital. Findings from this study help to inform future work connecting families to community resources.
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Affiliation(s)
- Janet E Semple-Hess
- Division of Emergency and Transport Medicine (JE Semple-Hess, PK Pham, and DB Liberman), Children's Hospital Los Angeles; Department of Pediatrics (JE Semple-Hess and DB Liberman), Keck School of Medicine, University of Southern California, Los Angeles.
| | - Phung K Pham
- Division of Emergency and Transport Medicine (JE Semple-Hess, PK Pham, and DB Liberman), Children's Hospital Los Angeles; Division of Behavioral and Organizational Sciences (PK Pham), Claremont Graduate University of the Claremont Colleges, Claremont
| | - Samuel A Cohen
- Department of Preventive Medicine (SA Cohen), Keck School of Medicine, University of Southern California, Los Angeles
| | - Danica B Liberman
- Division of Emergency and Transport Medicine (JE Semple-Hess, PK Pham, and DB Liberman), Children's Hospital Los Angeles; Department of Pediatrics (JE Semple-Hess and DB Liberman), Keck School of Medicine, University of Southern California, Los Angeles
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