Cross-Sector Approach Expands Screening and Addresses Health-Related Social Needs in Primary Care.

Autor:	Arbour MC; Brigham and Women's Hospital, Boston, Massachusetts marbour@bwh.harvard.edu., Floyd B; Stanford School of Medicine, Stanford, California., Morton S; MLPB, Boston, Massachusetts., Hampton P; Center for the Study of Social Policy, Washington, DC., Sims JM; UCSF Benioff Children's Hospital, Oakland, California., Doyle S; Center for the Study of Social Policy, Washington, DC., Atwood S; Brigham and Women's Hospital, Boston, Massachusetts., Sege R; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	Pediatrics [Pediatrics] 2021 Nov; Vol. 148 (5). Date of Electronic Publication: 2021 Oct 27.
DOI:	10.1542/peds.2021-050152
Abstrakt:	Objectives: During infancy, the American Academy of Pediatrics Bright Futures fourth edition health supervision guidelines recommend frequent well-child visits (WCVs) in which providers are expected to screen for and address maternal depression, intimate partner violence (IPV), and health-related social needs (HRSN). We spread an evidence-based approach that implements these recommendations (Developmental Understanding and Legal Collaboration for Everyone; DULCE) with 3 aims for 6-month-old infants and their families: 75% receive all WCVs on time, 95% are screened for 7 HRSNs, and 90% of families with concrete supports needs and 75% of families with maternal depression or IPV receive support. Methods: Between January 2017 and July 2018, five DULCE teams (including a community health worker, early childhood system representative, legal partner, clinic administrator, pediatric and behavioral health clinicians) from 3 communities in 2 states participated in a learning collaborative. Teams adapted DULCE using Plan-Do-Study-Act cycles, reported data, and shared learning monthly. Run charts were used to study measures. The main outcome was the percent of infants that received all WCVs on time. Results: The percentage of families who completed all WCVs on time increased from 46% to 65%. More than 95% of families were screened for HRSNs, 70% had ≥1 positive screen, and 86% and 71% of those received resource information for concrete supports and maternal depression and IPV, respectively. Conclusions: Quality improvement-supported DULCE expansion increased by 50% the proportion of infants receiving all WCVs on time and reliably identified and addressed families' HRSNs, via integration of existing resources. Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. (Copyright © 2021 by the American Academy of Pediatrics.)
Databáze:	MEDLINE
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