ImportanceMany known correlates of kindergarten readiness are captured in developmental and social screenings in primary care; little is known about how primary care data predicts school readiness.ObjectiveTo identify early Kindergarten Readiness Assessment (KRA) correlates by linking electronic health record (EHR) data with school district KRA data and to examine potential outcomes of the COVID-19 pandemic using KRA scores between 2018 and 2021.Design, Setting, and ParticipantsThis was a retrospective cohort study linking a large primary care practice (PCP) with school assessment data. Linkage used patient name, date of birth, and address. The setting was an urban school district and PCP affiliated with an academic medical center. Students had a KRA score from fall of 2018, 2019, or 2021 (no 2020 KRA due to the COVID-19 pandemic) and at least 1 prior well-child visit at the PCP.ExposuresExposures included year KRA administered, reported child race and ethnicity, child sex, interpreter for medical visits, child ever failed Ages & Stages Questionnaire (ASQ) 18 to 54 months, ever rarely read to, Medicaid status, food insecurity, housing insecurity, problems with benefits, and caregiver depressive symptoms.Main Outcomes and MeasuresKRA score (continuous), with a possible range of 0 to 300 (passing score = 270).ResultsA total of 3204 PCP patients (mean [SD] age, 67 [4] months; 1612 male [50.3%]; 2642 Black [82.5%]; 94 Hispanic [2.9%]; 244 White [7.6%]) were matched to their KRA score. Mean (SD) KRA scores were significantly lower in 2021 (mean [SD], 260.0 [13.0]; 214 of 998 [21.4%]) compared with 2019 (mean [SD], 262.7 [13.5]; 317 of 1114 [28.5%]) and 2018 (mean [SD], 263.5 [13.6]; 351 of 1092 [32.1%]), a pattern mirrored in the larger school district. In the linear regression final model (n = 2883), the following binary variables significantly lowered the child’s KRA score (points lowered [95% CI]) below a mean passing score of 270.8: child ever failed ASQ after 18 months (−6.7; 95% CI, −7.7 to −5.6), Medicaid insured (−5.7; 95% CI, −9.0 to −2.3), Hispanic ethnicity (−3.8; 95% CI, −6.9 to −0.6), requires interpreter (−3.6; 95% CI, −7.1 to −0.1), 2021 year (−3.5; 95% CI, −4.7 to −2.3), male sex (−2.7; 95% CI, −3.7 to −1.8), ever rarely read to (−1.5; 95% CI, −2.6 to −0.4), and food insecurity (−1.2; 95% CI, −2.4 to −0.1). Race, caregiver depression, housing insecurity, and problems receiving benefits were not associated with KRA scores in final model.Conclusions and RelevanceFindings of this cohort study suggest a deleterious association of the COVID-19 pandemic with early learning and development. There may be potential for PCPs and school districts to collaborate to identify and mitigate risks much earlier.

中文翻译：

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COVID-19 大流行之前和期间学校准备情况的早期相关性将健康和学校数据联系起来

重要性许多已知的幼儿园准备情况的相关因素都在初级保健的发展和社会筛查中得到体现；关于初级保健数据如何预测入学准备情况知之甚少。目的通过将电子健康记录 (EHR) 数据与学区 KRA 数据联系起来，确定早期幼儿园准备情况评估 (KRA) 的相关性，并使用 KRA 分数检查 COVID-19 大流行的潜在结果2018 年至 2021 年间。设计、设置和参与者这是一项回顾性队列研究，将大型初级保健实践 (PCP) 与学校评估数据联系起来。链接使用患者姓名、出生日期和地址。地点是一个城市学区和附属于一个学术医疗中心的 PCP。学生自 2018 年、2019 年或 2021 年秋季起获得 KRA 分数（由于 COVID-19 大流行，没有 2020 年 KRA），并且之前至少有 1 次在 PCP 进行儿童健康检查。暴露暴露包括 KRA 管理年份、报告的儿童种族和民族、 儿童性行为、医疗访问翻译、儿童曾经失败过年龄和年龄；阶段问卷 (ASQ) 18 至 54 个月，很少读到医疗补助状况、食品不安全、住房不安全、福利问题和护理人员抑郁症状。主要结果和措施 KRA 评分（连续），可能范围为 0 到 300 （通过分数 = 270）。结果共有 3204 名 PCP 患者（平均 [SD] 年龄，67 [4] 个月；1612 名男性 [50.3%]；2642 名黑人 [82.5%]；94 名西班牙裔 [2.9%]；244 名白人 [ 7.6%]）与其 KRA 分数相匹配。与 2019 年相比（平均 [SD]，262.7 [13.5]；1114 人中的 317 人 [28.5%]），2021 年 KRA 平均得分显着降低（平均 [SD]，260.0 [13.0]；998 人中的 214 人 [21.4%]） ]）和 2018 年（平均值 [SD]，263.5 [13.6]；1092 中的 351 [32.1%]），这一模式反映在较大的学区。在线性回归最终模型 (n = 2883) 中，以下二元变量显着降低了孩子的 KRA 分数（分数降低了 [95% CI]），低于平均通过分数 270.8：孩子在 18 个月后未通过 ASQ（−6.7； 95% CI，-7.7 至 -5.6)，医疗补助保险（-5.7；95% CI，-9.0 至 -2.3），西班牙裔（-3.8；95% CI，-6.9 至 -0.6），需要口译员（-3.6） ；95% CI，-7.1 至 -0.1），2021 年（-3.5；95% CI，-4.7 至 -2.3），男性（-2.7；95% CI，-3.7 至 -1.8），很少阅读（-1.5；95% CI，-2.6 至 -0.4），粮食不安全（-1.2；95% CI，-2.4 至 -0.1）。最终模型中的种族、看护者抑郁、住房不安全和领取福利问题与 KRA 分数无关。结论和相关性 这项队列研究的结果表明，COVID-19 大流行与早期学习和发展存在有害关联。PCP 和学区可能有潜力合作，更早地识别和减轻风险。