Reducing Socioeconomic Disparities in Health at Pediatric Visits
Grant #: 1R01MD007793
PI: Arvin Garg, MD, MPH
Project Period: 7/10/2014-3/31/2020
Description: This research project aims 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.
This study tests the effectiveness of a further strengthened and augmented WE CARE model on provider referrals and family receipt of resources, along with its impact on child health, health care utilization, and developmental outcomes. Finally, we gathered information from stakeholders at the health centers in order to learn more about the facilitators and barriers to implementation of the model.
The study took place at six community health centers in the Greater Boston area. The centers were randomized to either an intervention or control site. Data is being collected on referrals, receipt of resources, and child outcomes from the child's electronic health record (EHR) from birth to age 3. Focus groups and one on one interviews will be used to gather implementation data from 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) a peer patient navigator who assists 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.
Implementing an Intervention to Address Social Determinants of Health in Pediatric Practices
Grant #: 1R01HD090191
PI: Arvin Garg, MD, MPH
Project Period: 7/20/2017-4/30/2022
Description: A Hybrid Type 2 effectiveness-implementation trial with stepped wedge cluster RCT design will be used to test the effectiveness, implementation and sustainability of WE CARE. Practices will be randomized to receive either on-site or distance learning training for WE CARE procedures. Each site will have three phases to measure implementation and sustainability of the WE CARE screening and referral program. We will collect data from reviews of patient medical records, index and follow-up questionnaires of parents, and surveys and key informant interviews with pediatric practitioners and office staff.
This multi-site trial will take place in 18 practices nationwide, including 6 from the Academic Pediatric Association’s (APA) Continuity Research Network (CORNET) and 12 from the American Academy of Pediatrics’ (AAP) Pediatric Research in Office Settings (PROS) Network.
Understanding and Addressing the Social Determinants of Health for Families of Children with Sickle Cell Anemia within Pediatric Hematology
Grant #: 1R01HL141774
PIs: Arvin Garg, MD, MPH and Patricia L Kavanagh, MD
Project Period: 5/16/2019-2/28/2023
Description: Although pediatric professional guidelines are now recommending medical providers screen for SDOH, there is no evidence to date that SDoH screening improves the health of pediatric patients and studies have fallen short of exploring its impact on the health of children with medical complexity, including children with sickle cell anemia (SCA). This mixed-methods study aims to understand the implementation of Dr. Garg’s previously tested, efficacious SDOH screening and referral intervention in the outpatient pediatric hematology setting; qualitatively assess possible mechanisms for such interventions on improving child health; and obtain population-specific empirical estimates to plan a large-scale clinical trial.
The specific aims are to: (1) Implement WE CARE in two pediatric hematology clinics in order to field test key study logistics and understand the facilitators and barriers to implementation and accelerate its adoption; (2) Obtain population-specific empirical estimates of study parameters to plan a large-scale multi-site cluster RCT of WE CARE that will definitely assess its impact on improving health outcomes for children with SCA; and (3) Qualitatively assess possible mechanisms linking social determinants of health interventions to improved health outcomes.