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Smith M, Tepe KA, Sauers-Ford H, Atarama D, Gilliam M, Unaka N, Beck AF, Shah AN, Schondelmeyer AC, Auger KA. Addressing food insecurity in the inpatient setting: Results of a postdischarge pilot study. J Hosp Med 2024. [PMID: 38837594 DOI: 10.1002/jhm.13421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/06/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND AND OBJECTIVES With a growing interest in screening for food insecurity (FI) during pediatric hospitalization, there is a parallel need to develop interventions. With input from caregivers experiencing FI, we sought to identify interventions to assist with short-term FI after discharge and evaluate their feasibility, acceptability, and appropriateness. METHODS We first employed qualitative methods to identify potential interventions. Next, we conducted a pilot study of selected interventions for families experiencing FI. Seven days postdischarge, caregivers rated the intervention's feasibility, acceptability, and appropriateness. We also assessed for ongoing FI. We summarized the median and proportion of "completely agree" responses to feasibility, acceptability, and appropriateness questions, and we compared in-hospital and postdischarge FI using McNemar's test. RESULTS In the qualitative stage, 14 caregivers prioritized three interventions: grocery store gift cards, grocery delivery/pick-up, and frozen meals. In the pilot study, 53 caregivers (25% of those screened) endorsed FI during their child's hospitalization and received one or more of the interventions. Every caregiver selected the grocery gift card option; 37 families (69.8%) also received frozen meals. Seven days after discharge, most caregivers rated the intervention as "completely" feasible (76%), acceptable (90%), and appropriate (88%). There was a significant decrease in caregivers who reported FI after discharge compared to during the hospitalization (p < .001). CONCLUSIONS This study demonstrates the feasibility, acceptability, and appropriateness of inpatient interventions to address FI, particularly at the time of pediatric hospital discharge and transition home. Randomized trials are needed to further evaluate the efficacy of interventions employed during hospitalization.
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Affiliation(s)
- Megan Smith
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kerry A Tepe
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Hadley Sauers-Ford
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Denise Atarama
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Monique Gilliam
- Division of Hospital Medicine, Parent Partner Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ndidi Unaka
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew F Beck
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Anita N Shah
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Amanda C Schondelmeyer
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Katherine A Auger
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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2
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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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3
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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] [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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4
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Sheak K, Shah A, Unaka NI. Forging a Path to Effective Inpatient Health-Related Social Needs Screening and Response. Hosp Pediatr 2024; 14:e209-e211. [PMID: 38463006 DOI: 10.1542/hpeds.2023-007668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 03/12/2024]
Affiliation(s)
- Kenna Sheak
- Division of Hospital Medicine
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Anita Shah
- Division of Hospital Medicine
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ndidi I Unaka
- Division of Hospital Medicine
- Fischer Child Health Equity Center
- Office of Population Health, Cincinnati Children's Hospital, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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5
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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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6
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Pantell MS, Holmgren AJ, Leary JC, Iott BE, Neuhaus J, Adler-Milstein J, Gottlieb LM. Social and Medical Care Integration Practices Among Children's Hospitals. Hosp Pediatr 2023; 13:886-894. [PMID: 37718963 PMCID: PMC10520266 DOI: 10.1542/hpeds.2023-007246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
OBJECTIVES In response to evidence linking social risk factors and adverse health outcomes, new incentives have emerged for hospitals to screen for adverse social determinants of health (SDOH). However, little information is available about the current state of social risk-related care practices among children's hospitals. To address outstanding knowledge gaps, we sought to describe social risk-related care practices among a national sample of children's hospitals. METHODS We analyzed responses to the 2020 American Hospital Association Annual Survey. Among children's hospitals, we calculated the prevalence of screening for social needs, strategies to address social risks/needs, partnerships with community-based organizations to address social risks/needs at the individual and community level, and rates of impact assessments of how social risk-related interventions affect outcomes. We also used χ2 tests to compare results by hospital characteristics. We weighted results to adjust for nonresponse. RESULTS The sample included 82 children's hospitals. A total of 79.6% screened for and 96.0% had strategies to address at least 1 social risk factor, although rates varied by SDOH domain. Children's hospitals more commonly partnered with community-based organizations to address patient-level social risks than to participate in community-level initiatives. A total of 39.2% of hospitals assessed SDOH intervention effectiveness. Differences in social risk-related care practices commonly varied by hospital ownership and Medicaid population but not by region. CONCLUSIONS We found wide variability in social risk-related care practices among children's hospitals based on the risk domain and hospital characteristics. Findings can be used to monitor whether social risk-related care practices change in the setting of new incentives.
