National Healthcare Quality and Disparities Report
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Topics
- Access to Care (1)
- Asthma (1)
- Behavioral Health (2)
- Cardiovascular Conditions (1)
- Caregiving (1)
- (-) Children/Adolescents (17)
- Chronic Conditions (2)
- COVID-19 (1)
- Diagnostic Safety and Quality (1)
- Disparities (4)
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- Provider: Clinician (1)
- Provider: Physician (1)
- Public Health (1)
- Quality Improvement (1)
- Quality Measures (1)
- Quality of Care (2)
- Racial and Ethnic Minorities (4)
- Registries (1)
- Respiratory Conditions (1)
- Risk (2)
- Screening (2)
- Sickle Cell Disease (1)
- (-) Social Determinants of Health (17)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 17 of 17 Research Studies DisplayedStransky ML, Fuchu P, Prendergast K
Beyond housing for health: using flexible funds to improve maternal and child health.
The purpose of this article is to describe the Upstreaming Housing for Health’s (UHfH) use of a flexible fund. The UHfH was a pilot program developed and implemented to improve housing stability and decrease health inequities among people with high-risk pregnancies and their babies. The flexible fund is a cash transfer policy that served 50 families from 2019 to 2020 and addressed housing stability and material needs that encouraged family stability within the context of their housing. The researchers found that 76% of the families accessed flexible funds for items such as rental assistance, cribs, and breast pumps, with average financial support of $1343 (standard deviation = $625). The researchers advise that cash transfer policies such as the flexible fund have been shown to positively impact family health and well-being around the world.
AHRQ-funded; HS022242.
Citation: Stransky ML, Fuchu P, Prendergast K .
Beyond housing for health: using flexible funds to improve maternal and child health.
J Urban Health 2022 Dec;99(6):1027-32. doi: 10.1007/s11524-022-00686-8..
Keywords: Children/Adolescents, Behavioral Health, Social Determinants of Health, Outcomes
Kim B, Mulready-Ward C, Thorpe LE
Housing environments and asthma outcomes within population-based samples of adults and children in NYC.
This study assessed the relationship between housing type (i.e., home ownership, public housing, rental assistance, rent-controlled housing, and other rental housing) and asthma outcomes among New York City (NYC) adults and children (ages 1-13). The authors used the 2019 NYC Community Health Survey (CHS) and 2019 NYC KIDS survey to analyze associations between housing type and ever having been diagnosed with asthma (“ever asthma”) and experiencing an asthma attack within the past year. They also examined whether associations were modified by smoking status (among adults), smoking within the house (among children), and overweight/obesity. Among adults, living in public housing, compared to home ownership, was associated with higher odds of ever asthma and past-year asthma attack. Rental assistance housing living was also significantly associated with ever asthma. Public or rental assistance housing associations and ever asthma were marginally significant among children but were more pronounced among ever smokers than among never smokers.
AHRQ-funded; HS026120.
Citation: Kim B, Mulready-Ward C, Thorpe LE .
Housing environments and asthma outcomes within population-based samples of adults and children in NYC.
Prev Med 2022 Aug;161:107147. doi: 10.1016/j.ypmed.2022.107147..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Social Determinants of Health, Vulnerable Populations, Urban Health, Chronic Conditions
Bucholz EM, Toomey SL, McCulloch CE EM, Toomey SL, McCulloch CE
Adjusting for social risk factors in pediatric quality measures: adding to the evidence base.
The purpose of this study was to evaluate a method for incorporating social risk variables into a pediatric measure of utilization from the Pediatric Quality Measures Program (PQMP). The researchers utilized data from California Medicaid claims (2015-16) and Massachusetts All Payer Claims Database (2014-2015) to assess health plan performance using the Pediatric Asthma Emergency Department Use measure. The study found that of 133 health plans serving 404,649 pediatric patients with asthma, 7% to 13% changed performance categories after social risk adjustment. Health plans that shifted to higher performance categories cared for lower socioeconomic status (SES) patients, while those that shifted to lower performance categories cared for higher SES patients. The study concluded that adjustment for social risk factors shifted performance rankings on the PQMP Pediatric Asthma Emergency Department Use measure for a large number of health plans.
