Effects of In-Person Navigation to Address Family Social Needs on Child Health Care Utilization: A Randomized Clinical Trial.
Pantell Matthew S,Hessler Danielle,Long Dayna,Alqassari Maoya,Schudel Christine,Laves Ellen,Velazquez Denisse E,Amaya Anais,Sweeney Patricia,Burns Abigail,Harrison Francis L,Adler Nancy E,Gottlieb Laura M
JAMA network open
Importance:While many organizations endorse screening for social risk factors in clinical settings, few studies have examined the health and utilization effects of interventions to address social needs. Objective:To compare the acute care utilization effects of a written resources handout vs an in-person navigation service intervention to address social needs. Design, Settings, and Participants:In this secondary analysis of a randomized clinical trial, 1809 adult caregivers of pediatric patients seen in primary and urgent care clinics of 2 safety-net hospitals in northern California were recruited between October 13, 2013, and August 27, 2015. Each participating family was randomly assigned to an in-person navigator intervention vs active control to address the family's social needs. Analyses were conducted between February 28, 2018, and September 25, 2019. Interventions:Caregivers either received written information about relevant local resources related to social needs (active control) or met with a patient navigator focused on helping them resolve social needs (navigator intervention). After an initial in-person visit, navigation services included telephone, email, and/or in-person follow-up for up to 3 months. Main Outcome and Measures:Child emergency department visit or hospitalization within 12 months of study enrollment. Results:Among the 1300 caregivers enrolled in the study without missing follow-up data, most spoke English (878 [67.5%]) and were women (1127 [86.7%]), with a mean (SD) age of 33.0 (9.33) years. Most children were aged 0 to 5 years (779 of 1300 [59.9%]), 723 children (55.6%) had Hispanic ethnicity, and 462 children (35.5%) were in excellent health; 840 families (64.6%) were recruited from urgent care. In total, 637 families (49.0%) were randomized to the in-person navigator group and 663 (51.0%) to the active control group. There was no difference in risk of an emergency department visit between the 2 groups. Children enrolled in the in-person navigator group had a decreased risk of hospitalization within 12 months (hazard ratio, 0.59; 05% CI, 0.38-0.94; P = .03), making them 69% less likely to be hospitalized. Conclusions and Relevance:In this randomized clinical trial evaluating heath care utilization effects of programs designed to address social needs among families, children enrolled in the navigation group were significantly less likely to be hospitalized after the intervention but equally likely to have an emergency department visit. These findings strengthen our understanding of the effects of addressing social needs in clinical settings as part of a comprehensive strategy to improve health and reduce health care utilization. Trial Registration:ClinicalTrials.gov Identifier: NCT01939704.
10.1001/jamanetworkopen.2020.6445
Public satisfaction with the healthcare system in China during 2013-2015: a cross-sectional survey of the associated factors.
Zhang Jing Hua,Peng Xinxin,Liu Chengkun,Chen Yijun,Zhang Hongmin,Iwaloye Ojo Olukayode
BMJ open
OBJECTIVE:We explore how public satisfaction with the healthcare system in China varies with social and economic factors, especially regional variations and changes during 2013-2015. DESIGN:Population-based, cross-sectional survey performed between July 2013 and July 2015. SETTING:General population of China during 2013-2015. PARTICIPANTS:A total of 15 969 participants (women=49.4%, sample-weighted average age=51.9). PRIMARY OUTCOME MEASURE:Public satisfaction with the healthcare system, defined as 'being satisfied' if a respondent's satisfaction score is ≥70 points. RESULTS:The 2-year mean of the satisfaction score of the sample is 68.5 out of 100 points and the score in 2015 is higher than 2013 by 3.5 points. Senior respondents (OR=1.19, p<0.001), rural respondents (OR=1.23, p=0.009) and those with higher socioeconomic status are more likely to report being satisfied. Internal migrants (OR=0.75, p<0.001) and those with a higher level of education are less likely to report being satisfied. Total health expenditure as percentage of gross domestic product and density of hospital beds have a significantly positive association with satisfaction (OR=1.13, p<0.001). Meanwhile, the government's share in total healthcare expenditures has a moderately negative association with satisfaction (OR=0.97, p<0.001). In rural areas, the density of hospital beds has a positive association with satisfaction (OR=1.26, p=0.002). The Northeast region and Shanghai (OR=0.49, p<0.001; OR=0.71, p=0.034) are less likely to report being satisfied and this remained unchanged in 2015. CONCLUSION:There are considerable disparities in public satisfaction with the healthcare system in China, associated with demographic and socioeconomic characteristics, regional locations, urban-rural environment, and regional health resource abundance. Actions are recommended to improve satisfaction with the public healthcare system, especially in the Northeast region of China.
10.1136/bmjopen-2019-034414
Satisfaction With Community Health Education Among Residents in China: Results From a Structural Equation Model.