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Affiliation(s)
- Matthew S. Pantell
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California
- Social Interventions Research and Evaluation Network, San Francisco, California
| | - A. Jay Holmgren
- Department of Medicine, University of California, San Francisco, San Francisco, California
- Clinical Informatics and Improvement Research Center, San Francisco, California
| | - Jana C. Leary
- Department of Pediatrics, Tufts Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Bradley E. Iott
- Social Interventions Research and Evaluation Network, San Francisco, California
- Clinical Informatics and Improvement Research Center, San Francisco, California
| | - John Neuhaus
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Julia Adler-Milstein
- Department of Medicine, University of California, San Francisco, San Francisco, California
- Clinical Informatics and Improvement Research Center, San Francisco, California
| | - Laura M. Gottlieb
- Social Interventions Research and Evaluation Network, San Francisco, California
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
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7
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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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8
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Luke MJ, Scribano PV. Z-Codes: The First Step in Overcoming Barriers to Social Determinants of Health Documentation. Pediatrics 2023; 152:e2023062205. [PMID: 37431598 DOI: 10.1542/peds.2023-062205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 07/12/2023] Open
Affiliation(s)
- Michael J Luke
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Philip V Scribano
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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9
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Leary JC, Pantell M, Garg A. Elevating Parents' Voices in Designing and Implementing Pediatric Inpatient Social Care Systems. Hosp Pediatr 2023; 13:e213-e215. [PMID: 37483136 PMCID: PMC10375028 DOI: 10.1542/hpeds.2023-007326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Affiliation(s)
- Jana C. Leary
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
- Section of Hospital Medicine, Department of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Matthew Pantell
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California
- Center for Health and Community, San Francisco, California
| | - Arvin Garg
- Child Health Equity Center, Department of Pediatrics, UMass Chan Medical School, UMass Memorial Children’s Medical Center, Worcester, Massachusetts
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10
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Felder KK, Jungbauer RM, Woods ML, Vaz LE. Social Risk Screening Changes Medical Decision-Making in a Complex Outpatient Pediatric Antibiotic Therapy Program. J Pediatric Infect Dis Soc 2023; 12:117-119. [PMID: 36512521 DOI: 10.1093/jpids/piac128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Kimberly K Felder
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Madeline Lowry Woods
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Louise E Vaz
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
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11
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Lopez MA, Yu X, Hetrick R, Raman S, Lee J, Hall J, Tran K, Vonasek B, Garg A, Raphael J, Bocchini C. Social Needs Screening in Hospitalized Pediatric Patients: A Randomized Controlled Trial. Hosp Pediatr 2023; 13:95-114. [PMID: 36594231 DOI: 10.1542/hpeds.2022-006815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Addressing adverse social determinants of health is an upstream approach to potentially improve child health outcomes and health equity. We aimed to determine if systematically screening and referring for social needs in hospitalized pediatric patients increased families' enrollment in publicly available resources. METHODS Randomized controlled trial at a large urban children's hospital enrolled English-speaking caregivers of patients 0 to 36 months of age on the general pediatrics service from June 2016 to July 2017. The intervention arm received the WE CARE Houston social needs intervention (screener and resource referrals based on screening results and receptiveness to help); the control arm received standard of care. Baseline social risk data were collected for all participants. Caregivers who screened positive for mental health need, substance abuse, or domestic violence received additional support, including from social workers. The primary outcome was enrollment in resources at 6 months postdischarge. Univariate and multivariable analysis was performed to identify associations. RESULTS Our study sample consisted of 413 caregivers from diverse sociodemographic/socioeconomic backgrounds. Overall, 85% of study participants had ≥1 social risk (median 2, range 0-9). WE CARE Houston identified caregiver employment, health insurance, primary care physician, depression, childcare, smoking, and food resources as the most prevalent social needs. Among these, caregivers were most receptive to resources for childcare, mental health, health insurance, and primary care. There was no significant difference in enrollment in new resources by study arm. CONCLUSION Screening for social needs in the hospital is feasible and can result in the identification of social needs, but further work is needed to successfully address these needs.