AHRQ-funded; HS025297; HS025299.
Citation: Bucholz EM, Toomey SL, McCulloch CE EM, Toomey SL, McCulloch CE .
Adjusting for social risk factors in pediatric quality measures: adding to the evidence base.
Acad Pediatr 2022 Apr;22(3s):S108-s14. doi: 10.1016/j.acap.2021.09.023..
Keywords: Children/Adolescents, Quality Measures, Quality of Care, Risk, Social Determinants of Health
Vasan A, Darko O, Fortin K
Community resource connection for pediatric caregivers with unmet social needs: a qualitative study.
The authors aimed to explore caregivers' perceived barriers to and facilitators of community resource connection. Through semi-structured interviews, they identified four primary themes, including competing priorities and burdensome application processes. They recommended electronic resources to help caregivers identify locally available services, with longitudinal supports to ensure caregivers can establish and maintain linkages with these services.
AHRQ-funded; HS028555.
Citation: Vasan A, Darko O, Fortin K .
Community resource connection for pediatric caregivers with unmet social needs: a qualitative study.
Acad Pediatr 2022 Apr;22(3):461-69. doi: 10.1016/j.acap.2021.09.010..
Keywords: Children/Adolescents, Caregiving, Social Determinants of Health
de Loizaga SR, Schneider K, Beck AF
Socioeconomic impact on outcomes during the first year of life of patients with single ventricle heart disease: an analysis of the National Pediatric Cardiology Quality Improvement Collaborative Registry.
In a retrospective cohort analysis of infants enrolled in the National Pediatric Cardiology Improvement Collaborative, researchers investigated the impact of community-level deprivation on morbidity and mortality for infants with single ventricle heart disease in the first year of life. They found that community deprivation was associated with mortality and length of stay for patients with single ventricle congenital heart disease. While patients near the mean deprivation index had a higher hazard of one year mortality compared to those at the extremes of the deprivation index, length of stay and deprivation index were linearly associated, demonstrating the complex nature of socioeconomic factors.
AHRQ-funded; HS021114.
Citation: de Loizaga SR, Schneider K, Beck AF .
Socioeconomic impact on outcomes during the first year of life of patients with single ventricle heart disease: an analysis of the National Pediatric Cardiology Quality Improvement Collaborative Registry.
Pediatr Cardiol 2022 Mar;43(3):605-15. doi: 10.1007/s00246-021-02763-2..
Keywords: Children/Adolescents, Social Determinants of Health, Quality Improvement, Quality of Care, Cardiovascular Conditions, Registries, Outcomes
Hua CL, Brown JS
Childhood socioeconomic status and physical activity in later life: the role of perceived neighborhood cohesion and wealth in adulthood.
Researchers used data from the Health and Retirement Study and a structural equation modeling approach to examine whether perceived neighborhood social cohesion and adulthood wealth mediate the relationship between childhood socioeconomic status (SES) and physical activity. They found that perceived neighborhood social cohesion and adulthood wealth have small but statistically significant mediational effects in the relationship between childhood SES and physical activity.
AHRQ-funded; HS000011.
Citation: Hua CL, Brown JS .
Childhood socioeconomic status and physical activity in later life: the role of perceived neighborhood cohesion and wealth in adulthood.
J Appl Gerontol 2022 Feb;41(2):506-14. doi: 10.1177/0733464820969312..
Keywords: Children/Adolescents, Social Determinants of Health
Carroll AR, Hall M, Brown CM
Association of race/ethnicity and social determinants with rehospitalization for mental health conditions at acute care children's hospitals.
