Klein Melissa D, Alcamo Alicia M, Beck Andrew F, O'Toole Jennifer K, McLinden Daniel, Henize Adrienne, Kahn Robert S
Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Acad Pediatr. 2014 Mar-Apr;14(2):159-66. doi: 10.1016/j.acap.2013.11.002.
Screening and management of the social determinants of health (SDH) are critical for child health promotion. We sought to evaluate the impact of a facilitated video curriculum on resident SDH screening competence, parental perceptions of resident practice, resident-initiated referrals to a medical-legal partnership (MLP), and formula distribution to food-insecure families.
This was a pre-post study with concurrent control performed at a large pediatric residency program. Second- and third-year residents were assigned to control and intervention groups on the basis of their continuity clinic day. The curriculum included videotaped vignettes of screening for SDH and a "day in the life" series of families describing the impact of intervention on their lives. Residents completed self-assessments on screening competence and resource knowledge. After a well-child encounter, families (3 per resident) assessed their level of trust and respect for the resident and the number of SDHs screened for. MLP referral rates and formula distribution were compared.
The intervention group's self-assessed competence in screening for housing, benefits, and educational concerns was significantly higher compared to controls (each P ≤ .05). Parents' rating of trust and respect was high and did not differ between groups. Screening for each SDH was higher in the intervention group with domestic violence (odds ratio 2.16, 95% confidence interval 1.01-4.63) and depression (odds ratio 2.63, 95% confidence interval 1.15-5.99), reaching statistical significance. MLP referral rates increased (P = .06), and formula distribution (P = .02) reached statistical significance in the intervention group.
This SDH video curriculum improved resident self-assessed screening competence, parental perception of screening, and both MLP referrals and formula distribution.
健康的社会决定因素（SDH）的筛查与管理对促进儿童健康至关重要。我们旨在评估一门辅助视频课程对住院医师SDH筛查能力、家长对住院医师诊疗的看法、住院医师发起的向医疗-法律合作项目（MLP）的转诊以及向粮食不安全家庭分发配方奶粉的影响。
这是一项在大型儿科住院医师培训项目中进行的前后对照研究。根据他们在连续性门诊日的安排，将二年级和三年级住院医师分配到对照组和干预组。该课程包括SDH筛查的录像短片以及一系列描述干预对其生活影响的家庭“生活一日”视频。住院医师完成了关于筛查能力和资源知识的自我评估。在一次健康儿童问诊后，家庭（每位住院医师3个家庭）评估了他们对住院医师的信任和尊重程度以及筛查的SDH数量。比较了MLP转诊率和配方奶粉分发情况。
与对照组相比，干预组在住房、福利和教育问题筛查方面的自我评估能力显著更高（P值均≤0.05）。家长对信任和尊重的评分较高，且两组之间没有差异。干预组在家庭暴力（优势比2.16，95%置信区间1.01 - 4.63）和抑郁症（优势比2.63，95%置信区间1.15 - 5.99）方面对每个SDH的筛查率更高，达到统计学显著性。干预组的MLP转诊率有所增加（P = 0.06），配方奶粉分发（P = 0.02）达到统计学显著性。
这一SDH视频课程提高了住院医师的自我评估筛查能力、家长对筛查的看法以及MLP转诊和配方奶粉分发情况。
