Abstract：
BACKGROUND: Early intervention for unmet needs is essential to improve health. Clear inequalities in healthcare use and outcomes exist. The Children and Young People\'s Health Partnership (CYPHP) model of care uses population health management methods to (1) identify and proactively reach children with asthma, eczema and constipation (tracer conditions); (2) engage these families, with CYPHP, by sending invitations to complete an online biopsychosocial Healthcheck Questionnaire; and (3) offer early intervention care to those children found to have unmet health needs. We aimed to understand this model\'s effectiveness to improve equitable access to care.
METHODS: We used primary care and CYPHP service-linked records and applied the same methods as the CYPHP\'s population health management process to identify children aged <16 years with a tracer condition between 1 April 2018 and 30 August 2020, those who engaged by completing a Healthcheck and those who received early intervention care. We applied multiple imputation with multilevel logistic regression, clustered by general practitioner (GP) practice, to investigate the association of deprivation and ethnicity, with children\'s engagement and receiving care.
RESULTS: Among 129 412 children, registered with 70 GP practices, 15% (19 773) had a tracer condition and 24% (4719) engaged with CYPHP\'s population health management system. Children in the most deprived, compared with least deprived communities, had 26% lower odds of engagement (OR 0.74; 95% CI 0.62 to 0.87). Children of Asian or black ethnicity had 31% lower odds of engaging, compared with white children (0.69 (0.59 to 0.81) and 0.69 (0.62 to 0.76), respectively). However, once engaged with the population health management system, black children had 43% higher odds of receiving care, compared with white children (1.43 (1.15 to 1.78)), and children from the most compared with least deprived communities had 50% higher odds of receiving care (1.50 (1.01 to 2.22)).
CONCLUSIONS: Detection of unmet needs is possible using population health management methods and increases access to care for children from priority populations with the highest needs. Further health system strengthening is needed to improve engagement and enhance proportionate universalist access to healthcare.
BACKGROUND: ClinicalTrials.gov Registry (NCT03461848).
METHODS: We used primary care and CYPHP service-linked records and applied the same methods as the CYPHP\'s population health management process to identify children aged <16 years with a tracer condition between 1 April 2018 and 30 August 2020, those who engaged by completing a Healthcheck and those who received early intervention care. We applied multiple imputation with multilevel logistic regression, clustered by general practitioner (GP) practice, to investigate the association of deprivation and ethnicity, with children\'s engagement and receiving care.
RESULTS: Among 129 412 children, registered with 70 GP practices, 15% (19 773) had a tracer condition and 24% (4719) engaged with CYPHP\'s population health management system. Children in the most deprived, compared with least deprived communities, had 26% lower odds of engagement (OR 0.74; 95% CI 0.62 to 0.87). Children of Asian or black ethnicity had 31% lower odds of engaging, compared with white children (0.69 (0.59 to 0.81) and 0.69 (0.62 to 0.76), respectively). However, once engaged with the population health management system, black children had 43% higher odds of receiving care, compared with white children (1.43 (1.15 to 1.78)), and children from the most compared with least deprived communities had 50% higher odds of receiving care (1.50 (1.01 to 2.22)).
CONCLUSIONS: Detection of unmet needs is possible using population health management methods and increases access to care for children from priority populations with the highest needs. Further health system strengthening is needed to improve engagement and enhance proportionate universalist access to healthcare.
BACKGROUND: ClinicalTrials.gov Registry (NCT03461848).
摘要：
背景：对未满足的需求进行早期干预对于改善健康至关重要。医疗保健使用和结果存在明显的不平等。儿童和青少年健康伙伴关系（CYPHP）护理模式使用人群健康管理方法（1）识别并主动接触哮喘儿童，湿疹和便秘(示踪剂状况)；(2)参与这些家庭，使用CYPHP，通过发送邀请来完成在线生物心理社会健康检查问卷;和（3）为那些被发现有未满足的健康需求的儿童提供早期干预护理。我们的目的是了解这种模式的有效性，以提高公平获得护理。
方法：我们使用了初级保健和CYPHP服务相关记录，并采用了与CYPHP的人口健康管理流程相同的方法，以识别2018年4月1日至2020年8月30日期间患有示踪剂状况的16岁以下儿童、通过完成健康检查参与的儿童和接受早期干预护理的儿童。我们应用了多重插补和多水平逻辑回归，由全科医生(GP)实践聚集，为了调查剥夺和种族之间的联系，与儿童的参与和接受照顾。
结果：在129412名儿童中，注册了70个GP实践，15％（19773）有示踪剂状况，24％（4719）从事CYPHP的人口健康管理系统。最贫困的孩子，与最贫困的社区相比，参与几率降低26%(OR0.74；95%CI0.62至0.87)。亚裔或黑人的孩子参与的几率降低了31%，与白人儿童（0.69（0.59至0.81）和0.69（0.62至0.76）相比，分别)。然而,一旦参与人口健康管理系统，黑人儿童接受护理的几率高出43%，与白人儿童(1.43(1.15至1.78))相比，与最贫困社区相比,最贫困社区的儿童接受护理的几率高出50%(1.50(1.01~2.22)).
结论：可以使用人口健康管理方法来检测未满足的需求，并增加来自需求最高的优先人群的儿童获得护理的机会。需要进一步加强卫生系统，以提高参与度，并提高普遍享有医疗保健的比例。
背景：ClinicalTrials.gov注册表（NCT03461848）。
方法：我们使用了初级保健和CYPHP服务相关记录，并采用了与CYPHP的人口健康管理流程相同的方法，以识别2018年4月1日至2020年8月30日期间患有示踪剂状况的16岁以下儿童、通过完成健康检查参与的儿童和接受早期干预护理的儿童。我们应用了多重插补和多水平逻辑回归，由全科医生(GP)实践聚集，为了调查剥夺和种族之间的联系，与儿童的参与和接受照顾。
结果：在129412名儿童中，注册了70个GP实践，15％（19773）有示踪剂状况，24％（4719）从事CYPHP的人口健康管理系统。最贫困的孩子，与最贫困的社区相比，参与几率降低26%(OR0.74；95%CI0.62至0.87)。亚裔或黑人的孩子参与的几率降低了31%，与白人儿童（0.69（0.59至0.81）和0.69（0.62至0.76）相比，分别)。然而,一旦参与人口健康管理系统，黑人儿童接受护理的几率高出43%，与白人儿童(1.43(1.15至1.78))相比，与最贫困社区相比,最贫困社区的儿童接受护理的几率高出50%(1.50(1.01~2.22)).
结论：可以使用人口健康管理方法来检测未满足的需求，并增加来自需求最高的优先人群的儿童获得护理的机会。需要进一步加强卫生系统，以提高参与度，并提高普遍享有医疗保健的比例。
背景：ClinicalTrials.gov注册表（NCT03461848）。