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Affiliation(s)
- Michelle A Lopez
- Departments of Pediatrics.,Center for Child Health Policy and Advocacy, Texas Children's Hospital, Houston, Texas
| | | | - Rebecca Hetrick
- Department of Pediatric Rheumatology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | | | | | - Bryan Vonasek
- Department of Pediatrics, University of WisconsinSchool of Medicine and Public Health, Madison, Wisconsin
| | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Chan Medical School, Boston, Massachusetts
| | - Jean Raphael
- Departments of Pediatrics.,Center for Child Health Policy and Advocacy, Texas Children's Hospital, Houston, Texas
| | - Claire Bocchini
- Departments of Pediatrics.,Center for Child Health Policy and Advocacy, Texas Children's Hospital, Houston, Texas
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12
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Abstract
PURPOSE OF REVIEW This article outlines updates in social determinants of health (SDOH) screening practices in pediatric healthcare and community settings. The transition to value-based care and the COVID-19 pandemic have both had significant impacts on screening practices, with implications for providers, communities, and policymakers. RECENT FINDINGS The COVID-19 pandemic has exacerbated social needs for vulnerable patients and families, resulting in increased recognition by healthcare teams through screening. Policy frameworks like value-based care that aim to deliver whole-child care in the community are reorienting the logistics of screening, including screening in acute-care settings and community settings. Recent studies on family and provider perspectives should be integrated into screening practices. SUMMARY Despite significant advances in and expansion of SDOH screening in the pediatric healthcare setting, there remain limitations and future research needs. More data is needed to evaluate social need screeners and interventions, and determine how healthcare systems, communities, and states can spread and scale such interventions based on outcomes and value measurements. Population-based social indices have the potential to augment individual patient screening, but this remains a future research need.
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Affiliation(s)
- Abby L Nerlinger
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
- Nemours Children's Hospital, Delaware, Wilmington, Delaware
| | - Gift Kopsombut
- University of Central Florida
- Nemours Children's Hospital, Florida, Orlando, Florida, USA
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13
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Vaz LE, Jungbauer RM, Jenisch C, Austin JP, Wagner DV, Everest SJ, Libak AJ, Harris MA, Zuckerman KE. Caregiver Experiences in Pediatric Hospitalizations: Challenges and Opportunities for Improvement. Hosp Pediatr 2022; 12:1073-1080. [PMID: 36412061 DOI: 10.1542/hpeds.2022-006645] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There are limited qualitative data describing general pediatric hospitalizations through the caregivers' lens, and most focus on one particular challenge or time during the hospitalization. This qualitative study aimed to address a gap in the description of the breadth and depth of personal challenges caregivers may face during the entire hospitalization, irrespective of severity of patient illness or diagnosis, and explored caregiver-suggested interventions. METHODS Caregivers of pediatric patients on the hospitalist service at a Pacific Northwest children's hospital were interviewed to explore their hospitalization experience and solicit feedback for potential interventions. Content was coded iteratively using a framework analysis until thematic saturation was met. Findings were triangulated through 2 focus groups, 1 with parent advisors and the other with hospital physicians and nurses. RESULTS Among 14 caregivers (7 each of readmitted and newly admitted patients) and focus group participants, emergent domains on difficulties faced with their child's hospitalization were anchored on physiologic (sleep, personal hygiene, and food), psychosocial (feelings of isolation, mental stress), and communication challenges (information flow between families and the medical teams). Caregivers recognized that addressing physiologic and psychosocial needs better enabled them to advocate for their child and suggested interventions to ameliorate hospital challenges. CONCLUSIONS Addressing physiologic and psychosocial needs may reduce barriers to caregivers optimally caring and advocating for their child. Downstream consequences of unaddressed caregiver challenges should be explored in relation to participation in hospital care and confidence in shared decision-making, both vital components for optimization of family-centered care.
