AbstractObjectiveUnplanned healthcare utilization after neonatal intensive care unit (NICU) discharge challenges families and healthcare systems. The impact of social needs on post-NICU healthcare utilization is underexplored. Our objective was to identify social needs among NICU graduates and examine associations between social needs and post-NICU healthcare utilization.Study designA prospective cohort design was used to screen for social needs and track healthcare utilization among 112 NICU graduates attending a NICU follow-up clinic (2021–2022).

摘要目的新生儿重症监护病房（NICU）出院后的非计划医疗利用对家庭和医疗保健系统提出了挑战。。我们的目标是确定NICU毕业生的社会需求，并研究社会需求与NICU后医疗保健利用之间的关联。研究设计采用前瞻性队列设计，对参加NICU后续诊所（2021-2022年）的112名NICU毕业生进行社会需求筛查和医疗保健利用追踪。

Associations between social needs and healthcare utilization were analyzed using non-parametric statistical tests.ResultsOf 112 patients screened, 20 (18%) had some social need. Infants with social needs experienced statistically significant higher rates of hospitalizations, overall encounters, and missed appointments.ConclusionSocial needs are associated with increased unplanned healthcare utilization and missed appointments.

使用非参数统计检验分析了社会需求与医疗保健利用之间的关联。结果筛查的112例患者中，20例（18%）有一定的社会需求。有社会需求的婴儿住院率，总体遭遇率和错过预约率在统计学上显着较高。结论社会需求与计划外医疗利用率增加和错过预约有关。

Addressing these needs during NICU follow-up may improve preventative care attendance and reduce unplanned healthcare use, leading to better outcomes for vulnerable infants and cost-savings for healthcare systems..

在新生儿重症监护病房随访期间满足这些需求可能会提高预防保健的出勤率，减少意外的医疗保健使用，从而为弱势婴儿带来更好的结果，并为医疗保健系统节省成本。。

IntroductionInfants requiring neonatal intensive care unit (NICU) care are more likely to experience increased healthcare utilization after discharge, causing stress for families and high costs for healthcare systems [1]. Clinical risk factors for increased healthcare utilization after a NICU stay include gestational age (with increased risk among very preterm and late preterm infants), bronchopulmonary dysplasia, and medical complexity [2].

引言需要新生儿重症监护病房（NICU）护理的婴儿出院后更有可能增加医疗保健利用率，给家庭带来压力，医疗保健系统成本高昂（1）。NICU住院后增加医疗保健利用率的临床危险因素包括胎龄（极早产儿和晚期早产儿的风险增加），支气管肺发育不良和医疗复杂性（2）。

Infants with Medicaid insurance also have increased frequency of readmissions; however, the drivers of this relationship are not well understood [2]. There is conflicting evidence as to whether race is associated with readmission rates [3,4,5]. Yet social and racial disparities, including black race (considered here as a proxy of structural racism), lower income, lower education, or living in an area with increased exposure to violence are associated with preterm birth and initial NICU hospitalization [6,7,8].

有医疗补助保险的婴儿再次入院的频率也有所增加；然而，这种关系的驱动因素尚不清楚（2）。。然而，社会和种族差异，包括黑人种族（这里被认为是结构性种族主义的代表），低收入，低教育，或生活在暴力暴露增加的地区，与早产和新生儿重症监护病房住院有关[6,7,8]。

Despite abundant research on the clinical risk factors associated with readmissions after NICU care, and social risk factors associated with initial NICU hospitalization, there remains limited study on the effects of social needs on healthcare utilization in infants that have graduated from the NICU.Social needs, also referred to in some studies as social risks, are associated with increased pediatric readmissions, emergency care utilization and decreased well child visits; addressing these needs is associated with increased preventative care in infants and decreased high cost healthcare use for some conditions, including asthma [9,10,11,12].

