Prevalence of Social Risks on Inpatient Screening and Their Impact on Pediatric Care Use

Abstract

OBJECTIVES: Screening for social determinants of health in the inpatient setting is uncommon. However, social risk factors documented in billing and electronic medical record data are associated with increased pediatric care use. We sought to describe (1) the epidemiology of social risks and referral acceptance and (2) association between social risks identified through routine inpatient screening and care use. METHODS: Parents of children ages 0 to 18 admitted to a general pediatric floor at an academic children’s hospital completed a psychosocial screening survey from October 2017 to June 2019. The survey covered the following domains: finances, housing, food security, medications, and benefits. Patient characteristics and care use outcomes were abstracted from the electronic medical record and compared by using Pearson’s χ2 or the Wilcoxon rank test and logistic regression analyses. RESULTS: Of 374 screened families, 141 (38%) had a positive screen result, of whom 78 (55%) reported >1 need and 64 (45%) accepted a community resource. In bivariate analyses, patients with a positive screen result had higher 30-day readmission (10% vs 5%; P = .05), lower median household income ($62 321 vs $71 460; P < .01), lower parental education (P < .01), public insurance (57% vs 43%; P < .01), lived in a 1-parent household (30 vs 12%; P < .01), and had a complex chronic condition (35% vs 23%; P = .01) compared with those with a negative screen result. There was no difference in care reuse by screening status in adjusted analyses. CONCLUSIONS: Social risks are common in the pediatric inpatient setting. Children with medical complexity offer a good target for initial screening efforts.

Social determinants of health screening in pediatric healthcare settings

“…However, quantitative studies of screening effectiveness in the inpatient setting remain limited. The largest studies showed that about one-third of families were identified as having positive SDOH screens, and this was found to be increased in children with medical complexity [55,56]. Frequent and extended hospitalizations in children with medical complexity resulting in high per capita healthcare costs makes the inpatient setting an important opportunity to recognize and address SDOH.…”

Child Opportunity Index 2.0 and acute care utilization among children with medical complexity

“…For instance, despite higher socioeconomic status than parents of children with noncomplex chronic disease, parents of CMC more commonly report financial and social hardships 4 . Parents are also more likely to report health‐related social needs on routine inpatient screening 5 . CMC utilizes significantly more social work services in a medical setting than nonmedically complex children 6,7 .…”

“…4 Parents are also more likely to report health-related social needs on routine inpatient screening. 5 CMC utilizes significantly more social work services in a medical setting than nonmedically complex children. 6,7 Previous work has suggested that certain patient-or family-level factors like public insurance, non-White race, and barriers to consistent follow-up influence risk of preventable hospitalizations and more hospital bed-days.…”

Development and Validation of an Integrated Suite of Prediction Models for All-Cause 30-Day Readmissions of Children and Adolescents Aged 0 to 18 Years

“…This separation of models may explain why many of the SES factors we considered were not associated with readmission in final models, despite many prior studies demonstrating their importance as risk factors for pediatric readmission. 25 , 26 Many SES factors we considered are likely stable during a 6-month period and may not be relevant for those with preceding care, as for the RAM cohort. In fact, only Black race and Hispanic ethnicity were associated with lower readmission risk in the cohort without prior utilization (NAM).…”