Screening for Social Determinants of Health in Hospitalized Children

Abstract

Outpatient screening for social determinants of health (SDH) improves patient access to resources. However, no studies have examined if and how inpatient pediatric providers perform SDH screening. We aimed to identify inpatient pediatric provider screening practices for SDH, barriers to screening, and the acceptability of screening for hospitalized patients. METHODS: We conducted a multicenter descriptive study at 4 children's hospitals surveying inpatient hospitalists and nurses on the general wards about their SDH screening practices. A survey instrument was developed on the basis of literature pertaining to SDH, content expert review, cognitive interviews, and survey piloting. Descriptive statistics and logistic regression analyses are reported. RESULTS: Results from 146 hospitalists and 227 nurses were analyzed (58% and 26% response rate, respectively). Twenty-nine percent of hospitalists and 41% of nurses reported screening for $1 SDH frequently or with every hospitalized patient. Only 26% of hospitalists reported consistently communicating SDH needs with primary care providers. Most respondents (97% of hospitalists and 65% of nurses) reported they do not use a specific screening tool, and only 34% of hospitalists and 32% of nurses reported feeling competent screening for SDH. Lack of time, resources, and a standardized inpatient screening tool were reported as barriers to screening. CONCLUSIONS: Hospitalization provides an opportunity for SDH screening and connecting patients to resources; however, a minority of pediatric providers currently report screening. Professional development activities training inpatient providers in SDH screening, using a screening instrument, and communicating identified needs to primary care providers may improve the effectiveness of SDH screening in the hospital.

Structural and social determinants of mental health inequities among collegiate athletes during the COVID-19 pandemic

“…This is an approach gaining traction in healthcare settings. 36 Social workers or others with skills in care coordination or patient navigation can then help connect individuals with the necessary resources that are available on their campus and in their community. Such an approach is broadly consistent with evidence in other domains about the benefits of intervening on contextual factors that shape primary routines in times of stress.…”

Redesigning Care of Hospitalized Young Adults With Chronic Childhood-Onset Disease

“…Despite a study reporting that only 38% of pediatric hospitals perform inpatient transition initiatives [15], we found that transition-specific interventions during hospitalization were possible, including administration of the TRAQ and providing education, instruction, and goal-setting based on responses. Similarly, although SDHs are rarely screened for during hospitalization, we were able to implement screening on our patients [16][17][18].…”

Implementing a Process for Screening Hospitalized Adults for Food Insecurity at a Tertiary Care Center

“…[13][14][15] In primary care and emergency department settings, [16][17][18][19] SDoH screening is often performed by medical assistants, medical students, or nurses early during a patient encounter; a positive screen generates an electronic health record (EHR) order set visible to a provider, who then provides a patient with appropriate community resources and referrals. Previous models have suggested that screening tools should be integrated into the EHR [16][17][18][19][20] and screening should be made a formal part of the patient registration or rooming process, with tasks assigned to a specific care team member. 19 At this time, food insecurity screening is less established in hospital settings compared to ambulatory care settings.…”