Pediatric emergency department organization and social care practices among U.S. fellowship programs

Abstract

Background: Social care has become increasingly relevant to the emergency physician and includes activities that address health-related social risk and social needs. The literature has consistently documented substantial health care provider challenges in incorporating social care into routine practice. Yet, interventions on the health care organizational level hold promise to bring about more widespread, sustainable impact. Methods: This study was a subanalysis of the 2021 National Social Care Practices Survey data set among pediatric emergency medicine (PEM) program directors (PDs) and fellows. The purpose was to investigate the association between health care organizational factors and PEM physician social care practices and perceptions among PEM PDs and fellows. We performed binary and ordinal logistic regressions of organizational factors and five specific PEM physician social care perspective and practice outcomes. Results:The sample population included 153 physicians-44 PDs (49% response rate) and 109 fellows (28%). PDs and fellows with access to a social care systematic workflow in their pediatric emergency department (PED) had higher odds of comfort assessing social risk (odds ratio [OR] 2.1%, 95% confidence interval [CI] 1.1-4.0), valuation of social care (OR 3.2, 95% CI 1.3-7.9), preparedness to assist families (OR 2.4, 95% CI 1.1-5.2), screening tendency (OR 2.2, 95% CI 1.1-4.5), and ability to refer to community resources (OR 2.3, 95% CI 1.2-4.6). A similarly directed, but less pronounced pattern was noted with access to a community resource database for referrals and 24-h access to a social worker in the PED.

Social Care Education and Training Among US Pediatric Emergency Medicine Fellowship Programs

“…However, based on recent national data, only 21% of participating physicians had access to a community resource database in their ED and those with access had a 2.3 greater odds of referral activity. 16,21 Knowledge of referrals may be more dependent on organizational-level factors to support social care in the ED; however, education and training in social care may still be beneficial. Second, education and training may not be appropriately suited to the complexities of the community resource referral landscape, which demands up to date knowledge of eligibility criteria for services, specific services provided, and community agency availability.…”

“…16 With this study's findings in the context of contemporary literature, it seems that social care education and training are currently rooted outside of the common PEM fellowship experience. 7,10,11,16,[20][21][22][23][24][25][26][27] Among fellows who had received some education and training, the majority occurred during residency (92% and 90%, respectively), followed by medical school (82% and 48%, respectively). Compared with other results, this finding in particular seemed to be uniquely generational, as only 52% of PDs reported prior education and 7% prior training in social care, compared with 82% and 46% of fellows, respectively ( P < 0.001).…”

“…First, there may be differences in physician social care roles by institution such that personnel other than physicians (ie, social workers or community navigators) may perform referrals to social services. However, based on recent national data, only 21% of participating physicians had access to a community resource database in their ED and those with access had a 2.3 greater odds of referral activity 16,21 . Knowledge of referrals may be more dependent on organizational-level factors to support social care in the ED; however, education and training in social care may still be beneficial.…”

“…The first three of these assess physicians' social care perspectives, while the final two assess social care practice. Methods are similar to those outlined in a subanalysis of ED organizational factors using a dataset derived from the 2021 National Social Care Practices Survey 21 . The variables perceived value, preparedness, and comfort were assessed using a Likert scale of 5 items ranging from lower-scale to neutral to higher-scale optional responses.…”

“…Methods are similar to those outlined in a subanalysis of ED organizational factors using a dataset derived from the 2021 National Social Care Practices Survey. 21 The variables perceived value, preparedness, and comfort were assessed using a Likert scale of 5 items ranging from lower-scale to neutral to higher-scale optional responses. For these scales, responses were categorized as lower levels (composed of 2 lower-scale responses), neutral, and higher levels (composed of 2 higher-scale responses).…”