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

Author:

Fritz Cristin. Q.12,Thomas Jacob3,Gambino Jessica4,Torok Michelle5,Brittan Mark S.346

Affiliation:

1. Monroe Carell Jr Children’s Hospital at Vanderbilt, Nashville, Tennessee;

2. Department of Pediatrics, School of Medicine, Vanderbilt University, Nashville, Tennessee;

3. Adult and Child Consortium for Health Outcomes Research and Delivery Science and

4. Children’s Hospital Colorado, Aurora, Colorado; and

5. Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado

6. Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado

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.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics,General Medicine,Pediatrics, Perinatology and Child Health

Reference54 articles.

1. World Health Organization. Social determinants of health. Available at: www.who.int/social_determinants/en/. Accessed August 31, 2018

2. Cumulative social disadvantage and child health;Bauman;Pediatrics,2006

3. Influence of multiple social risks on children’s health;Larson;Pediatrics,2008

4. Poverty and childhood chronic illness;Newacheck;Arch Pediatr Adolesc Med,1994

5. The effects of poverty on children;Brooks-Gunn;Future Child,1997

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