Predictors of Elevated Social Risk in Pediatric Emergency Department Patients and Families

Abstract

This study aimed to identify predictors of high unmet social needs among pediatric emergency department (ED) patients. We hypothesized that obesity, frequent nonurgent visits, reported food insecurity, or an at-risk chief complaint (CC) would predict elevated social risk. Methods:We administered a tablet-based survey assessing unmet social needs in 13 domains to caregivers of patients aged 0 to 17 years presenting to an urban pediatric ED. Responses were used to tabulate a social risk score (SRS). We performed multivariable logistic regression to measure associations between a high SRS (≥3) and obesity, frequent nonurgent visits, food insecurity, or an at-risk CC (physical abuse, sexual abuse, assault, mammalian bites, reproductive/sexual health complaints, intoxication, ingestion/ poisoning, psychiatric/behavioral complaints, or any complaint triaged as "least urgent").Results: Five hundred seventy caregivers completed the survey. Eighty-one percent reported at least one unmet social need, and 33% identified ≥3 social needs. Caregivers of patients with an at-risk CC had twice the odds of a high SRS (adjusted odds ratio [aOR], 1.8; 95% confidence interval [CI], 1.0-3.3). Caregivers of patients reporting food insecurity had 4 times the odds of a high SRS (aOR, 4.3; 95% CI, 2.5-7.3). Neither obesity (aOR, 1.5; 95% CI, 0.9-2.6) nor frequent nonurgent visits (aOR, 0.9; 95% CI, 0.4-1.9) were predictive of a high SRS.Conclusions: Unmet social needs are prevalent among caregivers of pediatric ED patients, supporting universal screening in this population. Patients with an at-risk CC or reported food insecurity might benefit from proactive intervention. Future studies should examine optimal methods for ED-based interventions that address social determinants of health.

Social determinants of health screening in pediatric healthcare settings

“…Liberman et al [51] demonstrated the pediatric ED setting could provide successful referrals as a result of screeners, with over 90% of families reporting satisfaction with services received. Although the ED offers one such potential setting for screening [52], these visits and provider relationships are limited to what is often a brief encounter.…”

Social care practices and perspectives among U.S. pediatric emergency medicine fellowship programs

“…Increased social needs screening in emergency departments (ED) is supported by recent literature reporting high rates of unmet social needs, their health and wellness impact, and numerous policy statements on poverty by the American Academy of Pediatrics (AAP) 1‐13 . Pediatric emergency physicians report a high perceived value of social needs screening and intervention, yet few feel prepared to address this need largely due to lack of time and training 11,14,15 .…”

“…Increased social needs screening in emergency departments (ED) is supported by recent literature reporting high rates of unmet social needs, their health and wellness impact, and numerous policy statements on poverty by the American Academy of Pediatrics (AAP). [1][2][3][4][5][6][7][8][9][10][11][12][13] Pediatric emergency physicians report a high perceived value of social needs screening and intervention, yet few feel prepared to address this need largely due to lack of time and training. 11,14,15 Rather than looking to advocacy efforts provided by individual health care workers, there is now a call for the integration of social care-services that address health-related social risk factors and social needs-into clinical practice and training at the health care system level.…”

Patient centered or provider centered? The inclusion of social determinants of health in emergency department billing and coding

“…2 Social risks (e.g., housing and food insecurity, inadequate access to preventative health care) are prevalent among emergency department (ED) patients. [3][4][5] Such social determinants of health are associated with poor health outcomes, including higher rates of ED utilization, hospitalization, and mortality. [6][7][8][9] By including social determinants of health in the assessment of medical complexity and risk, the new coding guidelines take an important step in recognizing the multifaceted care provided in the ED.…”

“…As providers of safety net health care, emergency medicine providers are intimately aware of the important role that social risk plays in patients' lives and, thus, in the medical decision‐making process 2 . Social risks (e.g., housing and food insecurity, inadequate access to preventative health care) are prevalent among emergency department (ED) patients 3–5 . Such social determinants of health are associated with poor health outcomes, including higher rates of ED utilization, hospitalization, and mortality 6–9 .…”