In a new clinical study published in JAMA Pediatrics, researchers at the University of Chicago Medicine found that a low-intensity program that “prescribes” community resources to every parent or other primary caregiver of a hospitalized child reduced the use of acute care for children of food-insecure families in the following year, saving potentially thousands of dollars in healthcare expenditures while demanding little more than minutes of staff time per family.
“Across history, doctors have always treated patients with consideration for the realities of their everyday lives,” said first author Stacy Lindau, MD, the Catherine Lindsay Dobson 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."
A simple prescription for social needs
Over three years, Lindau’s team randomized 640 parents and other primary caregivers of children hospitalized at an urban pediatric hospital to one of two arms in the trial. Half of those who enrolled received usual discharge instructions, while the other half also received an intervention called CommunityRx-Hunger, the pediatrics arm of the larger CommunityRx program. Rather than restricting the study group only to parents who screened positive for social risks or needs, all were eligible. Food secure and food insecure parents in the intervention arm received the intervention — a universal approach to social care.
In the CommunityRx-Hunger group, each caregiver received a customized “HealtheRx” printout listing food pantries, rental-assistance agencies, transportation aid and other resources in their specific community. For the next three months, an automated texting system sent reminders and fresh links; caregivers who replied to the texts got a human response from a navigator. Caregivers could reach out to navigators for a full year, but the proactive pings stopped after month three.
Importantly, neither families nor research staff knew who received the intervention versus standard care.
“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,” Lindau said. “This gold-standard evidence builds confidence that a relatively low intensity and highly scalable social care intervention using technologies that are widely used across the U.S. healthcare system actually can reduce costly acute healthcare utilization."
Major reductions in acute healthcare use
In their primary analysis, investigators focused on the 223 parents and other caregivers who reported food insecurity in the year before admission, because food insecurity is the most prevalent social condition known to compromise both child and adult health.
At the three-month checkpoint, 69% of food-insecure caregivers who received CommunityRx-Hunger rated their child’s health “excellent or very good,” compared with just 45% of those who received usual care. A year after receiving the intervention, only 30% of food-insecure children with a parent in the intervention group required an emergency visit, versus 52% in the standard care group. Hospital readmissions also trended downward, particularly for children of parents who requested additional resource information.
Previous community resource-focused interventions required more human effort. One hired social-work teams to make home visits and attend clinic appointments, logging up to five hours of staff time per family. In contrast, administering CommunityRx-Hunger intervention only required about 50 staff hours in total across the entire intervention group.
“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” Lindau said.
To estimate financial impact, the researchers applied national averages for pediatric ED and inpatient costs to the utilization counts reported by families. The difference came to roughly $3,000 saved per food-insecure child, easily eclipsing the modest expense of automated texting and navigator time.
Benefits of universal delivery
These findings arrived just as the U.S. Centers for Medicare and Medicaid Services issued a proposed rule that included the removal of directives for hospitals to screen for social drivers of health. In the absence of such screening, universally-delivered programs like CommunityRx-Hunger offer an especially important solution to addressing health-related social conditions.
“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 really urgent needs like mental health crisis, a safety concern and emergency housing,” said co-author Jennifer Makelarski, PhD, MPH, an epidemiologist who is the analyst team lead for CommunityRx. "If we limited the intervention only to those families who screened positive for food insecurity, many critical needs could have gone unaddressed."
“This finding drives home the fact that social risks are states, not traits,” Lindau added. “People move in and out of social risk, and a child’s hospitalization can be the trigger.”
Lindau and Makelarski also pointed to previous findings that more than half of CommunityRx participants used their HealtheRx list to connect someone else to local resources, indicating that a universally-delivered program can have ripple effects on communities as a whole, helping keep children healthier, caregivers less stressed and hospitals less crowded.
Since many U.S. health systems already license community-resource-referral platforms and patient texting tools, replicating CommunityRx-Hunger on a larger scale is highly feasible. Someday, a standard discharge process at hospitals across the country could include not only medications and follow-up appointments but also information about healthful community resources — pinged straight to a patient or caregiver’s phone.
“Low-Intensity Social Care and Child Acute Health Care Utilization: A Randomized Clinical Trial” was published in JAMA Pediatrics in April 2025. The research was supported by funding from the National Institutes of Health (NIH)/National Institute on Minority Health and Health Disparities. Co-authors include Stacy Tessler Lindau, Jennifer A. Makelarski, Victoria A. Winslow, Emily M. Abramsohn, Veera Anand, Deborah L. Burnet, Charles M. Fuller, Mellissa Grana, Doriane C. Miller, Eva S. Ren, Elaine Waxman and Kristen E. Wroblewski.