This retrospective cohort study evaluated the associations of race/ethnicity and social determinants with 90-day rehospitalization of children with mental health conditions to acute non-psychiatric children’s hospitals. Children included were aged 5 to 18 years at 32 freestanding U.S. children’s hospitals from 2016-2018 using the Children’s Hospital Association’s Pediatric Health Information System (PHIS) database to assess the association of race/ethnicity and social determinants (insurance payer, neighborhood median household income, and rurality of patient home location) with 90-day rehospitalization. Among 23,556 index hospitalizations, 5.9% (n = 1382) were rehospitalized for mental health within 90 days. Non-Hispanic Black children were 26% more likely to be rehospitalized than non-Hispanic White children. Those with government insurance were 18% more likely to rehospitalized than those with private insurance. Those living in a suburban location were 22% less likely to be rehospitalized than those living in an urban location.
AHRQ-funded; HS026122.
Citation: Carroll AR, Hall M, Brown CM .
Association of race/ethnicity and social determinants with rehospitalization for mental health conditions at acute care children's hospitals.
J Pediatr 2022 Jan;240:228-34.e1. doi: 10.1016/j.jpeds.2021.08.078..
Keywords: Children/Adolescents, Hospital Readmissions, Behavioral Health, Social Determinants of Health, Racial and Ethnic Minorities
Dickinson-Copeland CM, Immergluck LC, Britez M
Increased risk of sub-clinical blood lead levels in the 20-county metro Atlanta, Georgia area-a laboratory surveillance-based study.
This study looked at the distribution of blood lead levels (BLLs) in children aged 0-72 months and their associations with sociodemographic and area-level variables. Data from the Georgia Department of Public Health’s Healthy Homes for Lead Prevention Program surveillance data was used to describe the distribution of BLLs in metro Atlanta area children from 2010 to 2018. Residential addresses were geocoded and if BLLs were spatially clustered they were defined at “Hotspots”. Geographically defined hotspots for both clinical (≥5 µg/dL) and sub-clinical (2 to <5 µg/dL) BLLs diffused from the city-central area into suburban areas. Predictors of sub-clinical BLL levels from those with lower (<2 µg/dL) or higher ((≥5 µg/dL) BLLs included non-Medicaid insurance, the proportion of renters in a given geographical area, and proportion of individuals with a GED/high school diploma. Over half of the study children had sub-clinical BLL levels, a range that does not currently trigger public health measures but could result in adverse development outcomes if ignored.
AHRQ-funded; HS024338.
Citation: Dickinson-Copeland CM, Immergluck LC, Britez M .
Increased risk of sub-clinical blood lead levels in the 20-county metro Atlanta, Georgia area-a laboratory surveillance-based study.
Int J Environ Res Public Health 2021 May 13;18(10). doi: 10.3390/ijerph18105163..
Keywords: Newborns/Infants, Children/Adolescents, Social Determinants of Health, Public Health, Public Health
Javalkar K, Robson VK, Gaffney L
Socioeconomic and racial and/or ethnic disparities in multisystem inflammatory syndrome.
Researchers characterized the socioeconomic and racial and/or ethnic disparities impacting the diagnosis and outcomes of multisystem inflammatory syndrome in children (MIS-C). They found that lower socioeconomic status or higher social vulnerability index, Hispanic ethnicity, and Black race independently increased risk for MIS-C. They recommended additional studies to target interventions to improve health equity for children.
AHRQ-funded; HS000063.
Citation: Javalkar K, Robson VK, Gaffney L .
Socioeconomic and racial and/or ethnic disparities in multisystem inflammatory syndrome.
Pediatrics 2021 May;147(5). doi: 10.1542/peds.2020-039933..
Keywords: Children/Adolescents, Social Determinants of Health, Disparities, Racial and Ethnic Minorities, Risk
Cullen D, Abel D, Attridge M
Exploring the gap: food insecurity and resource engagement.
