UH Rainbow Center for Child Health and Policy, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio; Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio; Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, Ohio.
UH Rainbow Center for Child Health and Policy, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio.
Am J Prev Med. 2022 Sep;63(3 Suppl 2):S122-S130. doi: 10.1016/j.amepre.2022.03.036. Epub 2022 Aug 17.
Social determinants of health (SDoH) screening and intervention in primary care aim to alleviate adverse influences on health, but its efficacy may be diluted when offered supports are not well matched to families' desire for such services. The purpose of this prospective cohort study was to provide guidance to social care navigation teams regarding which families would be most likely to make use of services.
Analysis of registry data collected in April 1-September 30, 2021 from a social care navigation program embedded in a medical home was conducted. Multivariable regression models explored (1) whether family-reported urgency of needs, number of needs, and/or specific types of needs predicted completing program intake and (2) whether the degree of family activation regarding social needs predicted subsequent interactions with the navigation team.
Of the 1,483 families reporting any social care needs (38% of all screens completed, mean of 2.5 needs per screen), 31% indicated that their needs were urgent. Accounting for program factors and the number and type of needs reported, families whose needs were urgent were more likely to complete intake (OR=1.34; 95% CI=1.01, 1.82; p=0.04) and remain engaged with the program over time (OR=2.25; 95% CI=1.62, 3.12; p<0.01). Those who were self-advocates were substantially less likely to desire follow-up or stay engaged (OR=0.40; 95% CI=0.17, 0.93; p<0.01).
Family-reported urgency of needs and activation for social care assistance predicted engagement with the navigation team. SDoH interventions should prioritize outreach to those families expressing an interest in help with any of their identified needs.
初级保健中的社会决定因素健康（SDoH）筛查和干预旨在减轻对健康的不利影响，但如果提供的支持与家庭对这些服务的需求不匹配，其效果可能会减弱。本前瞻性队列研究的目的是为社会关怀导航团队提供指导，以了解哪些家庭最有可能使用服务。
对 2021 年 4 月 1 日至 9 月 30 日期间嵌入医疗之家的社会关怀导航计划中收集的登记数据进行了分析。多变量回归模型探讨了（1）家庭报告的需求紧迫性、需求数量和/或特定类型的需求是否预测完成计划入组，以及（2）家庭对社会需求的激活程度是否预测与导航团队的后续互动。
在报告有任何社会关怀需求的 1483 个家庭中（所有筛查的 38%，每个筛查的平均需求为 2.5 个），31%表示他们的需求紧急。考虑到计划因素以及报告的需求数量和类型，需求紧急的家庭更有可能完成入组（OR=1.34；95%CI=1.01，1.82；p=0.04），并随着时间的推移与该计划保持互动（OR=2.25；95%CI=1.62，3.12；p<0.01）。那些自我倡导的人不太可能希望跟进或保持参与（OR=0.40；95%CI=0.17，0.93；p<0.01）。
家庭报告的需求紧迫性和对社会关怀援助的激活程度预测了与导航团队的互动。SDoH 干预措施应优先向那些对帮助他们识别的任何需求感兴趣的家庭提供服务。