Method of Research
Randomized controlled/clinical trial
Subject of Research
People
Article Title
Low-Intensity Social Care and Child Acute Health Care Utilization: A Randomized Clinical Trial
Article Publication Date
28-Apr-2025
Children with liver disease face dramatically higher risk of early death
Largest-ever study of pediatric MASLD reveals premature mortality rate 40 times higher than national average
University of California - San Diego
Researchers from University of California San Diego have found that children diagnosed with metabolic dysfunction-associated steatotic liver disease (MASLD) are at significantly increased risk of premature death and serious long-term health complications. The findings, published April 22, 2025 in Hepatology, the scientific journal of the American Association for the Study of Liver Diseases, come from the Longitudinal InVestigation Evaluating Results of Steatosis (LIVERS) study, which followed 1,096 children over an average of 8.5 years. Nearly half of all deaths in the cohort were liver-related, and the overall mortality rate was 40 times higher than that of similar peers in the general U.S. population.
“Every child or young adult who died was a tragedy,” said Jeffrey Schwimmer, M.D., professor of pediatrics at UC San Diego School of Medicine and director of the Fatty Liver Clinic at Rady Children’s Hospital. “MASLD poses a real and measurable threat to pediatric health. To truly change outcomes, we need better tools to diagnose this disease, treatments that work for children, and systems that ensure every child has access to that care.”
MASLD, formerly known as nonalcoholic fatty liver disease (NAFLD), is the most common chronic liver disease in children, affecting nearly 10% of all youth and up to 25% of those with obesity. The reclassification to MASLD reflects growing recognition that fatty liver disease in children is closely linked to metabolic dysfunction, including obesity, hypertension and type 2 diabetes. Yet despite its prevalence, little has been known about the long-term risks it poses to children.
The LIVERS study is the most comprehensive assessment to date of clinical outcomes in pediatric MASLD. Conducted at Rady Children’s Hospital, the retrospective cohort study used medical records and National Death Index data to follow children ages 2 to 18 who were diagnosed with MASLD between 2000 and 2017. Over an average of 8.5 years of follow-up, 3.4% of children had died — a mortality rate more than 40 times higher than expected based on national averages and more than 50 times higher than expected based on state averages. These mortality rates are far higher than what has been reported in children with obesity or type 2 diabetes alone, suggesting that MASLD may confer independent risk beyond associated metabolic conditions.
The risk of death was higher in certain children, especially boys and those with low levels of high-density lipoprotein (HDL), often called the “good” cholesterol. Nearly half of the deaths were caused by liver disease itself, while others were due to heart-related conditions, accidents or suicide.
In addition to the risk of early death, many children in the study developed serious health problems while still in their teens or twenties. These included high blood pressure (14%), obstructive sleep apnea (9.5%) and type 2 diabetes (7.3%). Problems with blood fats, such as high triglycerides or low HDL, were even more common — making dyslipidemia, the presence of abnormal levels of fats (lipids) in the blood, the most frequent complication overall.
While many children showed improvement with clinical care, a substantial portion still experienced disease progression. The findings highlight how much we have yet to learn about the natural course of MASLD in children and reinforce the need for better tools to detect, monitor and manage this condition.
“We have shown that MASLD in children is a serious disease with life-threatening potential,” Schwimmer said. “Our hope is that these findings lead to greater awareness and stronger investment in pediatric-specific diagnostics, treatments and systems of care. With the right tools and commitment, we can make a meaningful difference in outcomes.”
Future research is needed to identify which children are at highest risk for progression to cirrhosis and early death, and to determine how lifestyle, medication or surgical interventions might change the disease course. For now, researchers emphasize that early recognition, consistent follow-up and greater public and provider awareness remain critical to protecting the health of children with MASLD.
Link to full study.
Additional co-authors on the study include: Nhat Quang N. Thai, M.P.H., Sheila L. Noon, Patricia Ugalde-Nicalo, M.D., Sabina R. Anderson, Lauren F. Chun, M.D., Nidhi P. Goyal, M.D., Kimberly P. Newton, M.D., Eleanor G. Hansen, M.D., Bonnie Lin, Warren L. Shapiro, M.D., Andrew Wang, D.O., Elizabeth L. Yu, M.D., Cynthia A. Behling, M.D., Ph.D. from UC San Diego; and Rhys S. David from Rady Children’s Hospital.
The study was funded, in part, by the National Institutes of Health (UL1TR001442), the Rady Children’s Hospital San Diego Physician Fund and a research grant from Intercept Pharmaceuticals.
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