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Kopsombut G, Rooney-Otero K, Craver E, Keyes J, McCann A, Quach H, Shiwmangal V, Bradley M, Ajjegowda A, Koster A, Werk L, Brogan R. Characteristics Associated With Positive Social Determinants of Health Screening in Patients Admitted to Pediatric Hospital Medicine. Hosp Pediatr 2024:e2023007434. [PMID: 39370893 DOI: 10.1542/hpeds.2023-007434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/24/2024] [Accepted: 07/29/2024] [Indexed: 10/08/2024]
Abstract
BACKGROUND AND OBJECTIVE There is limited research on screening for social determinants of health (SDOH) in hospitalized pediatric patients. In this article, we describe patient characteristics related to SDOH screening in the hospital setting and examine relationships with acute care metrics. METHODS This is a retrospective cohort study. From July 2020 to October 2021, a 14-question SDOH screener was administered to families of patients admitted or transferred to the hospital medicine service. Information was collected regarding screen results, demographics, patient comorbidities, patient complexity, and acute care metrics. Unadjusted and multivariable analyses were performed using generalized estimation equation logistic regression models. RESULTS Families in 2454 (65%) patient encounters completed SDOH screening, with ≥1 need identified in 662 (27%) encounters. Families with significant odds for positive screening results in a multivariable analysis included primary language other than English (odds ratio [OR] 4.269, confidence interval [CI] 1.731-10.533) or Spanish (OR 1.419, CI 1.050-1.918), families identifying as "Black" (OR 1.675, CI 1.237-2.266) or Hispanic (OR 1.347, CI 1.057-1.717) or having a child on the complex care registry (OR 1.466, CI 1.120-1.918). A positive screening result was not associated with increased length of stay, readmission, or 2-year emergency department or acute care utilization. CONCLUSIONS In hospitalized pediatric patients, populations at the greatest odds for positive needs include families with primary languages other than English or Spanish, those that identified as certain races or ethnicities, or those having a child on the complex care registry. A positive SDOH screening result in this study was not associated with an increase in length of stay, readmission, or acute care utilization.
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Affiliation(s)
- Gift Kopsombut
- Department of Pediatrics, Division of Hospital Medicine
- Clinical Informatics
- University of Central Florida College of Medicine, Orlando, Florida
| | - Kathleen Rooney-Otero
- Department of Pediatrics, Division of Hospital Medicine
- University of Central Florida College of Medicine, Orlando, Florida
| | - Emily Craver
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, Florida
| | - Jonathan Keyes
- Department of Internal Medicine, Graduate Medical Education, Emory University, Atlanta, Georgia
| | - Amanda McCann
- Department of Pediatrics, Graduate Medical Education, Children's Hospital of Los Angeles, Los Angeles, California
| | - Helena Quach
- University of Central Florida College of Medicine, Orlando, Florida
| | | | - Morgan Bradley
- Florida State University College of Medicine, Tallahassee, Florida
| | - Ashwini Ajjegowda
- Holtz Children's Hospital, Jackson Memorial Hospital, Miami, Florida
| | - Alex Koster
- Value-Based Services Organization, Nemours Children's Health Florida, Orlando, Florida
| | - Lloyd Werk
- Value-Based Services Organization, Nemours Children's Health Florida, Orlando, Florida
- University of Central Florida College of Medicine, Orlando, Florida
| | - Ryan Brogan
- Department of Pediatrics, Division of Hospital Medicine
- University of Central Florida College of Medicine, Orlando, Florida
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Westphaln KK, Pike NA, Li VR, Spurrier R, Imagawa KK. Pediatric Hospital Admissions with Concern for Neglect: Correlations Between Neglect Types and Other Clinical and Environmental Risk Factors. Matern Child Health J 2024; 28:1539-1550. [PMID: 38904903 DOI: 10.1007/s10995-024-03936-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE Child neglect is a public health concern with negative consequences that impact children, families, and society. While neglect is involved with many pediatric hospitalizations, few studies explore characteristics associated with neglect types, social needs, and post-discharge care. METHODS Data on neglect type, sociodemographics, social needs, inpatient consultations, and post-discharge care were collected from the electronic medical record for children aged 0-5 years who were hospitalized with concern for neglect during 2016-2020. Frequencies and percentages were calculated to determine sample characteristics. The Chi-square Test for Independence was used to evaluate associations between neglect type and other variables. RESULTS The most common neglect types were inadequate nutrition (40%), inability to provide basic care (37%), intrauterine substance exposure (25%), combined types (23%), and inadequate medical care (10%). Common characteristics among neglect types included age less than 1 year, male sex, Hispanic ethnicity, public insurance, past involvement with Child Protective Services, and inpatient consultation services (social work, physical therapy, and occupational therapy), and post-discharge recommendations (primary care, physical therapy, and regional center). Neglect type groups varied by child medical history, social needs, and discharge recommendations. Statistically significant associations supported differences per neglect type. CONCLUSIONS Our findings highlight five specific types of neglect seen in an impoverished and ethnically diverse geographic region. Post-discharge care needs should focus on removing social barriers and optimizing resources, in particular mental health, to mitigate the risk of continued neglect. Future studies should focus on prevention strategies, tailored interventions, and improved resource allocations per neglect type and discharge location.
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Affiliation(s)
- Kristi K Westphaln
- University of California Los Angeles, School of Nursing, 700 Tiverton Ave, Factor Building Room 3-246, Los Angeles, CA, 90095, USA.
- Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Nancy A Pike
- University of California Los Angeles, School of Nursing, 700 Tiverton Ave, Factor Building Room 3-246, Los Angeles, CA, 90095, USA
- Children's Hospital Los Angeles, Los Angeles, CA, USA
- University of California Irvine, Sue and Bill Gross School of Nursing, 854 Health Sciences Hall, Office 4515, Irvine, United States
| | - Vincent R Li
- University of Madison School of Medicine and Public Health, Madison, WI, USA
| | - Ryan Spurrier
- Children's Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Karen Kay Imagawa
- Children's Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Gross E, Jakubowski E, Sahai S. Social Determinants of Health in Hospitalized Children. Pediatr Ann 2024; 53:e337-e344. [PMID: 39240180 DOI: 10.3928/19382359-20240703-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
It has long been established that the environment in which a child grows and develops shapes their social and health outcomes. After all, collecting social history is a key component of a health care visit. In recent decades, the importance of social determinants of health (SDOH) has been rediscovered, and the impact of adverse childhood experiences has garnered great attention. Estimates show that health outcomes are influenced more by factors outside of health care, such as our patients' SDOH. Addressing SDOH is fundamental for improving health and reducing longstanding inequities in health. While understanding that SDOH needs to be addressed through the continuum of pediatric care, this article will focus on SDOH in the pediatric inpatient setting. [Pediatr Ann. 2024;53(9):e337-e344.].
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Cordova-Ramos EG, Burke J, Sileo N, McGean M, Torrice V, Mantri S, Parker MG, Drainoni ML. "We Don't Want to Screen for the Sake of Screening": A Qualitative Evaluation of a Social Needs Screening and Referral Intervention in the NICU. J Perinat Neonatal Nurs 2024; 38:271-279. [PMID: 37773583 PMCID: PMC10972769 DOI: 10.1097/jpn.0000000000000766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
BACKGROUND Low uptake of social determinants of health (SDH) screening and referral interventions within neonatal intensive care units (NICUs) is partly due to limited understanding of the best procedures to integrate this practice into routine clinical workflows. PURPOSE To examine the feasibility and acceptability of an SDH screening and referral intervention in the NICU from the perspective of neonatal nurses; and to identify factors affecting implementation outcomes. METHODS We conducted 25 semistructured interviews with NICU nurses. We used the Promoting Action on Research Implementation in Health Services (PARiHS) framework to guide interview questions and codebook development for directed content analysis. Themes were mapped onto the 3 PARiHS domains of context, evidence, and facilitation. FINDINGS Analysis yielded 8 themes. Context : Nurses felt that stressors experienced by NICU families are magnified in a safety net environment. Nurses shared varying viewpoints of the roles and responsibilities for social care in the NICU, and feared that scarcity of community resources would make it difficult to address families' needs. Evidence : The intervention was perceived to increase identification of adverse SDH and provision of resources; and to potentially jump-start better caregiver and infant health trajectories. Facilitation : Procedures that improved acceptability included dynamic training and champion support, regular feedback on intervention outcomes, and strategies to reduce stigma and bias. CONCLUSION We identified contextual factors, concrete messaging, and training procedures that may inform implementation of SDH screening and referral in NICU settings.