Researchers investigated participant interest in referral and engagement with resources provided by pediatric health care institutions implementing food insecurity (FI) screens. They found that, through hospital-community partnership in an initial attempt to screen and offer direct-referral for FI, they elicited considerable interest among families for connection to resource agencies. However, there was a substantial gap between referral acceptance and ultimate connection with the resource agency.
AHRQ-funded; HS026116.
Citation: Cullen D, Abel D, Attridge M .
Exploring the gap: food insecurity and resource engagement.
Acad Pediatr 2021 Apr;21(3):440-45. doi: 10.1016/j.acap.2020.08.005..
Keywords: Children/Adolescents, Nutrition, Social Determinants of Health
Malhotra NA, Nevar A, Yearby R
Medicaid's EPSDT benefit: an opportunity to improve pediatric screening for social determinants of health.
This paper discusses the Early and Periodic Screening, Diagnostic, and Treatment (EPDST) benefit which is a key component of Medicaid policy intended to define an essential set of services provided to patients age 21 and younger. This qualitative review examines the extent to which EPSDT might be used to implement structured screening to identify environmental and social factors affecting children’s health. Semistructured interviews conducted in 2017 were triangulated with a review of the recent literature to describe how states currently consider the EPSDT benefit with respect to social determinants of health (SDOH) screening. Findings suggest that with sufficient stakeholder advocacy given the evidence supporting social determinants of health as “medically necessary”, EPSDT benefits could be considered as a funding source to incentivize the incorporation of SDOH screening into the basic package of well-child care.
AHRQ-funded; 233201600221A.
Citation: Malhotra NA, Nevar A, Yearby R .
Medicaid's EPSDT benefit: an opportunity to improve pediatric screening for social determinants of health.
Med Care Res Rev 2021 Apr;78(2):87-102. doi: 10.1177/1077558719874211..
Keywords: Children/Adolescents, Medicaid, Social Determinants of Health, Screening, Disparities, Policy
Fraiman YS, Litt JS, Davis JM
Racial and ethnic disparities in adult COVID-19 and the future impact on child health.
This article discusses the impact of the COVID-19 pandemic on children who are racial and ethnic minorities and the disproportionate harm to them. The authors urge that COVID-19-focused research consider racial and ethnic disparity. The paper discusses the lasting and intergenerational impact of COVID-19 on communities of color, especially children, due to increase in stress, material hardship, food insecurity, and long-term school readiness.
AHRQ-funded; HS000063.
Citation: Fraiman YS, Litt JS, Davis JM .
Racial and ethnic disparities in adult COVID-19 and the future impact on child health.
Pediatr Res 2021 Apr;89(5):1052-54. doi: 10.1038/s41390-021-01377-x..
Keywords: COVID-19, Children/Adolescents, Racial and Ethnic Minorities, Disparities, Health Status, Social Determinants of Health
Loo S, Brochier A, Wexler MG
Addressing unmet basic needs for children with sickle cell disease in the United States: clinic and staff perspectives.
The purpose of this study was to assess pediatric hematology clinic staff's perspectives regarding barriers and facilitators in addressing unmet basic needs for children with sickle cell disease. Six focus groups were held at urban pediatric hematology clinics in the Northeastern region of the U.S. Four themes emerged: families of children with SCD have numerous unmet basic needs; clinic staff felt they had a role to play in addressing these needs; staff felt their ability to address these needs depended upon caregivers' capacity to act on staff recommendations; clinic staff's ability to address these needs was limited by organizational and systemic factors beyond their control. These findings have important implications for how best to address adverse social determinants of health for this vulnerable pediatric population so that urban-based pediatric hematology clinics can more equitably support families.
AHRQ-funded; HS022242.
Citation: Loo S, Brochier A, Wexler MG .
Addressing unmet basic needs for children with sickle cell disease in the United States: clinic and staff perspectives.
BMC Health Serv Res 2021 Jan 12;21(1):55. doi: 10.1186/s12913-020-06055-y..
