Shaikh Ulfat, Gosdin Melissa, Helmke Elizabeth
Pediatrics, University of California Davis School of Medicine, 2516 Stockton Blvd, Suite 340, Sacramento, CA 95817, United States.
Center for Healthcare Policy and Research, University of California Davis, 4900 Broadway, Suite 1430, Sacramento, CA 95820, United States.
Int J Qual Health Care. 2025 Jul 4;37(3). doi: 10.1093/intqhc/mzaf067.
Child health is influenced by a range of social drivers. This necessitates a multipronged approach to pediatric care with collaborative efforts of multiple sectors. Children's hospitals have unique expertise and resources to identify pressing issues in child health and partner with community organizations and local governing bodies to address gaps in child health. The goal of this study was to identify multisector collaborations that children's hospitals in the USA engage in, facilitators and challenges of these efforts, and best practices that hospitals can employ to implement and sustain such collaborations.
An environmental scan was conducted utilizing the following approaches: a content analysis of Community Health Needs Assessments (CHNAs) and implementation strategies at 35 children's hospitals, and semistructured qualitative interviews with leaders who manage community partnerships at 14 select children's hospitals. This purposive sample was selected for national representation, including geographic location, size, and type of pediatric hospital. Qualitative relational analysis enabled exploration of descriptive and interpretive meanings within CHNA documents. Audio recordings were transcribed, the interview guide focused on domains of the PRISM (practical robust implementation and sustainability model) implementation science framework, and interviews were conducted and analyzed by a team of qualitative researchers.
Most hospitals engaged in multisector collaborations that addressed health disparities. The most frequently identified priorities included mental and behavioral health, access to health services, neighborhood safety and violence prevention, early childhood education, and chronic disease prevention. Key challenges were limited funding for multisector collaboration, shortage of staff with training and experience in multisector work, and variable readiness of community partners. Facilitators included adequate staffing and funding, community trust, and building on existing partnerships. All hospitals highlighted the crucial need to build trust within the community as a key factor to implement successful multisector collaborations. Best practices included examining the hospital's internal organization to avoid duplication of efforts, leveraging existing hospital resources to support local initiatives, incorporating community partners and financially supporting their efforts, creating avenues for bidirectional communication with community partners, measuring and tracking effectiveness of collaborations, and developing infrastructures to keep projects moving forward despite staff turnover.
Efforts to transform child health care from sick-care systems to community-integrated systems require children's hospitals to partner with community-based organizations to extend their reach and effectiveness. These findings can be used to develop strategies to implement and sustain future multisector collaborations at children's hospitals to effectively leverage their existing strengths and resources.
儿童健康受到一系列社会驱动因素的影响。这就需要采取多管齐下的方法来进行儿科护理，需要多个部门的共同努力。儿童医院拥有独特的专业知识和资源，能够识别儿童健康方面的紧迫问题，并与社区组织和地方管理机构合作，以弥补儿童健康方面的差距。本研究的目的是确定美国儿童医院参与的多部门合作、这些努力的促进因素和挑战，以及医院可以采用的实施和维持此类合作的最佳实践。
采用以下方法进行环境扫描：对35家儿童医院的社区健康需求评估（CHNAs）和实施策略进行内容分析，以及对14家选定儿童医院中管理社区伙伴关系的领导人进行半结构化定性访谈。这个有目的的样本是为了具有全国代表性而选择的，包括地理位置、规模和儿科医院类型。定性关系分析有助于探索CHNA文件中的描述性和解释性意义。对录音进行转录，访谈指南侧重于PRISM（实用稳健实施和可持续性模型）实施科学框架的领域，访谈由一组定性研究人员进行和分析。
大多数医院参与了解决健康差距问题的多部门合作。最常确定的优先事项包括精神和行为健康、获得医疗服务、社区安全和暴力预防、幼儿教育以及慢性病预防。关键挑战包括多部门合作资金有限、缺乏具有多部门工作培训和经验的工作人员，以及社区伙伴的准备程度参差不齐。促进因素包括充足的人员配备和资金、社区信任以及在现有伙伴关系的基础上发展。所有医院都强调，在社区内建立信任作为实施成功的多部门合作的关键因素至关重要。最佳实践包括审视医院的内部组织以避免工作重复、利用医院现有资源支持地方倡议、纳入社区伙伴并在经济上支持他们的努力、为与社区伙伴的双向沟通创造途径、衡量和跟踪合作的有效性，以及建立基础设施以使项目在人员更替的情况下仍能继续推进。
将儿童医疗保健从疾病护理系统转变为社区综合系统的努力要求儿童医院与社区组织合作，以扩大其覆盖范围和提高其有效性。这些发现可用于制定战略，以实施和维持儿童医院未来的多部门合作，从而有效利用其现有优势和资源。