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Affiliation(s)
- Louise E Vaz
- Department of Pediatrics, Doernbecher Children's Hospital
| | - Rebecca M Jungbauer
- Pacific Northwest Evidence-Based Practice Center, Oregon Health and Science University, Portland, Oregon
| | - Celeste Jenisch
- Department of Pediatrics, Doernbecher Children's Hospital.,Build Exito Program, Portland State University, Portland, Oregon
| | - Jared P Austin
- Department of Pediatrics, Doernbecher Children's Hospital
| | - David V Wagner
- Department of Pediatrics, Doernbecher Children's Hospital
| | - Steven J Everest
- Build Exito Program, Portland State University, Portland, Oregon
| | - Alyssa J Libak
- Build Exito Program, Portland State University, Portland, Oregon
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14
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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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15
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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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16
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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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17
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Macias‐Konstantopoulos W, Ciccolo G, Muzikansky A, Samuels‐Kalow M. A pilot mixed‐methods randomized controlled trial of verbal versus electronic screening for adverse social determinants of health. J Am Coll Emerg Physicians Open 2022; 3:e12678. [PMID: 35224551 PMCID: PMC8847702 DOI: 10.1002/emp2.12678] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 01/18/2022] [Accepted: 01/27/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Wendy Macias‐Konstantopoulos
- Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA
- Harvard Medical School Boston Massachusetts USA
- Center for Social Justice and Health Equity Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA
| | - Gia Ciccolo
- Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA
| | - Alona Muzikansky
- Biostatistics Center, Division of Clinical Research, Mass General Research Institute Massachusetts General Hospital Boston Massachusetts USA
| | - Margaret Samuels‐Kalow
- Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA
- Harvard Medical School Boston Massachusetts USA
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18
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Jenisch CL, Jungbauer RM, Zuckerman KE, Wagner DV, Ramsey KL, Austin JP, Everest SJ, Libak AJ, Harris MA, Vaz LE. Below the Surface: Caregivers' Experience of Hospital-to-Home Transitions. Hosp Pediatr 2022; 12:e54-e60. [PMID: 35067720 DOI: 10.1542/hpeds.2021-006248] [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
OBJECTIVE Our aim was to understand the breadth of the hospital-to-home experience from the caregiver perspective using a mixed method approach. METHODS Caregivers of children who experienced an inpatient admission (N = 184) completed a hospital-to-home transition questionnaire after discharge. Twenty-six closed-ended survey items captured child's hospitalization, discharge, and postdischarge experiences and were analyzed using descriptive statistics. Four additional free-response items allowed caregivers to expand on specific challenges or issues. A conventional content analysis coding framework was applied to the free responses. RESULTS Ninety-one percent of caregivers reported satisfaction with the hospital experience and 88% reported they understood how to manage their child's health after discharge. A majority of survey respondents (74%) provided answers to 1 or more of the qualitative free-response items. In the predischarge period, qualitative responses centered on concerns related to finances or available resources and support, communication, hospital environment, and the discharge process. Responses for the postdischarge time period centered on family well-being (child health, other family member health), finances (bills, cost of missed work), and medical follow-up (supplies, appointments, instruction). CONCLUSIONS Caregivers were generally satisfied with their hospital experience; however, incorporating survey items specifically related to family stressors either through closed- or open-ended questions gave a richer context for caregiver-identified concerns. Basing future quality improvement efforts on supporting caregiver needs and identifying stressors before discharge may make for a more robust and successful transition to home.