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Affiliation(s)
- Erika G. Cordova-Ramos
- Boston Medical Center, Department of Pediatrics, Boston, MA
- Evans Center for Implementation and Improvement Sciences (CIIS), Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Judith Burke
- Boston Medical Center, Department of Pediatrics, Boston, MA
| | - Nicole Sileo
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Maggie McGean
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Vanessa Torrice
- Children’s Hospital at Montefiore, Department of Pediatrics, Bronx, NY
| | - Saaz Mantri
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | | | - Mari-Lynn Drainoni
- Evans Center for Implementation and Improvement Sciences (CIIS), Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
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Alvis CE, Mosha M, Amankwah EK, Hernandez RG, Morrison JM. Comparison of Caregiver and Provider Food Insecurity Screening Preferences Within a Health System. Clin Pediatr (Phila) 2024; 63:650-658. [PMID: 37559340 DOI: 10.1177/00099228231191926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Food insecurity is a public health concern associated with poor health. Evidence guiding how to best implement screening for food insecurity across a pediatric health care system is lacking. We performed a single-center, multi-department, cross-sectional study of caregivers and health care providers in outpatient and inpatient settings to describe the beliefs, barriers, preferences, and preferred food insecurity screening location. Most providers and caregivers underestimated the pervasiveness of food insecurity while acknowledging the benefit of screening. Caregivers are overall receptive to food insecurity screening and disagree with feelings of discomfort or shame when disclosing food insecurity status. Providers acknowledged perceived caregiver discomfort, lack of community food resources, and lack of a validated screening tool as barriers to screening. Both caregivers and providers identified the primary care setting as the preferred screening setting.
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Affiliation(s)
- Courtney E Alvis
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
| | - Maua Mosha
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
| | - Ernest K Amankwah
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raquel G Hernandez
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John M Morrison
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Islam F, Fiori KP, Rinke ML, Acholonu R, Luke MJ, Cabrera KI, Chandhoke S, Friedland SE, McKenna KJ, Braganza SF, Philips K. Implementing Inpatient Social Needs Screening in an Urban Tertiary Care Children's Hospital. Hosp Pediatr 2024; 14:480-489. [PMID: 38742306 DOI: 10.1542/hpeds.2023-007486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/18/2024] [Accepted: 01/28/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND AND OBJECTIVES The American Academy of Pediatrics recommends screening for unmet social needs, and the literature on inpatient screening implementation is growing. Our aim was to use quality improvement methods to implement standardized social needs screening in hospitalized pediatric patients. METHODS We implemented inpatient social needs screening using the Model for Improvement. An interprofessional team trialed interventions in a cyclical manner using plan-do-study-act cycles. Interventions included a structured screening questionnaire, standardized screening and referrals workflows, electronic health record (EHR) modifications, and house staff education, deliberate practice, and feedback. The primary outcome measure was the percentage of discharged patients screened for social needs. Screening for social needs was defined as a completed EHR screening questionnaire or a full social work evaluation. Process and balancing measures were collected to capture data on screening questionnaire completion and social work consultations. Data were plotted on statistical process control charts and analyzed for special cause variation. RESULTS The mean monthly percentage of patients screened for social needs improved from 20% at baseline to 51% during the intervention period. Special cause variation was observed for the percentage of patients with completed social needs screening, EHR-documented screening questionnaires, and social work consults. CONCLUSIONS Social needs screening during pediatric hospitalization can be implemented by using quality improvement methods. The next steps should be focused on sustainability and the spread of screening. Interventions with greater involvement of interdisciplinary health care team members will foster process sustainability and allow for the spread of screening interventions to the wider hospitalized pediatric population.
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Affiliation(s)
- Fahmida Islam
- Department of Pediatrics, Children's Hospital at Montefiore, Montefiore Medical Center
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Kevin P Fiori
- Department of Pediatrics
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Michael L Rinke
- Department of Pediatrics, Children's Hospital at Montefiore, Montefiore Medical Center
| | - Rhonda Acholonu
- Department of Pediatrics, Children's Hospital at Montefiore, Montefiore Medical Center
| | - Michael J Luke
- Department of Pediatrics, Children's Hospital at Montefiore, Montefiore Medical Center
| | - Keven I Cabrera
- Department of Pediatrics, Children's Hospital at Montefiore, Montefiore Medical Center
| | - Swati Chandhoke
- Department of Pediatrics, Children's Hospital at Montefiore, Montefiore Medical Center
| | - Sarah E Friedland
- Department of Pediatrics, Children's Hospital at Montefiore, Montefiore Medical Center
| | - Kevin J McKenna
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Sandra F Braganza
- Department of Pediatrics
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Kaitlyn Philips
- Department of Pediatrics, Children's Hospital at Montefiore, Montefiore Medical Center
- Department of Pediatrics, Hackensack Meridian Children's Health, Hackensack School of Medicine, Hackensack, New Jersey
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Astorino JA, Pratt-Chapman ML, Schubel L, Lee Smith J, White A, Sabatino SA, Littlejohn R, Buckley BO, Taylor T, Arem H. Contextual Factors Relevant to Implementing Social Risk Factor Screening and Referrals in Cancer Survivorship: A Qualitative Study. Prev Chronic Dis 2024; 21:E22. [PMID: 38573795 PMCID: PMC10996388 DOI: 10.5888/pcd21.230352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Introduction Social risk factors such as food insecurity and lack of transportation can negatively affect health outcomes, yet implementation of screening and referral for social risk factors is limited in medical settings, particularly in cancer survivorship. Methods We conducted 18 qualitative, semistructured interviews among oncology teams in 3 health systems in Washington, DC, during February and March 2022. We applied the Exploration, Preparation, Implementation, Sustainment Framework to develop a deductive codebook, performed thematic analysis on the interview transcripts, and summarized our results descriptively. Results Health systems varied in clinical and support staff roles and capacity. None of the participating clinics had an electronic health record (EHR)-based process for identifying patients who completed their cancer treatment ("survivors") or a standardized cancer survivorship program. Their capacities also differed for documenting social risk factors and referrals in the EHR. Interviewees expressed awareness of the prevalence and effect of social risk factors on cancer survivors, but none employed a systematic process for identifying and addressing social risk factors. Recommendations for increasing screening for social risk factors included designating a person to fulfill this role, improving data tracking tools in the EHR, and creating systems to maintain up-to-date information and contacts for community-based organizations. Conclusion The complexity of cancer care workflows and lack of reimbursement results in a limited ability for clinic staff members to screen and make referrals for social risk factors. Creating clinical workflows that are flexible and tailored to staffing realities may contribute to successful implementation of a screening and referral program. Improving ongoing communication with community-based organizations to address needs was deemed important by interviewees.
