Seattle Children's Research Institute, Seattle, Washington
Washington State Department of Social and Health Services, Division of Research and Data Analysis, Olympia, Washington.
Ann Fam Med. 2018 Jan;16(1):62-69. doi: 10.1370/afm.2134.
Screening for social determinants of health is challenging but critically important for optimizing child health outcomes. We aimed to test the feasibility of using an integrated state agency administrative database to identify social complexity risk factors and examined their relationship to emergency department (ED) use.
We conducted a retrospective cohort study among children younger than 18 years with Washington State Medicaid insurance coverage (N = 505,367). We linked child and parent administrative data for this cohort to identify a set of social complexity risk factors, such as poverty and parent mental illness, that have either a known or hypothesized association with suboptimal health care use. Using multivariate analyses, we examined associations of each risk factor and of number of risk factors with the rate of ED use.
Nine of 11 identifiable social complexity risk factors were associated with a higher rate of ED use. Additionally, the rate increased as the number of risk factors increased from 0 to 5 or more, reaching approximately twice the rate when 5 or more risk factors were present in children aged younger than 5 years (incidence rate ratio = 1.92; 95% CI, 1.85-2.00) and in children aged 5 to 17 years (incidence rate ratio = 2.06; 95% CI, 1.99-2.14).
State administrative data can be used to identify social complexity risk factors associated with higher rates of ED use among Medicaid-insured children. State agencies could give primary care medical homes a social risk flag or score to facilitate targeted screening and identification of needed resources, potentially preventing future unnecessary ED use in this vulnerable population of children.
筛查健康的社会决定因素具有挑战性，但对于优化儿童健康结果至关重要。我们旨在测试使用集成的州机构行政数据库来识别社会复杂性风险因素的可行性，并研究其与急诊部（ED）使用的关系。
我们对 505367 名有华盛顿州医疗补助保险的 18 岁以下儿童进行了回顾性队列研究。我们将儿童和父母的行政数据与该队列联系起来，以确定一组社会复杂性风险因素，如贫困和父母精神疾病，这些因素与医疗保健利用不足有已知或假设的关联。我们使用多变量分析来检查每个风险因素和风险因素数量与 ED 使用率的关联。
11 个可识别的社会复杂性风险因素中有 9 个与 ED 使用率较高有关。此外，随着风险因素数量从 0 增加到 5 个或更多，这种比率会增加，在年龄小于 5 岁的儿童中，当存在 5 个或更多风险因素时，比率达到近两倍（发病率比=1.92；95%置信区间，1.85-2.00），在 5 至 17 岁的儿童中，比率达到 2.06（95%置信区间，1.99-2.14）。
州行政数据可用于识别与 Medicaid 保险儿童中 ED 使用率较高相关的社会复杂性风险因素。州机构可以为初级保健医疗之家提供社会风险标志或评分，以促进有针对性的筛查和识别所需资源，有可能防止该脆弱儿童群体未来不必要的 ED 使用。
