Community resource program linked to better health of food-insecure children
A low-intensity program that “prescribes” community resources to a hospitalized child’s parents or caregivers has proven to reduce acute healthcare use for kids in food-insecure families in the following year. The clinical study notes this solution could save thousands of dollars in healthcare expenditures while only demanding “minutes of staff time” per family.
Over three years, researchers from the University of Chicago Medical Center, US, provided 640 food-secure and food-insecure parents and other primary caregivers of hospitalized children with standard care only or additional support in a CommunityRx-Hunger intervention.
The second group received education about common social conditions, personalized information about local resources, and ongoing support with automated, proactive text messages for three months. Support was also available for participant-initiated requests for up to one year.
A year after the intervention, 30% of food-insecure children with a parent in the CommunityRx-Hunger program required an emergency visit, versus 52% in the standard care group. In addition, there were fewer hospital readmissions, particularly for children of parents who requested additional resource information.
“Across history, doctors have always treated patients with consideration for the realities of their everyday lives,” says first author Stacy Lindau, professor of Obstetrics and Gynecology at UChicago Medicine.
“Today, with digital medical records and community resource referral technology in our workflow, clinicians can easily connect patients to vital community resources for wellness, disease self-management, and caregiving. This study finds that using a few minutes as part of the hospital discharge process to connect families to health-promoting resources in the community is good for kids and likely sustainable since it may lower healthcare costs.”
Universal delivery
The double-blind, randomized study, published in JAMA Pediatrics, took a universal approach to social care by enlisting food-secure and insecure families.
“Although our findings corroborate prior studies in other populations, this is — to our knowledge — the first double-blind randomized trial in the social care field,” says Lindau.
“This gold-standard evidence builds confidence that a relatively low-intensity and highly scalable social care intervention using technologies widely used across the US healthcare system actually can reduce costly acute healthcare utilization.”
Participants received automated texts with reminders and new links over three months, and could ask people for support up to one year.Caregivers in the CommunityRx-Hunger group received a customized HealtheRx printout listing available food pantries, rental assistance agencies, transportation aid, and other resources in their community.
Over three months, they received reminders and fresh links through an automated texting system while receiving human responses from a navigator if they replied to a text. The proactive texts stopped after three months, but caregivers could reach out to navigators for a year.
However, the researchers note that the intervention had “no significant impact” on caregiver self-efficacy for finding resources 12 months after hospital discharge — this was similar across the standard care and intervention groups.
Meanwhile, previous findings in other CommunityRx trials showed that participants used their HealtheRx list to connect others to local resources. According to the researchers, a universally delivered program can have ripple effects on communities, keeping children healthier, reducing stress among caregivers, and making hospitalizations less crowded.
Healthcare use reductions
The researchers say that food insecurity is the most prevalent social condition that compromises child and adult health. Of the 640 participants, 223 parents and caregivers reported food insecurity the year before admission.
Parents and caregivers received an overview of available food pantries, rental assistance agencies, transportation aid, and other resources.Three months after their intervention, 69% of food-insecure caregivers who received CommunityRx-Hunger rated their child’s health as “excellent or very good,” compared with 45% of participants receiving standard care.
Compared to previous community resource-focused interventions, the study required much less human effort for similar results. For example, in an earlier study, social work teams made home visits and attended clinic appointments, taking up to five hours of staff time per family. The researchers say CommunityRx-Hunger required around 50 staff hours for the entire intervention group of 320 parents and other caregivers.
“We achieved a very similar magnitude of impact on acute health care utilization reduction with this very low-intensity approach, an important advance toward sustainability,” says Lindau.
The team estimates that their intervention saved around US$3,000 per food-insecure child. They estimated this by applying a national average for pediatric emergency department and inpatient costs to the utilization counts reported by families.
According to the researchers, replicating the program on a larger scale is “highly feasible” because many US health systems already license community-resource referral platforms and patient texting tools.
After three months, 69% of food-insecure caregivers with community resource access rated their child’s health as “excellent or very good.”They envision a standard hospital discharge process that includes medications, follow-up appointments, and information about healthful community resources pinged to a parent’s or caregiver’s phone.
Screening for social drivers
The study authors note that their universally delivered program could offer an important solution to address health-related conditions without screening for social drivers of health, such as food security. They point to a recent proposed rule by the US Centers for Medicare and Medicaid Services to remove directives for hospitals to screen for such social drivers.
Co-author Jennifer Makelarski, Ph.D., an epidemiologist who is the analyst team lead for CommunityRx, comments: “If we limited the intervention only to those families who screened positive for food insecurity, many critical needs could have gone unaddressed.”
“In this study, one-third of food-secure parents in the intervention group reached out for additional resources, a similar rate as we saw among food-insecure parents, sometimes for urgent needs like a mental health crisis, a safety concern, and emergency housing.”
Lindau adds: “This finding drives home the fact that social risks are states, not traits. People move in and out of social risk, and a child’s hospitalization can be the trigger.”
Meanwhile, the US Department of Agriculture reported growing food insecurity among US households from 2022 to 2023, while almost 42% of insecure households did not participate in one of the country’s main nutrition programs. Moreover, recent budget cuts are threatening nutrition programs and Medicaid healthcare coverage.
