Using State Administrative Data to Identify Social Complexity Risk Factors for Children

Abstract

PURPOSE Screening for social determinants of health is challenging but critically important for optimizing child health outcomes. We aimed to test the feasibility of using an integrated state agency administrative database to identify social complexity risk factors and examined their relationship to emergency department (ED) use. METHODSWe conducted a retrospective cohort study among children younger than 18 years with Washington State Medicaid insurance coverage (N = 505,367). We linked child and parent administrative data for this cohort to identify a set of social complexity risk factors, such as poverty and parent mental illness, that have either a known or hypothesized association with suboptimal health care use. Using multivariate analyses, we examined associations of each risk factor and of number of risk factors with the rate of ED use. RESULTSNine of 11 identifiable social complexity risk factors were associated with a higher rate of ED use. Additionally, the rate increased as the number of risk factors increased from 0 to 5 or more, reaching approximately twice the rate when 5 or more risk factors were present in children aged younger than 5 years (incidence rate ratio = 1.92; 95% CI, 1.85-2.00) and in children aged 5 to 17 years (incidence rate ratio = 2.06; 95% CI, 1.99-2.14).CONCLUSIONS State administrative data can be used to identify social complexity risk factors associated with higher rates of ED use among Medicaid-insured children. State agencies could give primary care medical homes a social risk flag or score to facilitate targeted screening and identification of needed resources, potentially preventing future unnecessary ED use in this vulnerable population of children. 2018;16:62-69. https://doi.org/10.1370/afm.2134. Ann Fam Med INTRODUCTIONI n light of the strong evidence that exposure to social adversity in childhood is linked to poor child and adult health outcomes, 1-4 systematic strategies are needed to identify children at risk in order to provide appropriate referrals and services. Adverse childhood experiences, originally described by Felitti et al, 4 include family-related risk factors such as mental illness of a household member and exposure to abuse or neglect. There is a compelling case for identifying and addressing adverse childhood experiences and other social determinants of health at the family level because supporting parents is often the starting point for supporting children. 5Pediatric primary care interventions have successfully identified children with adverse childhood experiences or other social determinants of health, typically through parent report on a questionnaire. Subsequent intervention usually involves providing referrals to a social worker or appropriate community, hospital, or government programs, such as the Supplemental Nutrition Assistance Program, housing programs, utility bill assistance programs, transportation assistance, childcare providers, legal services, shelter arrangements, tax preparation support, or help in completing benefits forms ...

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