Background: Patient navigation is increasingly being used by pediatric health care delivery systems to address patients’ unmet social needs. However, it is not known whether navigators working remotely can be as effective at linking families to community resources as on-site navigators. The aim of this study was to assess whether a patient navigator located on-site versus remotely is more likely to receive referrals from clinicians, successfully follow-up with patients, and assist families with enrollment in social needs resources. Methods: A patient navigator worked on-site and remotely as she divided her time between 4 federally qualified health centers (FQHCs) from May 2015 to June 2019. We conducted a 1-sample test of proportion comparing the proportion of on-site referrals made with the proportion of the week spent in each FQHC. To assess the impact of on-site versus remote referrals on number of contacts with a family, we conducted a 2-sample t test. We used chi-square testing to assess the effect of on-site versus remote status on resource enrollment. Results: Of the referrals (N = 414) made to the patient navigator, the majority were made through the electronic health record (83%) versus in person (17%) ( P < .0001). When the navigator was on-site, significantly more referrals were made than expected (45% vs 29%, P < .0001). Between remote and on-site referral groups, there was no significant difference in number of contact points (1.0 vs 1.1 points, P = .32) or in the proportion of families who received a resource (4.6% vs 5.1%, P = .31). Conclusion: Our results indicate that clinicians were significantly more likely to refer families to patient navigation if the navigator was on-site. The likelihood of having contact with the navigator and enrolling in a resource, however, did not differ between families referred when the patient navigator was on-site compared with remote.

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Background To examine the differential relationships between seven social risk factors (individually and cumulatively) with the prevalence and severity of asthma, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and overweight/obesity in children. Methods Using the 2017–2018 National Survey of Children's Health, we examined associations between social risk factors (caregiver education, caregiver underemployment, discrimination, food insecurity, insurance coverage, neighborhood support, and neighborhood safety) and the prevalence and severity of asthma, ADHD, ASD, and overweight/obesity. We used multivariable logistic regression to assess the relationship between individual and cumulative risk factors with each pediatric chronic condition, controlling for child sex and age. Results Although each social risk factor was significantly associated with increased prevalence and/or severity of at least one of the pediatric chronic conditions we investigated, food insecurity was significantly associated with higher disease prevalence and severity for all four conditions. Caregiver underemployment, low social support, and discrimination were significantly associated with higher disease prevalence across all conditions. For each additional social risk factor a child was exposed to, their odds of having each condition increased: overweight/obesity (aOR: 1.2, 95% CI: [1.2, 1.3]), asthma (aOR: 1.3, 95% CI: [1.2, 1.3], ADHD (aOR: 1.2, 95% CI: [1.2, 1.3]), and ASD (aOR: 1.4, 95% CI: [1.3, 1.5]). Conclusions This study elucidates differential relationships between several social risk factors and the prevalence and severity of common pediatric chronic conditions. While more research is needed, our results suggest that social risks, particularly food insecurity, are potential factors in the development of pediatric chronic conditions.

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