Lindau Stacy Tessler, Makelarski Jennifer A, Winslow Victoria A, Abramsohn Emily M, Anand Veera, Burnet Deborah L, Fuller Charles M, Grana Mellissa, Miller Doriane C, Ren Eva S, Waxman Elaine, Wroblewski Kristen E
Department of Ob/Gyn, Medicine-Geriatrics and Palliative Medicine and the Comprehensive Cancer Center, University of Chicago, Chicago, Illinois.
Department of Ob/Gyn, University of Chicago, Chicago, Illinois.
JAMA Pediatr. 2025 Apr 28. doi: 10.1001/jamapediatrics.2025.0484.
Social care could be sustained with savings resulting from reduced acute health care utilization.
To evaluate the impact of CommunityRx, a low-intensity, high-scale social care assistance intervention.
DESIGN, SETTING, AND PARTICIPANTS: This double-blind randomized clinical trial took place from November 2020 through August 2023 at an urban children's hospital with 12-month follow-up. Inclusion criteria were primary caregiver of a child younger than 18 years who was hospitalized in general, intensive care, or transplant units, living in 1 of 42 zip codes, and consenting to text messages. Caregivers of healthy newborns and children with expected hospitalization less than 24 hours or longer than 30 days were excluded.
Participants were randomized to usual care (n = 320) or usual care plus CommunityRx (n = 320). Essential intervention components included education about common social conditions, personalized information about local resources, and ongoing navigator support with automated, proactive text messages (3 months) and ongoing availability for participant-initiated requests (12 months).
Preplanned analyses focused on food insecure (FI) subgroup outcomes (n = 223): self-efficacy for finding resources at 12 months (primary), caregiver-reported child health, and number of child emergency department (ED) and hospital admissions over 12 months. Regression models were fit with treatment group and baseline outcome characteristics. Odds ratios (ORs) or incidence rate ratios (IRRs) and 95% CIs were calculated. Post hoc analysis examined outcomes among the food secure (FS) subgroup (n = 414).
Preplanned analyses included 223 FI participants and most identified as female (180 [95%]) and had household income less than $50 000 per year (197 [91%]). Self-efficacy at 12 months was similar among treatment groups (OR, 0.59; 95% CI, 0.25-1.39, P = .23). At 3 months, when automated navigator texts ended, 53 intervention group participants (69%) and 39 controls (45%) rated their child's health as excellent or very good (OR, 2.67; 95% CI, 1.14-6.24). During 12 months postdischarge, 54 FI children (41%) had 1 or more ED visits (median, 0; range, 0-32; intervention, 30%; control, 52%; IRR, 0.40; 95% CI, 0.21-0.76) and 32 had 1 or more hospitalizations (24%) (median, 0; range, 0-5; intervention, 15%; control, 34%; IRR, 0.48; 95% CI, 0.21-1.06). The intervention did not impact outcomes among FS caregivers.
A low-intensity, high-scale social care assistance intervention beginning with pediatric hospitalization may be sustainable by reducing acute health care utilization, but did not increase caregiver self-efficacy for finding resources.
ClinicalTrials.gov Identifier: NCT04171999.
社会护理可以通过减少急性医疗保健利用所产生的节省来维持。
评估低强度、大规模社会护理援助干预措施CommunityRx的影响。
设计、设置和参与者：这项双盲随机临床试验于2020年11月至2023年8月在一家城市儿童医院进行，随访12个月。纳入标准为18岁以下儿童的主要照顾者，该儿童曾在普通病房、重症监护病房或移植病房住院，居住在42个邮政编码区域之一，并同意接收短信。健康新生儿以及预期住院时间少于24小时或超过30天的儿童的照顾者被排除。
参与者被随机分为常规护理组（n = 320）或常规护理加CommunityRx组（n = 320）。基本干预组成部分包括关于常见社会状况的教育、关于当地资源的个性化信息，以及通过自动、主动短信提供的持续导航支持（3个月）和对参与者发起请求的持续响应（12个月）。
预先计划的分析聚焦于粮食不安全（FI）亚组结局（n = 223）：12个月时寻找资源的自我效能感（主要指标）、照顾者报告的儿童健康状况，以及12个月内儿童急诊科（ED）就诊次数和住院次数。回归模型根据治疗组和基线结局特征进行拟合。计算优势比（OR）或发病率比（IRR）以及95%置信区间（CI）。事后分析考察了粮食安全（FS）亚组（n = 414）的结局。
预先计划的分析纳入了223名FI参与者，其中大多数为女性（180名[95%]），家庭年收入低于50000美元（197名[91%]）。治疗组在12个月时的自我效能感相似（OR，0.59；95% CI，0.25 - 1.39，P = 0.23）。在3个月时，当自动导航短信结束时，53名干预组参与者（69%）和39名对照组参与者（45%）将其孩子的健康状况评为优秀或非常好（OR，2.67；95% CI，1.14 - 6.24）。在出院后的12个月内，54名FI儿童（41%）有1次或更多次ED就诊（中位数为0；范围为 0 - 32；干预组为30%；对照组为52%；IRR，0.40；95% CI，0.21 - 0.76），32名儿童（24%）有1次或更多次住院（中位数为0；范围为0 - 5；干预组为15%；对照组为34%；IRR，0.48；95% CI，0.21 - 1.06）。该干预措施对FS照顾者组的结局没有影响。
一项从儿科住院开始实施的低强度、大规模社会护理援助干预措施，可能通过减少急性医疗保健利用而具有可持续性，但并未提高照顾者寻找资源的自我效能感。
ClinicalTrials.gov标识符：NCT04171999。