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Affiliation(s)
- Joseph A Astorino
- The George Washington Cancer Center, The George Washington School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Mandi L Pratt-Chapman
- The George Washington Cancer Center, The George Washington School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Laura Schubel
- Healthcare Delivery Research, MedStar Health Research Institute, Washington, District of Columbia
| | - Judith Lee Smith
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Arica White
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan A Sabatino
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robin Littlejohn
- Healthcare Delivery Research, MedStar Health Research Institute, Washington, District of Columbia
| | - Bryan O Buckley
- Department of General Medicine, Georgetown University, Washington, District of Columbia
| | | | - Hannah Arem
- Healthcare Delivery Research, MedStar Health Research Institute, Washington, District of Columbia
- Department of Oncology, Georgetown University, Washington, District of Columbia
- MedStar Health Research Institute, 3007 Tilden St NW, Ste 6N, Washington, DC 20008
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Leary JC, Bagley H, Chan IT, Coates JL, Foote AM, Murzycki JE, Perkins TA, Landrigan CP, Freund KM, Garg A. Evaluating the Impact of a Pediatric Inpatient Social Care Program in a Community Hospital. Hosp Pediatr 2024; 14:225-232. [PMID: 38463007 PMCID: PMC10965758 DOI: 10.1542/hpeds.2023-007487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
OBJECTIVES To evaluate the impact of implementing a stakeholder-informed social risk screening and social service referral system in a community hospital setting. METHODS We implemented a stakeholder-informed social care program at a community hospital in April 2022. The evaluation included patients aged 0 to 17 years admitted to the pediatric unit between April 2021 and March 2022 (1 year preimplementation) and between April 2022 and March 2023 (1 year postimplementation). For a random subset of 232 preimplementation and 218 postimplementation patients, we performed manual data extraction, documenting program process measures and preliminary effectiveness outcomes. We used χ square and Wilcoxon rank tests to compare outcomes between the preimplementation and postimplementation groups. Multivariable logistic regression was used to assess the preliminary effectiveness of the social care program in identifying social risks. RESULTS Screening rates were higher in the postimplementation group for nearly all social domains. Compared with preimplementation, the postimplementation group had higher rates of social risks identified (17.4% vs 7.8% [P < .01]: adjusted odds ratio 2.9 [95% confidence interval 1.5-5.5]) on multivariate testing. Social work consults were completed more frequently and earlier for the postimplementation group (13.8.% vs 5.6% [P < .01]) and median (19 hours vs 25 hours [P = .03]), respectively. Rates of communication of social risks in discharge summaries were higher in the postimplementation group (46.8% vs 8.2% [P < .001]). CONCLUSIONS The implementation of a stakeholder-informed social care program within a community hospital setting led to the increased identification of social risks and social work consultations and improved timeliness of social work consultations and written communication of social risks in discharge summaries for primary care providers.
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Affiliation(s)
- Jana C Leary
- Department of Pediatrics, Tufts Medicine Pediatrics with Boston Children's Hospital
| | - Hannah Bagley
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Iris T Chan
- Tufts University School of Medicine, Boston, Massachusetts
| | | | - Amy M Foote
- Department of Pediatrics, Lowell General Hospital, Lowell, Massachusetts
| | - Jennifer E Murzycki
- Department of Pediatrics, Tufts Medicine Pediatrics with Boston Children's Hospital
| | - Tiffany A Perkins
- Department of Pediatrics, Tufts Medicine Pediatrics with Boston Children's Hospital
| | - Christopher P Landrigan
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Karen M Freund
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Arvin Garg
- Department of Pediatrics, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
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Smith BM, Donohue PK, Seltzer RR. Family perspectives on provider conversations about housing needs for children with medical complexity. Child Care Health Dev 2024; 50:e13253. [PMID: 38529766 DOI: 10.1111/cch.13253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/19/2023] [Accepted: 02/27/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Children with medical complexity (CMC) have unique, and often unmet, housing needs that place them at risk for housing insecurity and poor health outcomes. Yet, little is known about how families with CMC discuss their housing needs with healthcare providers. We sought to understand: (1) how housing is currently discussed between CMC caregivers and healthcare providers, and (2) how CMC caregivers want such conversations to occur. METHODS From August to November 2020, we conducted semi-structured interviews with parents/guardians of CMC (<26 years old) in Maryland as part of a larger study to understand their housing experience. Four questions on communication with providers about housing were developed a priori and included in this analysis. Qualitative content analysis was applied to interview transcripts. RESULTS Among 31 completed interviews, most participants were female (90%), lived in single-family homes (68%) and were from a mix of neighbourhood types (urban 19%, suburban 58%, rural 22%). Their children ranged in age from 6 months to 22 years, had a mix of insurance types (public 65%, private 29%, both 6%) and nearly all required medical equipment or technology. Four themes emerged: (1) Current housing conversations are rare and superficial, (2) Ideal housing conversations would result in thoughtful care plans and concrete supports, (3) Frequency and initiation of housing conversations are best tailored to family preferences and (4) Value of housing conversations are limited by lack of provider knowledge and time. CONCLUSIONS Conversations about housing needs for CMC happen in limited ways with healthcare providers, despite a desire on the part of their caregivers. Such conversations can give meaningful insights into the family's specific housing challenges, allowing providers to appropriately tailor care plans and referrals. Future work is needed to capture provider perspectives, design CMC-specific housing screeners and develop interdisciplinary referral strategies.
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Affiliation(s)
- Brandon M Smith
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pamela K Donohue
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rebecca R Seltzer
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
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10
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Petruzzi L, Milano N, Chen Q, Noel L, Golden R, Jones B. Social workers are key to addressing social determinants of health in integrated care settings. SOCIAL WORK IN HEALTH CARE 2024; 63:89-101. [PMID: 38104559 DOI: 10.1080/00981389.2023.2292565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023]
Abstract
Social workers play an important role in assessing social determinants of health (SDH) and providing behavioral health services in integrated care settings. Evidence suggests that integrated care interventions improve quality of life and other patient outcomes. However, the ambiguous role of social workers on the interdisciplinary team, the lack of protocol in SDH screening and intervention, and restrictions due to healthcare reimbursement limit social workers' ability to intervene. Future directions include standardizing integrated care models, evaluating integrated care's efficacy to address SDH, incorporating SDH into interprofessional training including role clarification and reimbursing for SDH assessment and intervention.
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Affiliation(s)
- Liana Petruzzi
- Population Health Department, Dell Medical School, University of Texas, Austin, Texas, USA
| | - Nicole Milano
- Rutgers School of Social Work, New Brunswick, New Jersey, USA
| | - Qi Chen
- Steve Hicks School of Social Work, University of Texas, Austin, Texas, USA
| | - Lailea Noel
- Steve Hicks School of Social Work, University of Texas, Austin, Texas, USA
| | - Robyn Golden
- Rush University Medical Center, New Brunswick, New Jersey, USA
| | - Barbara Jones
- Steve Hicks School of Social Work, University of Texas, Austin, Texas, USA
- Health Social Work Department, Dell Medical School, University of Texas, Austin, Texas, USA
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van de Kamp E, Ma J, Monangi N, Tsui FR, Jani SG, Kim JH, Kahn RS, Wang CJ. Addressing Health-Related Social Needs and Mental Health Needs in the Neonatal Intensive Care Unit: Exploring Challenges and the Potential of Technology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7161. [PMID: 38131713 PMCID: PMC10742453 DOI: 10.3390/ijerph20247161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/21/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
Unaddressed health-related social needs (HRSNs) and parental mental health needs in an infant's environment can negatively affect their health outcomes. This study examines the challenges and potential technological solutions for addressing these needs in the neonatal intensive care unit (NICU) setting and beyond. In all, 22 semistructured interviews were conducted with members of the NICU care team and other relevant stakeholders, based on an interpretive description approach. The participants were selected from three safety net hospitals in the U.S. with level IV NICUs. The challenges identified include navigating the multitude of burdens families in the NICU experience, resource constraints within and beyond the health system, a lack of streamlined or consistent processes, no closed-loop referrals to track status and outcomes, and gaps in support postdischarge. Opportunities for leveraging technology to facilitate screening and referral include automating screening, initiating risk-based referrals, using remote check-ins, facilitating resource navigation, tracking referrals, and providing language support. However, technological implementations should avoid perpetuating disparities and consider potential privacy or data-sharing concerns. Although advances in technological health tools alone cannot address all the challenges, they have the potential to offer dynamic tools to support the healthcare setting in identifying and addressing the unique needs and circumstances of each family in the NICU.