尽管对NICU护理后再入院相关的临床风险因素以及与初始NICU住院相关的社会风险因素进行了大量研究，但关于社会需求对NICU毕业婴儿医疗保健利用的影响的研究仍然有限。社会需求，在一些研究中也被称为社会风险，与儿科再入院率增加，急诊护理利用率和儿童就诊率下降有关；解决这些需求与增加婴儿的预防保健和减少某些疾病（包括哮喘）的高成本医疗保健使用有关[9,10,11,12]。

Social needs are an individual or family-level measure of social drivers of health (previously known as the social determinants of health), and include food, housing, transportation and u.

社会需求是衡量健康的社会驱动因素（以前称为健康的社会决定因素）的个人或家庭水平的指标，包括食物、住房、交通和美国。

Data availability

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Data will not be made publicly available as it contains sensitive information that may be used to identify patients. De-identified data may be made available upon request if approved by our IRB.

。如果我们的IRB批准，可以根据要求提供取消识别的数据。

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Code availability can be made available on written request from the authors.

可以根据作者的书面要求提供代码可用性。

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运输服务部卫生保健服务2023[可从：https://www.dhcs.ca.gov/services/medi-cal/Pages/Transportation.aspx.CalAIM:我们为所有卫生保健服务部门打造一个更健康的加利福尼亚之旅[可从以下网站获得：https://www.dhcs.ca.gov/calaim.Download参考文献致谢作者要感谢David Ming和Kevin Fiori在临床环境中进行社会需求筛查方面的指导。

Additionally, they would like to thank William Malcolm, director of the Special Infant Care Clinic for his support of this project, and Ashlea Ritson, nurse navigator, who was instrumental in making this project a success on the ground.FundingResearch was supported by Duke University, the Duke Endowment for the original funding of the Transitional Medical Home program, the UCLA National Clinician Scholars Program, and the Los Angeles County Department of Health Services.Author informationAuthors and AffiliationsUCLA National Clinician Scholars Program, Los Angeles, CA, USACecile L.

此外，他们还要感谢特别婴儿护理诊所主任威廉·马尔科姆（William Malcolm）对该项目的支持，以及护士导航员阿什莉亚·里森（Ashlea Ritson），他在该项目取得成功的过程中发挥了重要作用。基金研究得到了杜克大学、杜克基金会过渡医疗之家计划原始资金、加州大学洛杉矶分校国家临床医生学者计划和洛杉矶县卫生服务部的支持。。

YamaLos Angeles County Department of Health Services, Los Angeles, CA, USACecile L. YamaDuke Clinical Research Institute, Durham, NC, USARachel G. GreenbergDepartment of Pediatrics, Duke University School of Medicine, Durham, NC, USARachel G. Greenberg, Erika Johnson & Deesha D. Mago-ShahAuthorsCecile L.

加利福尼亚州洛杉矶市亚马洛杉机县卫生服务部，USACecile L.YamaDuke临床研究所，北卡罗来纳州达勒姆，USARCHEL G.Greenberg杜克大学医学院儿科，北卡罗来纳州达勒姆，USARCHEL G.Greenberg，Erika Johnson＆Deesha D.Mago Shahouthorscecile L。

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PubMed Google ScholarContributionsCY: Conceptualization, methodology, investigation and drafting and editing manuscript. RG: Methodology, statistical analysis and review of manuscript. EJ: Conceptualization and investigation. DMS: Conceptualization, supervision, and review of manuscript.Corresponding authorCorrespondence to.

PubMed谷歌学术贡献SCY：概念化，方法论，调查以及起草和编辑手稿。RG：方法论，统计分析和手稿审查。EJ：概念化和调查。DMS：稿件的概念化，监督和审查。对应作者对应。

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The authors declare no competing interests.

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Ethics approval and consent to participate

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This study was approved by the Institutional Review Board of Duke University, reference number Pro00108987. The study was performed in accordance with the Declaration of Helsinki. Need for informed consent was waived by the IRB, as screeners represented a new routine in clinical practice, and chart review presented minimal risk of harm to subjects..

这项研究得到了杜克大学机构审查委员会的批准，参考号为Pro00108987。这项研究是根据赫尔辛基宣言进行的。IRB放弃了知情同意的需要，因为筛查人员代表了临床实践中的新常规，图表审查对受试者的伤害风险最小。。

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