Keywords: Children/Adolescents, Sickle Cell Disease, Chronic Conditions, Social Determinants of Health, Provider: Clinician, Provider: Physician, Provider, Urban Health
Fraiman YS, Wojcik MH
The influence of social determinants of health on the genetic diagnostic odyssey: who remains undiagnosed, why, and to what effect?
This review article synthesizes the available evidence regarding population disparities in genetic testing for pediatric rare disease diagnosis and identifies gaps in care. The influence of social determinants of health is known, but this study’s goal is to examine the prevalence and nature of disparities in diagnostic testing. It synthesizes the available evidence regarding disparities, defining the need for further, prospective studies.
AHRQ-funded; HS000063.
Citation: Fraiman YS, Wojcik MH .
The influence of social determinants of health on the genetic diagnostic odyssey: who remains undiagnosed, why, and to what effect?
Pediatr Res 2021 Jan;89(2):295-300. doi: 10.1038/s41390-020-01151-5..
Keywords: Children/Adolescents, Social Determinants of Health, Genetics, Diagnostic Safety and Quality, Screening, Disparities
Cai L, Wu Y, Cheskin LI
Effect of childhood obesity prevention programmes on blood lipids: a systematic review and meta-analysis.
This study, the first systematic, quantitative study of childhood obesity prevention programs on blood lipids in high-income countries found that most interventions (70 percent) showed similar significant or no effects on adiposity- and lipid outcomes; 15 percent of interventions improved both adiposity- and lipids outcomes; 55 percent had no significant effects on either. These programs had a significant desirable effect on LDL-C and HDL-C.
AHRQ-funded; 290200710061I
Citation: Cai L, Wu Y, Cheskin LI .
Effect of childhood obesity prevention programmes on blood lipids: a systematic review and meta-analysis.
Obes Rev. 2014 Dec;15(12):933-44. doi: 10.1111/obr.12227..
Keywords: Children/Adolescents, Obesity, Prevention, Outcomes, Social Determinants of Health
Angier H, Gregg J, Gold R
Understanding how low-income families prioritize elements of health care access for their children via the optimal care model.
The researchers explored low-income parents’ perspectives on accessing health care. Interviews with 29 Oregon parents revealed that affordability and limited availability were seen as barriers to care; while a continuous relationship with a health care provider helped them overcome these barriers. Parents also described the difficult decisions they made between affordability and acceptability in order to get the best care they could for their children.
AHRQ-funded; HS018569.
Citation: Angier H, Gregg J, Gold R .
Understanding how low-income families prioritize elements of health care access for their children via the optimal care model.
BMC Health Serv Res 2014 Nov 19;14:585. doi: 10.1186/s12913-014-0585-2..
Keywords: Access to Care, Children/Adolescents, Low-Income, Social Determinants of Health, Healthcare Costs
McCormick EV, Dickinson LM, Haemer MA
What can providers learn from childhood body mass index trajectories: a study of a large, safety-net clinical population.
The investigators described childhood weight gain using body mass index (BMI) z-score trajectories in a low-income urban safety-net population and identified among gender- and race/ethnicity-specific groups any trends for increased risk. They found that all gender and race/ethnicity subgroups showed increasing average BMI z-scores during childhood, with Hispanic boys and black girls showing the most significant increase during this observation period. They further found that many obese children were already overweight by age 3, and persistence of obesity after 3 years of age was high. They concluded that intervention before age 3 may be essential to curbing unhealthy weight trajectories.
AHRQ-funded; HS021138.
Citation: McCormick EV, Dickinson LM, Haemer MA .
What can providers learn from childhood body mass index trajectories: a study of a large, safety-net clinical population.
Acad Pediatr 2014 Nov-Dec;14(6):639-45. doi: 10.1016/j.acap.2014.06.009.
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Keywords: Children/Adolescents, Obesity, Racial and Ethnic Minorities, Social Determinants of Health, Obesity: Weight Management