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Affiliation(s)
- Eline van de Kamp
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Jasmin Ma
- Center for Policy, Outcomes, and Prevention, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA; (J.M.); (S.G.J.)
| | - Nagendra Monangi
- Division of Neonatology, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (N.M.); (J.H.K.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA;
| | - Fuchiang Rich Tsui
- Tsui Laboratory, Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA;
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Shilpa G. Jani
- Center for Policy, Outcomes, and Prevention, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA; (J.M.); (S.G.J.)
| | - Jae H. Kim
- Division of Neonatology, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (N.M.); (J.H.K.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA;
| | - Robert S. Kahn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA;
- Michael Fisher Child Health Equity Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - C. Jason Wang
- Center for Policy, Outcomes, and Prevention, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA; (J.M.); (S.G.J.)
- Department of Pediatrics and Department of Health Policy, Stanford University School of Medicine, Stanford, CA 94305, USA
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12
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Cacioppo AM, Winslow V, Abramsohn EM, Jagai JS, Makelarski JA, Waxman E, Wroblewski K, Tessler Lindau S. Food Insecurity and Experiences of Discrimination Among Caregivers of Hospitalized Children. Pediatrics 2023; 152:e2023061750. [PMID: 37986582 PMCID: PMC10657777 DOI: 10.1542/peds.2023-061750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Pediatric hospitals are adopting strategies to address food insecurity (FI), a stigmatizing condition, among families with children. We hypothesized that parents and other caregivers ("caregivers") from households with FI or marginal food security (MFS) are more likely to experience discrimination during their child's hospitalization. METHODS We analyzed data from 319 caregivers of children admitted to an urban, academic children's hospital and randomly assigned to the control arm of the double-blind randomized controlled CommunityRx-Hunger trial (November 2020 to June 2022, NCT R01MD012630). Household food security in the 30 days before admission and discrimination during hospitalization were measured with the US Household Food Security Survey and the Discrimination in Medical Settings Scale, respectively. We used logistic regression to model the relationship between food security status and discrimination, adjusting for gender, race, ethnicity, income, and partner status. RESULTS Most participants were African American or Black (81.5%), female (94.7%), and the parent of the hospitalized child (93.7%). FI and MFS were prevalent (25.1% and 15.1%, respectively). Experiences of discrimination during a child's hospitalization were prevalent (51.9%). Caregivers with FI had higher odds than caregivers with food security of experiencing discrimination (adjusted odds ratio = 2.0, 95% confidence interval 1.1-3.6, P = .03); MFS was not significantly associated with discrimination (P = .25). Compared with food secure caregivers, those with FI had higher odds of 5 of 7 experiences of discrimination assessed. CONCLUSIONS Among parents and other caregivers, household FI is associated with experiences of discrimination during a child's hospitalization.
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Affiliation(s)
| | | | | | | | | | - Elaine Waxman
- The Urban Institute, Washington, District of Columbia
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13
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Kroshus E, Bell L, Gurganus-Wright K, Hainline B. Structural and social determinants of mental health inequities among collegiate athletes during the COVID-19 pandemic. Br J Sports Med 2023; 57:1435-1441. [PMID: 37130616 DOI: 10.1136/bjsports-2022-106391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVES To characterise psychological distress during the COVID-19 pandemic among collegiate athletes and assess whether racial and ethnic differences in psychological distress are attenuated when accounting for inequitable exposure to structural and social determinants of health. METHODS Participants were collegiate athletes on teams competing in the National Collegiate Athletic Association (n=24 246). An electronic questionnaire was distributed by email, open for completion 6 October to 2 November 2020. Multivariable linear regression models were used to assess the cross-sectional associations between meeting basic needs, death or hospitalisation due to COVID-19 of a close contact, race and ethnicity, and psychological distress. RESULTS Athletes racialised as Black had higher levels of psychological distress than their white peers (B=0.36, 95% CI 0.08 to 0.64). Psychological distress was higher among athletes who had more difficulties meeting basic needs, and who had a close contact die or be hospitalised with COVID-19. After adjusting for these structural and social factors, Black athletes experienced less psychological distress than white peers (B=-0.27, 95% CI -0.54 to -0.01). CONCLUSIONS The present findings provide further evidence of how inequitable structural and social exposures are associated with racial and ethnic differences in mental health outcomes. Sports organisations should ensure the mental health services available for their athletes are appropriate for meeting the needs of individuals experiencing complex and traumatic stressors. Sports organisations should also consider whether there are opportunities to screen for social needs (eg, related to food or housing insecurity), and to connect athletes with resources to help meet those needs.
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Affiliation(s)
- Emily Kroshus
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Lydia Bell
- National Collegiate Athletic Association, Indianapolis, Indiana, USA
| | | | - Brian Hainline
- National Collegiate Athletic Association, Indianapolis, Indiana, USA
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14
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Shah AN, Goodman E, Lawler J, Bosse D, Rubeiz C, Beck AF, Parsons A. Inpatient Screening of Parental Adversity and Strengths. Hosp Pediatr 2023; 13:922-930. [PMID: 37724391 DOI: 10.1542/hpeds.2022-007111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Social adversities, including health-harming social risks and adverse childhood experiences, contribute to poor outcomes after hospital discharge. Screening for social adversities is increasingly pursued in outpatient settings. Identifying and addressing such adversities has been linked to improved child outcomes. Screening for social adversities and strengths in the inpatient setting may contribute to better transitions from hospital to home. Our goal was twofold: 1. to use qualitative methods to understand parent perspectives around screening tools for potential use in inpatient settings; and 2. to develop a family-friendly inpatient screening tool for social adversity. METHODS We used in-depth, cognitive qualitative interviews with parents to elicit their views on existing screening tools covering social adversities and strengths. We partnered with a local nonprofit to recruit parents who recently had a child hospitalized or visited the emergency department. There were 2 phases of the study. In the first phase, we used qualitative methods to develop a screening prototype. In the second phase, we obtained feedback on the prototype. RESULTS We interviewed 18 parents who identified 3 major themes around screening: 1. factors that promote parents to respond openly and honestly during screening; 2. feedback about screening tools and the prototype; and 3. screening should include resources. CONCLUSIONS Social adversity routinely affects children; hospitalization is an important time to screen families for adversity and potential coexisting strengths. Using qualitative parent feedback, we developed the family friendly Collaborate to Optimize Parent Experience screening tool.
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Affiliation(s)
- Anita N Shah
- Divisions of Hospital Medicine
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | | | - Julianne Lawler
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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15
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Oddo ER, Kumar N, Andrews AL, Kwon S. Firearm Safety Screening in the Pediatric Hospital Setting: A Quality Improvement Initiative. Pediatr Qual Saf 2023; 8:e689. [PMID: 37780602 PMCID: PMC10538933 DOI: 10.1097/pq9.0000000000000689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/02/2023] [Indexed: 10/03/2023] Open
Abstract
Background Firearm injuries are a leading cause of morbidity and mortality for US youth. Secure storage is protective against firearm injuries in children. Despite this evidence and national recommendations, rates of firearm safety screening among pediatric providers are low, particularly in the inpatient setting. Therefore, we aimed to increase the frequency of firearm safety screening among patients admitted to the Pediatric Hospital Medicine service. Methods This project occurred in a tertiary pediatric hospital with a medium-sized pediatric residency program. The initial intervention was a firearm safety screening tool embedded into the electronic health record history and physical note template. Subsequent interventions included nursing education, monthly reminder emails, and gun violence discussions during intern orientation. Patients who screened positive were provided with educational materials and a free gun lock. Data collection occurred by chart review to determine the frequency of screening documentation in the H&P. A survey was also conducted among pediatric residents to identify persistent barriers to screening. Results The percentage of inpatient firearm safety screening increased from 0.01% to 39% over 25 months, with a centerline shift noted after 2 months. Residents cited a lack of time with the patient and a belief that it was not the appropriate time to screen as persistent barriers to screening. Conclusions This study identified an effective approach to improving firearm safety screening in an academic pediatric hospital. Hospitalization represents a unique opportunity for firearm safety screening and counseling, and inpatient providers should feel empowered to intervene in this setting.
