Fritz Cristin Q, Thomas Jacob, Gambino Jessica, Torok Michelle, Brittan Mark S
Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee;
Department of Pediatrics, School of Medicine, Vanderbilt University, Nashville, Tennessee.
Hosp Pediatr. 2020 Oct;10(10):859-866. doi: 10.1542/hpeds.2020-0094.
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.
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 χ or the Wilcoxon rank test and logistic regression analyses.
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%; = .05), lower median household income ($62 321 vs $71 460; < .01), lower parental education ( < .01), public insurance (57% vs 43%; < .01), lived in a 1-parent household (30 vs 12%; < .01), and had a complex chronic condition (35% vs 23%; = .01) compared with those with a negative screen result. There was no difference in care reuse by screening status in adjusted analyses.
Social risks are common in the pediatric inpatient setting. Children with medical complexity offer a good target for initial screening efforts.
在住院环境中筛查健康的社会决定因素并不常见。然而，计费和电子病历数据中记录的社会风险因素与儿科医疗服务使用的增加有关。我们试图描述（1）社会风险和转诊接受情况的流行病学，以及（2）通过常规住院筛查确定的社会风险与医疗服务使用之间的关联。
2017年10月至2019年6月，入住一家学术儿童医院普通儿科病房的0至18岁儿童的家长完成了一项社会心理筛查调查。该调查涵盖以下领域：财务、住房、食品安全、药物和福利。从电子病历中提取患者特征和医疗服务使用结果，并使用Pearson卡方检验或Wilcoxon秩和检验以及逻辑回归分析进行比较。
在374个接受筛查的家庭中，141个（38%）筛查结果为阳性，其中78个（55%）报告有>1项需求，64个（45%）接受了社区资源。在双变量分析中，筛查结果为阳性的患者30天再入院率较高（10%对5%；P = .05），家庭收入中位数较低（62321美元对71460美元；P < .01），父母受教育程度较低（P < .01），公共保险比例较高（57%对43%；P < .01），生活在单亲家庭（30%对12%；P < .01），患有复杂慢性病的比例较高（35%对23%；P = .01），与筛查结果为阴性的患者相比。在调整分析中，按筛查状态划分的医疗服务重复使用情况没有差异。
社会风险在儿科住院环境中很常见。患有复杂疾病的儿童是初始筛查工作的良好目标。
