Rural and Minority Health Research Center, Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
Children's Trust of South Carolina, Columbia, SC, USA.
J Community Health. 2019 Aug;44(4):764-771. doi: 10.1007/s10900-018-00606-5.
In addition to individual-level characteristics, characteristics of the social and physical environments in which individuals reside may adversely impact health outcomes. Careful attention to the role of "place" can result in programs that successfully deliver services to those most at risk. This retrospective, cross-sectional study used geocoded residential addresses from 3090 households enrolled in a South Carolina (SC) home visiting program, 2013-2016, and corresponding years of data for maternal and child health outcomes obtained from vital records data. ZIP Code Tabulation Areas (ZCTAs) served as the primary geographic unit of analysis. ZCTAS with high volumes of birth or adverse maternal and child health outcomes for any of 10 indicators were flagged. Distribution of enrolled households across highest-risk ZCTAs was calculated. Of 379 ZCTAS with reported data, 152 had 8 or more risk flags. Of the 152 highest-risk ZCTAs, 33 also had high birth volumes. Fifty-seven of the 152 highest-risk ZCTAs had no enrollees; seven of the 33 highest-risk/highest-volume ZCTAS had no enrollees. Service delivery gaps existed despite a statewide, county-level needs assessment conducted prior to program implementation. This study suggests methods to identify service areas of need, as an ongoing effort toward program improvement.
除了个体层面的特征外，个体所在的社会和物理环境特征也可能对健康结果产生不利影响。仔细关注“地点”的作用，可以使那些风险最高的人成功地获得服务。本回顾性、横断面研究使用了 2013 年至 2016 年南卡罗来纳州（SC）家访项目中 3090 户家庭的经地理编码的居住地址，以及从生命记录数据中获得的母婴健康结果的相应年份数据。ZIP Code Tabulation Areas（ZCTA）是主要的分析地理单位。对于任何 10 个指标中的出生或母婴健康不良结果数量较多的 ZCTA 进行标记。计算了登记家庭在最高风险 ZCTA 中的分布情况。在报告数据的 379 个 ZCTA 中，有 152 个有 8 个或更多的风险标志。在 152 个高风险 ZCTA 中，有 33 个也有高出生量。在 152 个高风险 ZCTA 中，有 57 个没有登记家庭；在 33 个高风险/高容量 ZCTA 中，有 7 个没有登记家庭。尽管在项目实施前进行了全州和县一级的需求评估，但仍存在服务提供差距。这项研究提出了识别服务需求领域的方法，作为项目改进的持续努力。