Frontiers in public health
Background:Although community health education has drawn lots of attention from the public, evidence on resident satisfaction is still sparse. This study aims to explore the relationships among five dimensions (perceived quality, perceived value, public expectation, public trust, and public satisfaction) of satisfaction with community health education among Chinese residents. Methods:We constructed a theoretical public satisfaction model for community health education based on the American Customer Satisfaction Index (ACSI) model. There are five dimensions in the theoretical model, including public expectation, perceived quality, perceived value, public satisfaction, and public trust. We recruited 474 respondents from a quota sampling based on gender and age, and collected information on five dimensions of satisfaction with community health education. The relationships of the five dimensions were examined using structural equation model. Results:The mean scores of public expectation, perceived quality, perceived value, public satisfaction, and public trust for the participants were 11.44 (total 15), 123.89 (total 170), 14.18 (total 20), 10.19 (total 15), and 15.61 (total 20), respectively. We obtained a structural equation model with a good fitting degree. There was a direct effect of perceived quality on perceived value (γ = 0.85, < 0.01), public trust (γ = 0.81, < 0.01) and public satisfaction (γ = 0.58, < 0.01), and a direct effect of public expectation on public satisfaction (γ = 0.36, < 0.01) and perceived value (γ = 0.25, < 0.01). Conclusions:We provide a good tool to measure public satisfaction with community health education, which can be potentially used to measure public satisfaction and improve the effectiveness of health education.
10.3389/fpubh.2022.905952
Influencing Factors of Public Satisfaction with COVID-19 Prevention Services Based on Structural Equation Modeling (SEM): A Study of Nanjing, China.
International journal of environmental research and public health
Service satisfaction with public policies is an important component of public service quality management, which is of great significance to the improvement of public service quality. Based on an online questionnaire survey and in combination with the characteristics of public policies and services, in this study the influencing factors of residents' satisfaction with COVID-19 pandemic prevention services were analyzed with structural equation modeling. The results reveal that the data fit the model well, and all the hypotheses formulated in this study were supported. Among the factors that were found to directly affect residents' satisfaction with pandemic prevention services, perceived quality (PQ) has the greatest impact on satisfaction, followed by the disaster situation (DS) and policy expectation (PE). The observed variables that have significant impacts on the latent variables were also explored. Regarding the main findings, the residents who were seriously affected by the pandemic tended to have lower satisfaction with the policies and services provided by the government. Moreover, the improvement of PQ was found to significantly increase pandemic prevention service satisfaction (SS). Finally, the residents with a good psychological status during the pandemic were found to have higher satisfaction. According to the results, implications for the prevention and control practices of similar public health emergencies are proposed.
10.3390/ijerph182413281
Assessment of the satisfaction with public health insurance programs by patients with chronic diseases in China: a structural equation modeling approach.
Geng Jinsong,Chen Xiaowei,Shi Jianwei,Bao Haini,Chen Qian,Yu Hao
BMC public health
BACKGROUND:China has successfully sustained its universal health insurance coverage over the past decade. Although patient satisfaction has been recognized as an important indicator to measure the performance of insurance programs in China, there is a lack of evidence on how patients with chronic diseases are satisfied with China's public health insurance programs and whether their satisfaction differs by type of insurance. We aimed to fill the evidence gap. METHODS:We established a hypothetical model that comprised patients' awareness of insurance policies, the fulfillment of patients' expectations of insurance benefits, patients' perceived value of health insurance coverage, patients' satisfaction with health insurance programs, patients' complaints, and trust in health insurance programs. We performed a confirmatory factor analysis by using a structural equation modeling (SEM) approach to examine the hypothesized model. A model-testing survey in 10 tertiary hospitals was conducted between June and October 2018, with a valid sample of 922 insured patients with chronic diseases. RESULTS:The SEM model, with good fit indices, showed that patients' awareness of health insurance policies, insurance program's fulfillment of expectations, and patients' perceived value of insurance coverage, positively predicted patient satisfaction (P < 0.01). The fulfillment of patients' expectations of insurance benefits was the major predictor of satisfaction with health insurance (coefficient = 0.593, P < 0.001), while the patients' perceived value of insurance coverage had the largest impact on their trust in health insurance (coefficient = 0.409, P < 0.01). Compared to patients with Urban-Rural Resident Basic Medical Insurance, Urban Employee Basic Medical Insurance enrollees had a higher degree of satisfaction with insurance on average (P < 0.01). Despite differences in the degree of satisfaction, the main findings from the SEM were also proved by the multi-group analysis. CONCLUSIONS:Our findings highlight the importance of incorporating patients' perceived value as part of the ongoing efforts to increase satisfaction with health insurance by patients, especially those who have chronic diseases. Policymakers are also suggested to formulate evidence-informed reimbursement policies that meet patients' expectations.
10.1186/s12889-021-11947-7
The impact of social determinants of health on the overall wellbeing of children: A review for the pediatric surgeon.