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Affiliation(s)
- Elizabeth R Oddo
- From the Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Neha Kumar
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Annie L Andrews
- From the Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Stephanie Kwon
- From the Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
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16
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Akande M, Paquette ET, Magee P, Perry-Eaddy MA, Fink EL, Slain KN. Screening for Social Determinants of Health in the Pediatric Intensive Care Unit: Recommendations for Clinicians. Crit Care Clin 2023; 39:341-355. [PMID: 36898778 PMCID: PMC10332174 DOI: 10.1016/j.ccc.2022.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Social determinants of health (SDoH) play a significant role in the health and well-being of children in the United States. Disparities in the risk and outcomes of critical illness have been extensively documented but are yet to be fully explored through the lens of SDoH. In this review, we provide justification for routine SDoH screening as a critical first step toward understanding the causes of, and effectively addressing health disparities affecting critically ill children. Second, we summarize important aspects of SDoH screening that need to be considered before implementing this practice in the pediatric critical care setting.
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Affiliation(s)
- Manzilat Akande
- Section of Critical Care, Department of Pediatrics, Oklahoma University Health Sciences Center, OU Children's Physicians Building, 1200 Children's Avenue, Oklahoma City, OK 73104, USA.
| | - Erin T Paquette
- Division of Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East, Chicago Avenue, Box 73, Chicago, IL 60611, USA
| | - Paula Magee
- Division of Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East, Chicago Avenue, Box 73, Chicago, IL 60611, USA
| | - Mallory A Perry-Eaddy
- University of Connecticut School of Nursing, 231 Glenbrook Rd, U-4026, Storrs, CT 06269, USA; Department of Pediatrics, University of Connecticut School of Medicine, 200 Academic Way, Farmington, CT 06032, USA
| | - Ericka L Fink
- Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 2nd floor, Pittsburgh, PA 15206, USA
| | - Katherine N Slain
- Division of Pediatric Critical Care Medicine, University Hospitals Rainbow Babies & Children's Hospital, 11100 Euclid Avenue, RBC 6010 Cleveland, OH 44106, USA; Department of Pediatrics, Case Western Reserve University School of Medicine, 9501 Euclid Avenue, Cleveland, OH 44106, USA
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17
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Cordova-Ramos EG, Jain C, Torrice V, McGean M, Buitron de la Vega P, Burke J, Stickney D, Vinci RJ, Drainoni ML, Parker MG. Implementing Social Risk Screening and Referral to Resources in the NICU. Pediatrics 2023; 151:e2022058975. [PMID: 36919445 PMCID: PMC10797529 DOI: 10.1542/peds.2022-058975] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVE Social risk screening is recommended by the American Academy of Pediatrics, but this practice is underutilized in NICUs. To address this gap in social care, we aimed to increase rates of: (1) systematic social risk screening and (2) connection with community resources, each to ≥50% over a 14-month period. METHODS We conducted a quality improvement initiative from November 2020 to January 2022. We adapted a screening tool and used Plan-Do-Study-Act cycles to integrate screening and referral to resources into clinical workflow. Primary outcome measures included the percentage of (1) families screened and (2) connection with resources. We examined screening by maternal race/ethnicity and primary language. Process measures were (1) time from admission to screening and (2) percentage of referrals provided to families reporting unmet needs and requesting assistance. We used statistical process control to assess change over time and χ2 tests to compare screening by race/ethnicity and language. RESULTS The rates of systematic screening increased from 0% to 49%. Among 103 families screened, 84% had ≥1, and 64% had ≥2 unmet needs, with a total of 221 needs reported. Education, employment, transportation, and food were the most common needs. Screening rates did not vary by race/ethnicity or language. Among families requesting assistance, 98% received referrals. The iterative improvement of a written resource guide and community partnerships led to increased rates of connection with resources from 21% to 52%. CONCLUSION Leveraging existing staff, our social risk screening and referral intervention built the capacity to address the high burden of unmet needs among NICU families.
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Affiliation(s)
- Erika G. Cordova-Ramos
- Boston Medical Center, Department of Pediatrics
- Evans Center for Implementation and Improvement Sciences (CIIS), Department of Medicine, Boston University School of Medicine
| | | | | | | | - Pablo Buitron de la Vega
- Boston University School of Medicine
- Boston Medical Center, Department of General Internal Medicine
| | | | | | | | - Mari-Lynn Drainoni
- Evans Center for Implementation and Improvement Sciences (CIIS), Department of Medicine, Boston University School of Medicine
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine
- Department of Health Law, Policy and Management, Boston University School of Public Health
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18
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Sauers-Ford H, Schondelmeyer A, Shah A. What Should Hospitalists Consider in Addressing Social Determinants of Health? Hosp Pediatr 2023; 13:e40-e42. [PMID: 36594220 DOI: 10.1542/hpeds.2022-006959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
| | - Amanda Schondelmeyer
- Division of Hospital Medicine, and.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Anita Shah
- Division of Hospital Medicine, and.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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19
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Markowitz MA, Tiyyagura G, Quallen K, Rosenberg J. Food Insecurity Screening and Intervention in United States Children's Hospitals. Hosp Pediatr 2022; 12:849-857. [PMID: 36120739 DOI: 10.1542/hpeds.2022-006755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Food insecurity (FI) affects many United States families and negatively impacts the health of children. We assessed patterns of FI screening for United States children's hospitals, characterized screening protocols, and assessed how hospitals addressed general and inpatient-specific caregiver FI, including provision of food or meals for caregivers of admitted children. METHODS We conducted a cross-sectional, confidential survey of clinical team members at United States children's hospitals. We evaluated FI screening practices and responses, including which team members conduct FI screening, the types of screeners used, and interventions including social work consultations, referrals to community resources, and provision of food or meals. RESULTS Of the 76 children's hospital representatives (40% response rate) who participated in the survey, 67.1% reported at least some screening, and 34.2% performed universal screening for FI. Screening was conducted most frequently on the inpatient units (58.8%), with social workers (35.5%) and nurses (34.2%) administering screeners most frequently. Responses to positive screens included social work consultation (51.3%), referral to community resources (47.4%), and offering food or meals (43.4%). Eighty-four percent of hospitals provided food or meals to at least some caregivers for admitted pediatric patients. Conditional qualifications for food/meals included need-based (31.6%) and presence of breastfeeding mothers (30.3%). CONCLUSIONS Many United States children's hospitals screen for FI, but most survey respondents reported that their hospital did not conduct universal screening. Screening protocols and interventions varied among institutions. Children's hospitals could consider improving screening protocols and interventions to ensure that needs are identified and addressed.
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Affiliation(s)
- Molly A Markowitz
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Gunjan Tiyyagura
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Kaitlin Quallen
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Julia Rosenberg
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
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20
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Gore E, DiTursi J, Rambuss R, Pope-Collins E, Train MK. Implementing a Process for Screening Hospitalized Adults for Food Insecurity at a Tertiary Care Center. J Healthc Qual 2022; 44:305-312. [PMID: 36036781 DOI: 10.1097/jhq.0000000000000350] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Food insecurity has been linked to numerous chronic conditions and higher healthcare costs; however, screening for food insecurity lags behind screening for other social determinants of health, particularly in the hospital setting. Although our hospital serves a population with a high prevalence of food insecurity, no process previously existed to universally screen patients. Our multidisciplinary team developed and implemented a process to screen hospitalized adults for food insecurity and connect them with food resources, which we piloted on a 26-bed hospital medicine unit. We integrated a validated 2-item screen into the electronic health record (EHR) nursing admission workflow, and provided 2 weeks of nursing education before process implementation. Adherence to screening was monitored weekly and adjustments were made using plan-do-study-act cycles. After 28 weeks, 361/587 (61.5%; weekly average 61.1%) encounters were screened (compared with a baseline of 2.2%), with 21/361 (5.8%) identified as food insecure. The implementation of an EHR-based food insecurity screening process in the hospital setting increased screening and identification of food insecure patients. Through improved integration of screening questions into the existing nursing workflow and continued education, success was sustained despite challenges with nursing staff turnover and staff shortages during the COVID-19 pandemic.
