Reducing Socioeconomic Disparities in Health at Pediatric Visits

NCT02451059 | Completed

• 2 other identifiers: H-330611R01MD007793-01A1
• Study Type: interventional
• Target: 1,205
• Locations: 1 country
• Sites: 6

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.

Conditions

Asthma; Obesity; Health Care Utilization; Health Care Disparities; Basic Unmet Social Needs; Blood Pressure; Child Maltreatment; Child Development

Keywords

community resource; well-child care visit; low-income

Outcome Measures

Primary Outcomes (1)

• Health care utilization

  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.

  Throughout child's enrollment in study (0 years through 3 years of age)

Secondary Outcomes (8)

• Child maltreatment

  Throughout child's enrollment in study (0 years through 3 years of age)

• Developmental delay

  Throughout child's enrollment in study (0 years through 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)

• Asthma

  Throughout child's enrollment in study (0 years through 3 years of age)

• Blood pressure

  Measured at 3-year well child care visits

Study Arms (2)

Intervention-WE CARE

EXPERIMENTAL

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.

Behavioral: WE CARE survey; Behavioral: WE CARE Community Resource Handout; Behavioral: Patient Navigator

Control-Standard of Care

NO INTERVENTION

Participants in the delayed-intervention control group will receive standard pediatric care. However, since the health centers share a common EMR, and for ethical reasons, investigators will also embed the health IT referral mechanism into the EMR at the control sites. Control providers will be made aware of this prior to the start of the study. Although this may potentially reduce the effect size, the investigator's prior study found that the impact on referral rates of provider access to resource information was minimal. Families at control health centers will not receive the WE CARE surveys at health supervision visits and will not have access to the peer patient navigators

Interventions

WE CARE survey BEHAVIORAL

The WE CARE survey, consists of 14 questions used to identify seven unmet material needs (education, employment, food security, housing, childcare, household heat, language). The survey will be administered with patient's developmental screening forms at all health supervision visits from birth to two years of age. The office staff will instruct parents to give the WE CARE survey, along with the developmental screening tool, to their child's provider at the visit.

Intervention-WE CARE

WE CARE Community Resource Handout BEHAVIORAL

Providers will be trained to review the WE CARE survey at health supervision visits and generate referrals thru the EMR. Specifically, they will receive a one-hour teaching session one week prior to the study implementation. The goals for the session will include providing an overview of pediatric practice guidelines, introducing the WE CARE survey, reviewing the referral process, and discussing the role of peer patient navigators. Study staff will conduct periodic booster sessions; study staff will also train new providers should there be staff turnover

Also known as: Resource Referral

Intervention-WE CARE

Patient Navigator BEHAVIORAL

The peer patient navigator will offer guidance to families with accessing community resources. They will be available at least .5 days per week at intervention health centers to meet with families and offer guidance as well as be available via a hotline number. The navigator will speak with families and offer guidance on community resources and offer assistance with completing applications. In addition, they will offer to schedule and, if desired, accompany parents to the agencies. Interpreter services will be utilized at the health centers in case the navigator does not speak the parent's language. The navigator will also place an update note in the EMR within 1-month post-visit and one week after any contact with families.

Intervention-WE CARE

Eligibility Criteria

• Age: 1 Day - 1 Month
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Child is on Medicaid insurance
• Is attending routine newborn visit

You may not qualify if:

• Premature (less than or equal to 32 weeks GA)
• Has a chronic disease
• Has Neonatal Abstinence Syndrome
• Has a foster parent

Sponsors & Collaborators

• Boston Medical Center: lead
• Center for Community Health Education Research and Service, Inc.: collaborator
• National Institute on Minority Health and Health Disparities (NIMHD): collaborator

Study Sites (6)

South End Community Health Center

Boston, Massachusetts, 02118, United States

Location

Dorchester House Multi-Service Center

Boston, Massachusetts, 02122, United States

Location

Codman Square Health Center

Boston, Massachusetts, 02124, United States

Location

Uphams Corner Health Center

Dorchester, Massachusetts, 02125, United States

Location

Mattapan Community Health Center

Mattapan, Massachusetts, 02126, United States

Location

Greater Roslindale Medical and Dental Center

Roslindale, Massachusetts, 02131, United States

Location

MeSH Terms

Conditions

Asthma; Obesity; Patient Acceptance of Health Care

Interventions

Patient Navigation

Condition Hierarchy (Ancestors)

Bronchial Diseases; Respiratory Tract Diseases; Lung Diseases, Obstructive; Lung Diseases; Respiratory Hypersensitivity; Hypersensitivity, Immediate; Hypersensitivity; Immune System Diseases; Overweight; Overnutrition; Nutrition Disorders; Nutritional and Metabolic Diseases; Body Weight; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Treatment Adherence and Compliance; Health Behavior; Behavior

Intervention Hierarchy (Ancestors)

Patient-Centered Care; Primary Health Care; Comprehensive Health Care; Patient Care Management; Health Services Administration

Study Officials

• Arvin Garg, MD MPH

  Boston University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: May 14, 2015
• First Posted: May 21, 2015
• Study Start: September 1, 2015
• Primary Completion: December 29, 2020
• Study Completion: December 29, 2020
• Last Updated: May 18, 2021

Record last verified: 2021-05

Data Sharing

• IPD Sharing: Will not share

Locations

US (6)