Perez Numa P,Ahmad Hira,Alemayehu Hanna,Newman Erika A,Reyes-Ferral Cynthia
Journal of pediatric surgery
Disparities in health care access, quality, and outcomes for pediatric patients, and their relationship to race and socioeconomic status (SES) have been extensively documented. The underlying causes behind such disparities have been less carefully studied, as clinicians and researchers often fail to look past immutable features such as race, into modifiable factors like social determinants of health (SDOH). A child's environment affects their patterns of social engagement, sense of security, and overall well-being. Resources such as affordable housing, access to education, public safety, and availability of healthy foods and safe play spaces impact and enhance quality of life, and have significant influence on both health and health care outcomes. These upstream indicators are often unrecognized or misidentified as health concerns. Few pediatric surgery publications discuss SDOH and their effects on children. This paper aims to introduce the five domains of SDOH (economic stability, education, social and community context, health and healthcare, and neighborhood and built environment) along with strategies to identify and address needs in these domains from a provider, hospital, and health system's perspective. It is anticipated that this information will serve as a foundation for pediatric surgeons to understand and develop processes that ameliorate disparities related to SDOH and improve surgical outcomes and the well-being of all children.
10.1016/j.jpedsurg.2021.10.018
Relationship between subjective socioeconomic status and sense of gain of health-care reform and the mediating role of self-rated health: a cross-sectional study in China.
BMC public health
BACKGROUND:The sense of gain has gradually become the main evaluation index for the effectiveness of China's deepening reform and is affected by many factors. However, there is no relevant research on the sense of gain of health-care reform (SGHR) and its influencing factors. The purpose of this study was to explore the influence of subjective socioeconomic status (SSS) on SGHR and the mediating role of self-rated health (SRH) between them. METHODS:Data (25,149 samples total) from China Family Panel Studies (CFPS) in 2018 were included in the analysis. A nonparametric test was used to explore the differences in demographic characteristics of SGHR, and a correlation analysis and mediating effect model were used to explore the influence of SSS on SGHR and the mediating effect of SRH. RESULTS:Demographic characteristics such as age, urban and rural areas, educational background, marriage and choice of medical treatment had significant differences in the distribution of perceived acquisition of medical reform. SSS, SRH and SGHR are statistically positively correlated with each other. SSS has a positive statistical correlation with SGHR, and may have an indirect effect through SRH. CONCLUSIONS:SSS is an important predictor of SGHR, and SRH may play a partially mediating role in SGHR.
10.1186/s12889-022-13106-y
Does City Public Service Distance Increase Sense of Gain to Public Health Service? Evidence from 1394 Migrant Workers in Six Provinces.
International journal of environmental research and public health
Increasing the well-being of migrant workers is one of the key objectives of promoting equality and safe, people-oriented, and sustainable social development, as well as inclusive globalization. With the equalization reform of the public health system and the reduction of frictions between cities, the well-being of the sense of gain to public health service (SGPHS) of migrant workers has attracted widespread attention. Based on the migrant worker thematic survey data in 2017 and the city statistical data in six destination cities, this study constructed and measured the sense of gain to public health service index and city public service distance index, and then studied the effects of city public service distance on the SGPHS of migrant workers and the heterogeneous effect. The results showed that the SGPHS of Chinese migrant workers is at a moderate level and presents spatial differences. Under the dual mechanism of preference reinforcement effect and public service discount effect, the effect of city public service distance on the SGPHS of migrant works shows an inverted U-shaped relationship, and the results of the endogeneity test by the generalized propensity score matching model are robust. The city public service distance has a significant non-linear effect on the public health service accessibility and provision for migrant workers, as well as on second-generation, low-income migrant workers, and migrant workers in central and western regions. The results provide beneficial insights for the formulation of rational public service policies.
10.3390/ijerph19106131
The Mediating Effect of Community Identity between Socioeconomic Status and Sense of Gain in Chinese Adults.
Wang Yanli,Yang Chao,Hu Xiaoyong,Chen Hong
International journal of environmental research and public health
BACKGROUND:Several studies have explored the positive relationship between socioeconomic status and sense of gain. However, little is known about the underlying mechanism between them. This study aimed to explore whether community identity had a mediating role between them among Chinese adults. METHODS:Data were collected from a nationally representative samples of 28,300 adults from the China Family Panel Studies. Socioeconomic status was assessed using individuals' income and social status. Community identity was assessed through evaluation of the community's public facilities, surrounding environment, surrounding security, neighborhood relationship, neighborhood assistance and feelings towards the community. Sense of gain was measured by evaluation of environmental conservation, gap between the rich and the poor, employment, education, medical treatment, housing, social security, and government corruption. Pearson's correlation was used to examine the associations between major variables. Mediation analyses were performed to explore the mediating role of community identity between socioeconomic status and sense of gain. RESULTS:Socioeconomic status was positively associated with sense of gain. Community identity played a mediating role between socioeconomic status and sense of gain. CONCLUSION:Community identity mediated the relationship between socioeconomic status and sense of gain. Promoting the mobility of socioeconomic status and actively intervening in community identity are conducive to improve sense of gain.
10.3390/ijerph17051553