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21
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Feeney CD, Platt A, Rhodes J, Marcantonio Y, Patel-Nguyen S, White T, Wilson JA, Pendergast J, Ming DY. Redesigning Care of Hospitalized Young Adults With Chronic Childhood-Onset Disease. Cureus 2022; 14:e27898. [PMID: 36110484 PMCID: PMC9464098 DOI: 10.7759/cureus.27898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/11/2022] [Indexed: 11/22/2022] Open
Abstract
Background Young adults with chronic childhood-onset disease (CCOD) are routinely admitted to internal medicine hospitalist services, yet most lack transition preparation to adult care. Providers and patients feel the strain of admissions to adult services in part due to their medical and social complexity. Methods We performed a descriptive study of a care redesign project for young adults with CCOD hospitalized at a large, tertiary care academic hospital. We describe the process of implementation of the Med-Peds (MP) service line and characterize patients cared for by the service. We measured and analyzed patient demographics, process implementation, healthcare screening, and healthcare utilization data. Results During the 16 months of the study period, 254 patients were cared for by the MP service line, accounting for 385 hospitalizations. The most common CCODs were sickle cell disease (22.4%) and type 1 diabetes (14.6%). The majority (76%) of patients completed transition readiness assessment, and 38.6% completed social determinant of health (SDH) screening during their admission. Patients had high prevalence of SDH with 66.7% having an unmet social need. The average length of stay was 6.6 days and the average 30-day readmission rate was 20.0%. Conclusions There is opportunity to redesign the inpatient care of young adult patients with CCOD. The MP service line is a care model that can be integrated into existing hospital medicine teams with MP physicians. Hospitals should consider redesigning care for young adults with CCOD to meet the transitional and social needs unique to this patient population.
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22
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Leary JC, Rijhwani L, Bettez NM, Harrington Y, LeClair AM, Garg A, Freund KM. Parent Perspectives on Screening for Social Needs During Pediatric Hospitalizations. Hosp Pediatr 2022; 12:681-690. [PMID: 35843994 PMCID: PMC9885369 DOI: 10.1542/hpeds.2021-006411] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Social determinants of health have been demonstrated to be important drivers of health outcomes and disparities. Screening for social needs has been routinely performed and shown to be beneficial in ambulatory settings, but little is known regarding parent perspectives on screening during pediatric hospitalizations. This study sought to determine parental attitudes surrounding inpatient screening and screening process preferences in the hospital setting. METHODS We conducted 17 semistructured interviews with English- and Spanish-speaking parents of hospitalized children at 1 tertiary and 2 community hospitals between July 2020 and February 2021, with questions probing opinions and experiences with social needs screening, comfort level with discussing social needs with hospital providers, and screening process preferences in the hospital setting. Interviews were recorded, professionally transcribed, and analyzed thematically. RESULTS Participants were median age 32 years, with majority female and English-speaking, and nearly one-half with children admitted to a community hospital. Emergent themes included (1) importance of screening for social needs across multiple health care settings, (2) hospitals viewed as capable systems to respond to social needs, (3) most parents comfortable discussing social needs with inpatient providers, (4) appreciation for providers expressing caring and desire to help during inpatient screening, and (5) importance of a family-centered approach to inpatient screening. CONCLUSIONS Parents reported positive perceptions regarding pediatric inpatient social needs screening importance and hospitals' ability to address social needs and identified multiple screening process preferences for the hospital setting that can inform the development of family-centered inpatient social needs screening strategies.
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Affiliation(s)
- Jana C. Leary
- Department of Pediatrics, Tufts Children’s Hospital, Tufts University School of Medicine, Boston, Massachusetts,Address correspondence to Jana C. Leary, MD, MS, Tufts Children’s Hospital, Tufts University School of Medicine, PO Box 7051, 755 Washington St, Boston, MA 02111. E-mail:
| | - Leena Rijhwani
- Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Yevgeniya Harrington
- Department of Pediatrics, Tufts Children’s Hospital, Tufts University School of Medicine, Boston, Massachusetts
| | - Amy M. LeClair
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Arvin Garg
- Department of Pediatrics, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Karen M. Freund
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts
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23
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Shah AN, Rasnick E, Bhuiyan MA, Wolfe C, Bosse D, Simmons JM, Shah SS, Brokamp C, Beck AF. Using Geomarkers and Sociodemographics to Inform Assessment of Caregiver Adversity and Resilience. Hosp Pediatr 2022; 12:689-695. [PMID: 35909177 DOI: 10.1542/hpeds.2021-006121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES A high level of caregiver adverse childhood experiences (ACEs) and/or low resilience is associated with poor outcomes for both caregivers and their children after hospital discharge. It is unknown if sociodemographic or area-based measures (ie, "geomarkers") can inform the assessment of caregiver ACEs or resilience. Our objective was to determine if caregiver ACEs or resilience can be identified by using any combinations of sociodemographic measures, geomarkers, and/or caregiver-reported household characteristics. METHODS Eligible participants for this cohort study were English-speaking caregivers of children hospitalized on a hospital medicine team. Caregivers completed the ACE questionnaire, Brief Resilience Scale, and strain surveys. Exposures included sociodemographic characteristics available in the electronic health record (EHR), geomarkers tied to a patient's geocoded home address, and household characteristics that are not present in the EHR (eg, income). Primary outcomes were a high caregiver ACE score (≥4) and/or a low BRS Score (<3). RESULTS Of the 1272 included caregivers, 543 reported high ACE or low resilience, and 63 reported both. We developed the following regression models: sociodemographic variables in EHR (Model 1), EHR sociodemographics and geomarkers (Model 2), and EHR sociodemographics, geomarkers, and additional survey-reported household characteristics (Model 3). The ability of models to identify the presence of caregiver adversity was poor (all areas under receiver operating characteristics curves were <0.65). CONCLUSIONS Models using EHR data, geomarkers, and household-level characteristics to identify caregiver adversity had limited utility. Directly asking questions to caregivers or integrating risk and strength assessments during pediatric hospitalization may be a better approach to identifying caregiver adversity.
