Johns Hopkins University School of Medicine (S Hill, K Topel, and BS Solomon), Baltimore, Md.
Johns Hopkins Berman Institute of Bioethics (X Li), Baltimore, Md.
Acad Pediatr. 2022 Sep-Oct;22(7):1221-1227. doi: 10.1016/j.acap.2022.05.012. Epub 2022 May 18.
Evidence for social needs interventions on resource linkage has grown over the past decade. Though social and economic needs predict health care utilization, few studies have assessed social needs interventions on these outcomes. The objective of this study was to examine the association between enrollment in a clinic-based social needs program on subsequent well-child visit (WCV) attendance and emergency department (ED) use in 2 primary care clinics.
A retrospective cohort study was conducted of patients in 2 clinics referred to a social risk screening and navigation program between June and August 2018. We compared health care utilization over the subsequent 12 months for those who completed a full intake and received resource navigation (enrolled) to those referred (not enrolled). Logistic regression was used to assess the association between enrollment with WCV attendance and ED visits.
During the study period, of the 969 patients referred to the program, 761 were enrolled across the 2 clinics. At both sites, the majority of enrolled patients had high WCV attendance postintervention (Site A: 81.6%, Site B: 71.4%). High WCV attendance for nonenrolled but referred patients was significantly lower (Site A: 52.7%, Site B: 35.0%). Enrolled participants were significantly more likely to have high WCV attendance than nonenrolled patients, adjusting for preintervention utilization (Site A adjusted odds ratio [aOR]: 5.83, Site B aOR : 4.20). There were no significant differences in ED use at either clinic.
Addressing families' social needs through resource linkage and navigation can improve WCV attendance.
在过去十年中,有关社会需求干预对资源联系影响的证据不断增加。尽管社会和经济需求可以预测医疗保健的利用情况,但很少有研究评估过针对这些结果的社会需求干预措施。本研究的目的是评估在 2 家初级保健诊所中,参加基于诊所的社会需求计划与随后的儿童常规健康检查(WCV)就诊和急诊部(ED)就诊之间的关联。
本研究采用回顾性队列设计,对 2018 年 6 月至 8 月期间转诊至社会风险筛查和导航项目的 2 家诊所的患者进行研究。我们比较了在接下来的 12 个月内完成全面评估并接受资源导航(入组)的患者与被转诊(未入组)患者的医疗保健利用情况。采用逻辑回归评估了入组与 WCV 就诊和 ED 就诊之间的关联。
在研究期间,在 969 名被转诊至该项目的患者中,有 761 名患者在 2 家诊所被入组。在这两个地点,大多数入组患者在干预后有较高的 WCV 就诊率(地点 A:81.6%,地点 B:71.4%)。未入组但被转诊的患者的高 WCV 就诊率明显较低(地点 A:52.7%,地点 B:35.0%)。调整干预前的利用情况后,入组患者比未入组患者更有可能有较高的 WCV 就诊率(地点 A 的调整优势比[aOR]:5.83,地点 B 的 aOR:4.20)。在这两个诊所,ED 的使用均无显著差异。
通过资源联系和导航来满足家庭的社会需求,可以提高 WCV 的就诊率。