title: Determinants of Health and Pediatric Primary Care Practices.
abstract: More than 20% of children nationally live in poverty. Pediatric primary care practices are critical points-of-contact for these patients and their families. Practices must consider risks that are rooted in poverty as they determine how to best deliver family-centered care and move toward action on the social determinants of health. The Practice-Level Care Delivery Subgroup of the Academic Pediatric Association's Task Force on Poverty has developed a roadmap for pediatric providers and practices to use as they adopt clinical practice redesign strategies aimed at mitigating poverty's negative impact on child health and well-being. The present article describes how care structures and processes can be altered in ways that align with the needs of families living in poverty. Attention is paid to both facilitators of and barriers to successful redesign strategies. We also illustrate how such a roadmap can be adapted by practices depending on the degree of patient need and the availability of practice resources devoted to intervening on the social determinants of health. In addition, ways in which practices can advocate for families in their communities and nationally are identified. Finally, given the relative dearth of evidence for many poverty-focused interventions in primary care, areas that would benefit from more in-depth study are considered. Such a focus is especially relevant as practices consider how they can best help families mitigate the impact of poverty-related risks in ways that promote long-term health and well-being for children.
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; andrew.beck1@cchmc.org.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Beck
authors.affiliation: Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland;
authors.forename: Megan M
authors.initials: MM
authors.lastname: Tschudy
authors.affiliation: Department of Pediatrics, David Geffen School of Medicine and Mattel Children's Hospital, Los Angeles, California;
authors.forename: Tumaini R
authors.initials: TR
authors.lastname: Coker
authors.affiliation: Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Agency for Healthcare Research and Quality; Rockville, Maryland.
authors.forename: Kamila B
authors.initials: KB
authors.lastname: Mistry
authors.affiliation: Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts;
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Cox
authors.affiliation: Department of Pediatrics, Children's National Health System; Washington, District of Columbia.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Gitterman
authors.affiliation: Department of Pediatrics, Lucile Packard Children's Hospital, Palo Alto, California;
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Chamberlain
authors.affiliation: Office of US Senator Brian Schatz (D-HI) and George Washington University School of Medicine and Health Sciences, Washington, District of Columbia;
authors.forename: Aimee M
authors.initials: AM
authors.lastname: Grace
authors.affiliation: Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts;
authors.forename: Michael K
authors.initials: MK
authors.lastname: Hole
authors.affiliation: Department of Pediatrics, New York University School of Medicine, New York, New York;
authors.forename: Perri E
authors.initials: PE
authors.lastname: Klass
authors.affiliation: Department of Pediatrics, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York;
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Lobach
authors.affiliation: Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, Oakland, California;
authors.forename: Christine T
authors.initials: CT
authors.lastname: Ma
authors.affiliation: Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;
authors.forename: Dipesh
authors.initials: D
authors.lastname: Navsaria
authors.affiliation: Department of Pediatrics, University of Kentucky College of Medicine, Lexington, Kentucky; and.
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Northrip
authors.affiliation: Department of Pediatrics, Baystate Children's Hospital, Springfield, Massachusetts.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Sadof
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
authors.forename: Anita N
authors.initials: AN
authors.lastname: Shah
authors.affiliation: Department of Pediatrics, New York University School of Medicine, New York, New York;
authors.forename: Arthur H
authors.initials: AH
authors.lastname: Fierman
mesh_terms: D002648:Child; D002662:Child Health Services; D003695:Delivery of Health Care / Q000458:organization & administration*; D006291:Health Policy; D006801:Humans; D010372:Pediatrics / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*