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Affiliation(s)
- Anita N Shah
- Division of Hospital Medicine
- Department of Pediatrics, University of Cincinnati College of Medicine
| | | | - Mohammad An Bhuiyan
- Division of Clinical Informatics, Department of Medicine, Louisiana State University Health Sciences Center
| | | | | | - Jeffrey M Simmons
- Division of Hospital Medicine
- James M. Anderson Center for Health Systems Excellence
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Samir S Shah
- Division of Hospital Medicine
- James M. Anderson Center for Health Systems Excellence
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Cole Brokamp
- Division of Biostatistics and Epidemiology
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Andrew F Beck
- Division of Hospital Medicine
- James M. Anderson Center for Health Systems Excellence
- General and Community Pediatrics
- Department of Pediatrics, University of Cincinnati College of Medicine
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24
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Bouchelle Z, Vasan A. Promoting Health Equity Through Family-Centered Social Needs Screening and Intervention in the Inpatient Setting. Hosp Pediatr 2022; 12:e275-e277. [PMID: 35843956 PMCID: PMC9390831 DOI: 10.1542/hpeds.2022-006725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Zoe Bouchelle
- National Clinician Scholars Program, Perelman School of Medicine.,Department of Pediatrics, Perelman School of Medicine.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Aditi Vasan
- Department of Pediatrics, Perelman School of Medicine.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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25
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Leary JC, Rijhwani L, Bettez NM, LeClair AM, Murillo A, Berrios MR, Garg A, Freund KM. Clinical Stakeholder Perspectives on Pediatric Inpatient Screening for Social Needs. Acad Pediatr 2022; 22:470-477. [PMID: 34600113 PMCID: PMC8964835 DOI: 10.1016/j.acap.2021.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/08/2021] [Accepted: 09/22/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Social determinants of health are major drivers of health outcomes and quality of life. While several social needs screening tools have been created for use in primary care settings, the best procedures to incorporate these tools into hospital workflow remain unclear. This study aimed to elicit clinical stakeholder perspectives on proposed screening for social needs during pediatric hospitalizations, with particular focus on informing implementation strategies. METHODS We conducted 23 semistructured interviews with pediatric clinical stakeholders (physicians, nurses, social workers, and case managers) at 1 tertiary and 2 community hospitals between July 2020 and January 2021, on topics including social needs screening practices, benefits and challenges to inpatient screening, and optimal screening and referral processes within hospital workflow. Interviews were recorded, professionally transcribed, and analyzed thematically. RESULTS Participants ranged in age from 25 to 62 years, with nearly half working in community hospitals. Regarding inpatient social needs screening, themes emerged about benefits, including enabling clinicians to identify vulnerable patients/moments, and providing clinicians with comprehensive understanding of social context; barriers, including prioritization of medical needs, lack of clinician education surrounding screening, and lack of pre-established relationships; facilitators, including duration of time spent with families, and multidisciplinary clinicians; screening process preferences, including verbal screening, and integration into pre-existing systems; and referral process preferences, including resource provision with family empowerment, and care transition to outpatient clinicians. CONCLUSIONS Clinical stakeholders identified multiple barriers, facilitators, and process preferences for pediatric inpatient social needs screening, which may inform the future development of feasible and sustainable implementation strategies.
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Affiliation(s)
- Jana C Leary
- Department of Pediatrics (JC Leary), Tufts Children's Hospital, Tufts University School of Medicine, Boston, Mass.
| | - Leena Rijhwani
- Robert Wood Johnson Medical School, 125 Paterson St, New
Brunswick, NJ, 08901
| | - Natalie M Bettez
- Tufts University School of Medicine, 145 Harrison Ave,
Boston, MA, 02111
| | - Amy M LeClair
- Department of Medicine, Tufts Medical Center, 800
Washington St, Boston, MA, 02111
| | - Anays Murillo
- Tufts University School of Medicine, 145 Harrison Ave,
Boston, MA, 02111
| | | | - Arvin Garg
- Department of Pediatrics, UMass Memorial Medical Center,
University of Massachusetts Medical School, 55 N. Lake Ave, Worcester, MA,
01655
| | - Karen M Freund
- Department of Medicine, Tufts Medical Center, 800
Washington St, Boston, MA, 02111
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26
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Abstract
The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report recognizes nurses' impact on the medical and social factors that drive health outcomes (National Academies of Sciences, Engineering, and Medicine [NASEM], 2021). The report calls for nursing to take bold steps to address individual and structural level social determinants of health (SDoH)-or social and environmental factors contributing to poor health, poor health outcomes, and health disparities (NASEM, 2021, p. 5). Nurses must recognize the significance of SDoH on patient health outcomes in order to advance health equity and employ nursing interventions to affect positive change for our patients. SDoH are part of our patients' stories, and holistic nursing means we know the whole patient story. Although it is now widely recognized that SDoH affect health outcomes, a key challenge for nurses is that they represent an enormous range of factors-from food and housing insecurity to personal safety and environmental exposures-that may be more or less able to change with interventions in clinical settings. Furthermore, concerns have been raised that screening for SDoH-especially when not done with sensitivity, cultural competence, or ready intervention-may compromise therapeutic relationships and marginalize patients (Wallace et al., 2020). However, despite these concerns, healthcare systems are widely adopting SDoH assessments, generally through electronic health record screening questions, and attempting to implement associated workflows and interventions. Given this landscape, the purpose of this article, within this special issue of Orthopaedic Nursing, is to provide an overview of SDoH factors, identify best practices related to screening and referral, and highlight nurse-directed interventions in clinical settings.
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Affiliation(s)
- Charla B Johnson
- Charla B. Johnson, DNP, RN-BC, ONC, System Director, Nursing Informatics, Franciscan Missionaries of Our Lady Health System, Baton Rouge, LA
- Brenda Luther, PhD, RN, Associate Professor, College of Nursing, University of Utah, Salt Lake City, UT
- Andrea S. Wallace, PhD, RN, Assistant Dean of Research, Associate Professor, College of Nursing, University of Utah, Salt Lake City, UT
- Marjorie Gibson Kulesa, RN, BS, ONC, CNOR-E, Retired Nurse Coordinator, Department of Orthopaedic Surgery, NYU Langone Long Island, NY
| | - Brenda Luther
- Charla B. Johnson, DNP, RN-BC, ONC, System Director, Nursing Informatics, Franciscan Missionaries of Our Lady Health System, Baton Rouge, LA
- Brenda Luther, PhD, RN, Associate Professor, College of Nursing, University of Utah, Salt Lake City, UT
- Andrea S. Wallace, PhD, RN, Assistant Dean of Research, Associate Professor, College of Nursing, University of Utah, Salt Lake City, UT
- Marjorie Gibson Kulesa, RN, BS, ONC, CNOR-E, Retired Nurse Coordinator, Department of Orthopaedic Surgery, NYU Langone Long Island, NY
| | - Andrea S Wallace
- Charla B. Johnson, DNP, RN-BC, ONC, System Director, Nursing Informatics, Franciscan Missionaries of Our Lady Health System, Baton Rouge, LA
- Brenda Luther, PhD, RN, Associate Professor, College of Nursing, University of Utah, Salt Lake City, UT
- Andrea S. Wallace, PhD, RN, Assistant Dean of Research, Associate Professor, College of Nursing, University of Utah, Salt Lake City, UT
- Marjorie Gibson Kulesa, RN, BS, ONC, CNOR-E, Retired Nurse Coordinator, Department of Orthopaedic Surgery, NYU Langone Long Island, NY
| | - Marjorie Gibson Kulesa
- Charla B. Johnson, DNP, RN-BC, ONC, System Director, Nursing Informatics, Franciscan Missionaries of Our Lady Health System, Baton Rouge, LA
- Brenda Luther, PhD, RN, Associate Professor, College of Nursing, University of Utah, Salt Lake City, UT
- Andrea S. Wallace, PhD, RN, Assistant Dean of Research, Associate Professor, College of Nursing, University of Utah, Salt Lake City, UT
- Marjorie Gibson Kulesa, RN, BS, ONC, CNOR-E, Retired Nurse Coordinator, Department of Orthopaedic Surgery, NYU Langone Long Island, NY
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Schechter SB, Lakhaney D, Peretz PJ, Matiz LA. Community Health Worker Intervention to Address Social Determinants of Health for Children Hospitalized With Asthma. Hosp Pediatr 2021; 11:1370-1376. [PMID: 34849926 DOI: 10.1542/hpeds.2021-005903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Social determinants of health (SDOH) contribute to racial disparities in asthma outcomes. Community health worker (CHW) programs represent a promising way to screen for SDOH and connect patients to resources, but the impact of CHW programs in the inpatient pediatric setting has been examined in few studies. In this study, we aimed to evaluate a CHW program for children hospitalized with asthma in a predominantly Hispanic community by examining rates of SDOH and social resource navigation. METHODS This pilot study involved a CHW intervention to improve pediatric asthma care. Patients were included if they were hospitalized with asthma over an 18-month period and enrolled in the CHW program during their hospitalization. In an intake interview, CHWs screened caregivers for SDOH and provided tailored social resource navigation. Descriptive statistics were used to assess rates of social risk factors and social resource navigation. RESULTS Eighty patients underwent SDOH screening. The majority of patients were Hispanic (81.3%, n = 65). Half of caregivers reported food or housing insecurity over the past 12 months (50.0%, n = 40), and most reported inadequate housing conditions (63.8%, n = 51). CHWs coordinated social resources for the majority of families (98.8%, n = 79), with the most common being food resources (42.5%, n = 34), housing resources (82.5%, n = 66), and appointment navigation (41.3%, n = 33). CONCLUSIONS CHWs identified a high burden of unmet social needs and provided associated social resource navigation in a largely Hispanic pediatric population hospitalized for asthma. CHW programs have potential to improve asthma outcomes by linking high-risk patients with social resources.
