Colvin Jeffrey D, Bettenhausen Jessica L, Anderson-Carpenter Kaston D, Collie-Akers Vicki, Plencner Laura, Krager Molly, Nelson Brooke, Donnelly Sara, Simmons Julia, Higinio Valeria, Chung Paul J
Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Mo; Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Mo.
Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Mo; Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Mo.
Acad Pediatr. 2016 Mar;16(2):168-74. doi: 10.1016/j.acap.2015.06.001. Epub 2015 Jul 14.
It is critical that pediatric residents learn to effectively screen families for active and addressable social needs (ie, negative social determinants of health). We sought to determine 1) whether a brief intervention teaching residents about IHELP, a social needs screening tool, could improve resident screening, and 2) how accurately IHELP could detect needs in the inpatient setting.
During an 18-month period, interns rotating on 1 of 2 otherwise identical inpatient general pediatrics teams were trained in IHELP. Interns on the other team served as the comparison group. Every admission history and physical examination (H&P) was reviewed for IHELP screening. Social work evaluations were used to establish the sensitivity and specificity of IHELP and document resources provided to families with active needs. During a 21-month postintervention period, every third H&P was reviewed to determine median duration of continued IHELP use.
A total of 619 admissions met inclusion criteria. Over 80% of intervention team H&Ps documented use of IHELP. The percentage of social work consults was nearly 3 times greater on the intervention team than on the comparison team (P < .001). Among H&Ps with documented use of IHELP, specificity was 0.96 (95% confidence interval 0.87-0.99) and sensitivity was 0.63 (95% confidence interval 0.50-0.73). Social work provided resources for 78% of positively screened families. The median duration of screening use by residents after the intervention was 8.1 months (interquartile range 1-10 months).
A brief intervention increased resident screening and detection of social needs, leading to important referrals to address those needs.
儿科住院医师学会有效筛查家庭中存在的可解决的社会需求（即健康的负面社会决定因素）至关重要。我们试图确定：1）针对住院医师开展关于社会需求筛查工具IHELP的简短培训干预能否改善住院医师的筛查情况；2）IHELP在住院环境中检测需求的准确性如何。
在18个月的时间里，在两个其他方面相同的住院普通儿科团队之一轮转的实习医生接受了IHELP培训。另一个团队的实习医生作为对照组。对每份入院病史和体格检查（H&P）进行IHELP筛查评估。利用社会工作评估来确定IHELP的敏感性和特异性，并记录为有实际需求的家庭提供的资源。在干预后的21个月期间，每三份H&P进行一次评估，以确定IHELP持续使用的中位时长。
共有619例入院病例符合纳入标准。干预组超过80%的H&P记录了IHELP的使用情况。干预组的社会工作咨询比例几乎是对照组的3倍（P < 0.001）。在记录使用IHELP的H&P中，特异性为0.96（95%置信区间0.87 - 0.99），敏感性为0.63（95%置信区间0.50 - 0.73）。社会工作为78%筛查呈阳性的家庭提供了资源。干预后住院医师使用筛查工具的中位时长为8.1个月（四分位间距1 - 10个月）。
简短干预增加了住院医师对社会需求的筛查和检测，从而促成了针对这些需求的重要转诊。