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Affiliation(s)
- Celeste L Jenisch
- Department of Pediatrics, Doernbecher Children's Hospital.,Build Exito Program, Portland State University, Portland, Oregon
| | | | | | - David V Wagner
- Department of Pediatrics, Doernbecher Children's Hospital
| | - Katrina L Ramsey
- Biostatistics and Design Program, Oregon Health & Science University, Portland, Oregon
| | - Jared P Austin
- Department of Pediatrics, Doernbecher Children's Hospital
| | - Steven J Everest
- Build Exito Program, Portland State University, Portland, Oregon
| | - Alyssa J Libak
- Build Exito Program, Portland State University, Portland, Oregon
| | | | - Louise E Vaz
- Department of Pediatrics, Doernbecher Children's Hospital
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19
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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: 5] [Impact Index Per Article: 1.7] [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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20
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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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21
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Samuels-Kalow ME, Boggs KM, Cash RE, Herrington R, Mick NW, Rutman MS, Venkatesh AK, Zabbo CP, Sullivan AF, Hasegawa K, Zachrison KS, Camargo CA. Screening for Health-Related Social Needs of Emergency Department Patients. Ann Emerg Med 2020; 77:62-68. [PMID: 33160720 DOI: 10.1016/j.annemergmed.2020.08.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 01/20/2023]
Abstract
STUDY OBJECTIVE There has been increasing attention to screening for health-related social needs. However, little is known about the screening practices of emergency departments (EDs). Within New England, we seek to identify the prevalence of ED screening for health-related social needs, understand the factors associated with screening, and understand how screening patterns for health-related social needs differ from those for violence, substance use, and mental health needs. METHODS We analyzed data from the 2018 National Emergency Department Inventory-New England survey, which was administered to all 194 New England EDs during 2019. We used descriptive statistics to compare ED characteristics by screening practices, and multivariable logistic regression models to identify factors associated with screening. RESULTS Among the 166 (86%) responding EDs, 64 (39%) reported screening for at least one health-related social need, 160 (96%) for violence (including intimate partner violence or other violent exposures), 148 (89%) for substance use disorder, and 159 (96%) for mental health needs. EDs reported a wide range of social work resources to address identified needs, with 155 (93%) reporting any social worker availability and 41 (27%) reporting continuous availability. CONCLUSION New England EDs are screening for health-related social needs at a markedly lower rate than for violence, substance use, and mental health needs. EDs have relatively limited resources available to address health-related social needs. We encourage research on the development of scalable solutions for identifying and addressing health-related social needs in the ED.
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Affiliation(s)
- Margaret E Samuels-Kalow
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - Krislyn M Boggs
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Rebecca E Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ramsey Herrington
- Division of Emergency Medicine, University of Vermont, Burlington, VT
| | - Nathan W Mick
- Department of Emergency Medicine, Maine Medical Center, Portland, ME
| | - Maia S Rutman
- Departments of Pediatrics and Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | | | - Ashley F Sullivan
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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22
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Martens AM, Leyenaar JK, Mallory LA. Improvements to Foster Caregiver Experiences in Pediatric Hospital-to-Home Transitions. Acad Pediatr 2020; 20:1069-1070. [PMID: 32561496 DOI: 10.1016/j.acap.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/18/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Anna M Martens
- Tufts University School of Medicine- Maine Track (AM Martens), Boston, Mass.
| | - JoAnna K Leyenaar
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center and Dartmouth Institute for Health Policy and Clinical Practice (JK Leyenaar), Lebanon, NH
| | - Leah A Mallory
- Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center (LA Mallory), Portland, Maine
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23
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McDaniel CE, Russell CJ. Top Articles in Pediatric Hospital Medicine: July 2019 to June 2020. Hosp Pediatr 2020; 10:906-912. [PMID: 32703814 DOI: 10.1542/hpeds.2020-001651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Corrie E McDaniel
- Division of Hospital Medicine, Seattle Children's Hospital and Department of Pediatrics, University of Washington, Seattle, Washington; and
| | - Christopher J Russell
- Division of Hospital Medicine, Children's Hospital Los Angeles and Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
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24
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Samuels‐Kalow ME, Ciccolo GE, Lin MP, Schoenfeld EM, Camargo CA. The terminology of social emergency medicine: Measuring social determinants of health, social risk, and social need. J Am Coll Emerg Physicians Open 2020; 1:852-856. [PMID: 33145531 PMCID: PMC7593464 DOI: 10.1002/emp2.12191] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 01/12/2023] Open
Abstract
Emergency medicine has increasingly focused on addressing social determinants of health (SDoH) in emergency medicine. However, efforts to standardize and evaluate measurement tools and compare results across studies have been limited by the plethora of terms (eg, SDoH, health-related social needs, social risk) and a lack of consensus regarding definitions. Specifically, the social risks of an individual may not align with the social needs of an individual, and this has ramifications for policy, research, risk stratification, and payment and for the measurement of health care quality. With the rise of social emergency medicine (SEM) as a field, there is a need for a simplified and consistent set of definitions. These definitions are important for clinicians screening in the emergency department, for health systems to understand service needs, for epidemiological tracking, and for research data sharing and harmonization. In this article, we propose a conceptual model for considering SDoH measurement and provide clear, actionable, definitions of key terms to increase consistency among clinicians, researchers, and policy makers.
