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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)).
Conclusion 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.
Trial registration number ClinicalTrials.gov Registry (NCT03461848).
- Healthcare quality improvement
- Health services research
- Paediatrics
Data availability statement
Data are available upon reasonable request. The datasets analysed during the current study are not publicly available as access is subject to approval. We will consider (via the corresponding author) requests for data sharing on an individual basis; however, we will be governed in respect of data sharing by the data owners and to the approval of ethics committees overseeing the use of these data sources.
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Data availability statement
Data are available upon reasonable request. The datasets analysed during the current study are not publicly available as access is subject to approval. We will consider (via the corresponding author) requests for data sharing on an individual basis; however, we will be governed in respect of data sharing by the data owners and to the approval of ethics committees overseeing the use of these data sources.
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Footnotes
Contributors EC conceptualised and designed the study, carried out the analysis, interpreted the findings, drafted the initial manuscript, wrote the final manuscript and led manuscript revisions. IW was principal investigator for the trial, contributed to the conception and design of the study and interpretation of findings, and wrote, reviewed, and edited the manuscript and its revisions. RL was external trial lead and contributed to the conception, design and interpretation of the study findings, reviewed and edited the manuscript and its revisions. JF, JN and NH contributed to the conception and design of the study, interpretation of the study findings and contributed to writing the manuscript. The lead author (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.
Funding This study was funded by Guy's & St Thomas' Foundation (HIF1080101KCL).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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