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Affiliation(s)
- Sarah B Schechter
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Divya Lakhaney
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Patricia J Peretz
- Division of Community and Population Health, New York-Presbyterian Hospital, New York
| | - Luz Adriana Matiz
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
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28
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Purtell R, Tam RP, Avondet E, Gradick K. We are part of the problem: the role of children's hospitals in addressing health inequity. Hosp Pract (1995) 2021; 49:445-455. [PMID: 35061953 DOI: 10.1080/21548331.2022.2032072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
Racism is an ongoing public health crisis that undermines health equity for all children in hospitals across our nation. The presence and impact of institutionalized racism contributes to health inequity and is under described in the medical literature. In this review, we focus on key interdependent areas to foster inclusion, diversity, and equity in Children's Hospitals, including 1) promotion of workforce diversity 2) provision of anti-racist, equitable hospital patient care, and 3) prioritization of academic scholarship focused on health equity research, quality improvement, medical education, and advocacy. We discuss the implications for clinical and academic practice.Plain Language Summary: Racism in Children's Hospitals harms children. We as health-care providers and hospital systems are part of the problem. We reviewed the literature for the best ways to foster inclusion, diversity, and equity in hospitals. Hospitals can be leaders in improving child health equity by supporting a more diverse workforce, providing anti-racist patient care, and prioritizing health equity scholarship.
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Affiliation(s)
- Rebecca Purtell
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Reena P Tam
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Erin Avondet
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Katie Gradick
- Assistant Professor of Pediatrics, Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
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29
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Winthrop ZA, Michelson CD, Nash KA. Training the Next Generation of Pediatrician-Advocates: A New Focus on the Inpatient Setting. Hosp Pediatr 2021; 11:e266-e269. [PMID: 34493588 DOI: 10.1542/hpeds.2021-005983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Zachary A Winthrop
- The Boston Combined Residency Program, Boston Children's Hospital and Boston Medical Center, Boston, Massachusetts
| | - Catherine D Michelson
- Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts.,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Katherine A Nash
- National Clinician Scholars Program.,Department of Pediatrics, School of Medicine, Yale University, New Haven, Connecticut
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30
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Fortin K, Vasan A, Wilson-Hall CL, Brooks E, Rubin D, Scribano PV. Using Quality Improvement and Technology to Improve Social Supports for Hospitalized Children. Hosp Pediatr 2021; 11:1120-1129. [PMID: 34475224 DOI: 10.1542/hpeds.2020-005800] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To develop and test the feasibility of a caregiver self-administered social needs screener, a Web-based searchable community resource map, and a process map for implementation of these tools as part of social needs screening and referral on a pediatric inpatient unit. METHODS A multidisciplinary team used quality improvement methodology to develop an electronic social needs screener, resource map Web site, and electronic health record enhancements. A process map for implementation of these tools was refined through plan-do-study-act cycles before full implementation. Weekly measures included the number of eligible caregivers screened, prevalence of reported social needs, and use of social work resources. RESULTS During the 22-week study period, 147 caregivers were screened and 2 declined to participate. Thirty-four percent of caregivers endorsed ≥1 social need. The most common needs identified were depressive symptoms (23%), food insecurity (19%), and need for assistance with utilities (10%). All participants received information about the resource map, and 99% of caregivers with an identified need met with a social worker during their admission. CONCLUSIONS Using quality improvement methodology and technology, the team implemented a new standardized process for addressing social needs on an inpatient unit. This led to identification of social needs in more than one-third of caregivers screened and provision of resource map information to all caregivers. These findings reinforce the importance of standardized assessment of social needs in the pediatric inpatient setting. The role of technology, including resource maps and electronic health record enhancements, was highlighted.
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Affiliation(s)
- Kristine Fortin
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania .,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aditi Vasan
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,PolicyLab
| | | | | | - David Rubin
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,PolicyLab
| | - Philip V Scribano
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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31
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Fritz CQ, Thomas J, Gambino J, Torok M, Brittan MS. Prevalence of Social Risks on Inpatient Screening and Their Impact on Pediatric Care Use. Hosp Pediatr 2021; 10:859-866. [PMID: 32967923 DOI: 10.1542/hpeds.2020-0094] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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.
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Affiliation(s)
- Cristin Q Fritz
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee; .,Department of Pediatrics, School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Jacob Thomas
- Adult and Child Consortium for Health Outcomes Research and Delivery Science and
| | | | - Michelle Torok
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - Mark S Brittan
- Adult and Child Consortium for Health Outcomes Research and Delivery Science and.,Children's Hospital Colorado, Aurora, Colorado; and.,Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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32
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Affiliation(s)
- Jordan Tyris
- Children's National Hospital, Washington, District of Columbia; and .,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of ColumbiaDrs Tyris and Parikh conceptualized, drafted, and approved the final manuscript as submitted
| | - Kavita Parikh
- Children's National Hospital, Washington, District of Columbia; and.,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of ColumbiaDrs Tyris and Parikh conceptualized, drafted, and approved the final manuscript as submitted
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Silver AH, Andrews AL, Azzarone G, Bhansali P, Hjelmseth E, Hogan AH, O'Connor KM, Romo N, Parikh K. Engagement and Leadership in Firearm-Related Violence Prevention: The Role of the Pediatric Hospitalist. Hosp Pediatr 2020; 10:523-530. [PMID: 32366383 DOI: 10.1542/hpeds.2019-0327] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Gun violence is a US public health crisis. Approximately 7000 children are hospitalized each year because of firearm-related injuries. As pediatric hospitalists, we are poised to address this crisis, whether we care directly for patients who are victims of gun violence. In this article, we aim to provide practical tools and opportunities for pediatric hospitalists to address the epidemic of gun safety and gun violence prevention, including specifics related to the inpatient setting. We provide a framework to act within 4 domains: clinical care, advocacy, education and research.
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Affiliation(s)
- Alyssa H Silver
- Division of Hospital Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York .,Albert Einstein College of Medicine, Bronx, New York
| | - Annie L Andrews
- Division of General Pediatrics, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Gabriella Azzarone
- Division of Hospital Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York
| | - Priti Bhansali
- Division of Hospitalist Medicine, Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University and Children's National Hospital, Washington, District of Columbia
| | | | - Alexander H Hogan
- Division of Hospital Medicine, Connecticut Children's Medical Center, Hartford, Connecticut; and
| | - Katherine M O'Connor
- Division of Hospital Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York
| | - Noé Romo
- Albert Einstein College of Medicine, Bronx, New York.,Jacobi Medical Center, Bronx, New York
| | - Kavita Parikh
- Division of Hospitalist Medicine, Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University and Children's National Hospital, Washington, District of Columbia
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Affiliation(s)
- Alexander H Hogan
- Division of Hospital Medicine and
- Department of Pediatrics, School of Medicine, University of Connecticut, Farmington, Connecticut
| | - Glenn Flores
- Department of Pediatrics, School of Medicine, University of Connecticut, Farmington, Connecticut
- Department of Research, Connecticut Children's Medical Center, Hartford, Connecticut; and
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