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Affiliation(s)
- Margaret E. Samuels‐Kalow
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolMassachusettsUSA
| | - Gia E. Ciccolo
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolMassachusettsUSA
| | - Michelle P. Lin
- Department of Emergency MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Elizabeth M. Schoenfeld
- Department of Emergency Medicine and Institute for Healthcare Delivery and Population ScienceUniversity of Massachusetts Medical School – BaystateSpringfieldMassachusettsUSA
| | - Carlos A. Camargo
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolMassachusettsUSA
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25
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Vaz LE, Wagner DV, Jungbauer RM, Ramsey KL, Jenisch C, Koskela-Staples N, Everist S, Austin JP, Harris MA, Zuckerman KE. The Role of Caregiver-Reported Risks in Predicting Adverse Pediatric Outcomes. J Pediatr Psychol 2020; 45:957-970. [PMID: 32815539 PMCID: PMC8312731 DOI: 10.1093/jpepsy/jsaa067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Certain social risk factors (e.g., housing instability, food insecurity) have been shown to directly and indirectly influence pediatric health outcomes; however, there is limited understanding of which social factors are most salient for children admitted to the hospital. This study examines how caregiver-reported social and medical characteristics of children experiencing an inpatient admission are associated with the presence of future health complications. METHODS Caregivers of children experiencing an inpatient admission (N = 249) completed a predischarge questionnaire designed to capture medical and social risk factors across systems (e.g., patient, caregiver, family, community, healthcare environment). Electronic health record (EHR) data were reviewed for child demographic data, chronic disease status, and subsequent emergency department visits or readmissions (i.e., acute events) 90 days postindex hospitalization. Associations between risk factors and event presence were estimated using odds ratios (ORs) and confidence intervals (CI), both unadjusted and adjusted OR (aOR) for chronic disease and age. RESULTS Thirty-three percent (N = 82) of children experienced at least one event. After accounting for child age and chronic disease status, caregiver perceptions of child's health being generally "poor" or "not good" prior to discharge (aOR = 4.7, 95% CI = 2.3, 9.7), having high care coordination needs (aOR = 3.2, 95% CI = 1.6, 6.1), and experiencing difficulty accessing care coordination (aOR = 2.5, 95% CI = 1.4, 4.7) were significantly associated with return events. CONCLUSIONS Caregiver report of risks may provide valuable information above and beyond EHR records to both determine risk of future health problems and inform intervention development.
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Affiliation(s)
- Louise E Vaz
- Department of Pediatrics, Doernbecher Children’s Hospital
| | - David V Wagner
- Department of Pediatrics, Doernbecher Children’s Hospital
| | - Rebecca M Jungbauer
- Pacific Northwest Evidence-Based Practice Center, Oregon Health
& Science University
| | - Katrina L Ramsey
- Biostatistics and Design Program, Oregon Health & Science
University
| | | | | | - Steven Everist
- Department of Pediatrics, Doernbecher Children’s Hospital
- BUILD EXITO Program, Portland State University
| | - Jared P Austin
- Department of Pediatrics, Doernbecher Children’s Hospital
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26
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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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