Reducing Socioeconomic Disparities in Health at Pediatric Visits
- Conditions
- Health Care DisparitiesBasic Unmet Social NeedsBlood PressureObesityAsthmaChild MaltreatmentHealth Care UtilizationChild Development
- Interventions
- Behavioral: WE CARE surveyBehavioral: WE CARE Community Resource HandoutBehavioral: Patient Navigator
- Registration Number
- NCT02451059
- Lead Sponsor
- Boston Medical Center
- Brief Summary
This research project is aimed to assess the effectiveness and impact of a pediatric-based intervention aimed at reducing low-income families' unmet material needs (food, housing, employment, childcare, household heat, education and learning the English language ) on child health.
- Detailed Description
This project builds upon the PI's prior studies including a recently completed cluster randomized controlled trial (RCT) at community health centers in Boston, which demonstrated a positive impact on provider referrals, discussion, and family receipt of resources.
This study will specifically test the effectiveness of a further strengthened intervention "WE CARE 2.0" on provider referrals and family receipt of resources, along with its impact on child health, health care utilization, and developmental outcomes. Finally, we will gather information from stakeholders at the health centers in order to learn more about the facilitators and barriers to implementation of the model.
The study will take place at six community health centers in the Greater Boston area. The centers will be randomized to either an intervention or control site. Data will be collected on referrals, receipt of resources, and child outcomes from the child's electronic medical record (EMR) from birth to age 3. Focus groups will be used to gather implementation data from intervention health center personnel.
The WE CARE 2.0 intervention consists of: 1) WE CARE surveys which parents complete prior to their child's well-child visits; 2) information technology (IT) generated provider referrals which providers use to provide families with resource information sheets; 3) peer patient navigators who assist families in connecting to available resources and updating providers; and 4) training sessions for providers and office staff.
Families attending the control health centers will receive standard of care. Of note, since the health centers share a common EMR and for ethical reasons, control sites will have access to the IT generated referral mechanism.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 1205
- Child is on Medicaid insurance
- Is attending routine newborn visit
- Premature (less than or equal to 32 weeks GA)
- Has a chronic disease
- Has Neonatal Abstinence Syndrome
- Has a foster parent
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Intervention-WE CARE Patient Navigator 1. The WE CARE survey is used to identify unmet material needs; it will be administered with patient's developmental screening forms at all health supervision visits from birth to two years of age. 2. Providers will be trained to review the WE CARE survey at health supervision visits and generate our WE CARE community resource handouts (referrals) through the EMR. 3. A peer patient navigator will offer personalized guidance to families with accessing community resources. The patient navigator will be available for at least a 1/2 day per week at each intervention health center to meet with families and offer guidance. Providers can communicate the patient navigator to refer families via the electronic medical record and families will also have the opportunity to contact the peer navigator at any time via the hotline number listed on the referral information sheets. Intervention-WE CARE WE CARE survey 1. The WE CARE survey is used to identify unmet material needs; it will be administered with patient's developmental screening forms at all health supervision visits from birth to two years of age. 2. Providers will be trained to review the WE CARE survey at health supervision visits and generate our WE CARE community resource handouts (referrals) through the EMR. 3. A peer patient navigator will offer personalized guidance to families with accessing community resources. The patient navigator will be available for at least a 1/2 day per week at each intervention health center to meet with families and offer guidance. Providers can communicate the patient navigator to refer families via the electronic medical record and families will also have the opportunity to contact the peer navigator at any time via the hotline number listed on the referral information sheets. Intervention-WE CARE WE CARE Community Resource Handout 1. The WE CARE survey is used to identify unmet material needs; it will be administered with patient's developmental screening forms at all health supervision visits from birth to two years of age. 2. Providers will be trained to review the WE CARE survey at health supervision visits and generate our WE CARE community resource handouts (referrals) through the EMR. 3. A peer patient navigator will offer personalized guidance to families with accessing community resources. The patient navigator will be available for at least a 1/2 day per week at each intervention health center to meet with families and offer guidance. Providers can communicate the patient navigator to refer families via the electronic medical record and families will also have the opportunity to contact the peer navigator at any time via the hotline number listed on the referral information sheets.
- Primary Outcome Measures
Name Time Method Health care utilization Throughout child's enrollment in study (0 years through 3 years of age) Investigators will measure whether child is up to date with well child visits between 0-3 years of age. Investigators will measure whether child is up to date on their immunizations between 0-3 years of age. Investigators will measure if and how many times child has been hospitalized or had a visit to the emergency department (ED) between 0-3 years of age.
- Secondary Outcome Measures
Name Time Method Family receipt of community based resource Throughout child's enrollment in study (0 years through 3 years of age) Investigators will determine whether families who were printed out community resource handouts had been able to receive services from a community based resource organization. This will be recorded in the EMR by the patient navigator at anytime from age 0-3 years of age.
Provider referrals Throughout child's enrollment in study (0 years through 3 years of age) Investigators will measure if and how many times a provider made a referral/printed out a community resource handout for patients during their enrollment in the study at any point, from age 0-3 years of age.
Developmental delay Throughout child's enrollment in study (0 years through 3 years of age) Investigators will measure whether a developmental delay has been added to the child's problem list in their EMR or if provider has noted a concern of a developmental delay in their routine well-child care notes, at any point, from age 0-3 years of age.
Asthma Throughout child's enrollment in study (0 years through 3 years of age) Investigators will record whether asthma or concerns about asthma have been added to child's problem list in the EMR or noted in the EMR by child's provider at any point, from age 0-3 years of age.
Obesity Measured at 2-year, 30-month, and 3-year well child care visits (as recommended by the American Academy of Pediatrics) Investigators will record the child's reported BMI at their 2-year, 30-month, and 3-year well child care visits from the EMR
Blood pressure Measured at 3-year well child care visits We will record the child's reported blood pressure number as measured at their 3-year well child care visit. We will gather this information from the EMR.
Focus group data gathered by audio recordings then transcribed and coded During 1st month pilot phase and again after investigators have enrolled our the cohort, approximately 3 years after the first focus groups and the study initiation Investigators will gain insight into the context and implementation of the augmented WE CARE model from providers and administrative staff at the intervention sites
Child maltreatment Throughout child's enrollment in study (0 years through 3 years of age) Investigators will measure in the child's EMR whether or not there are any reports of child maltreatment and/or involvement with the Department of Child and Families, at any point, from age 0-3 years of age.
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Trial Locations
- Locations (6)
South End Community Health Center
🇺🇸Boston, Massachusetts, United States
Greater Roslindale Medical and Dental Center
🇺🇸Roslindale, Massachusetts, United States
Mattapan Community Health Center
🇺🇸Mattapan, Massachusetts, United States
Codman Square Health Center
🇺🇸Boston, Massachusetts, United States
Dorchester House Multi-Service Center
🇺🇸Boston, Massachusetts, United States
Uphams Corner Health Center
🇺🇸Dorchester, Massachusetts, United States