Department of Pediatrics, Boston Medical Center.
Evans Center for Implementation and Improvement Sciences, Department of Medicine.
Hosp Pediatr. 2022 Dec 1;12(12):1040-1047. doi: 10.1542/hpeds.2022-006767.
The extent that universal social determinants of health (SDH) screening in clinical encounters, as recommended by the American Academy of Pediatrics, has been implemented in inpatient pediatric settings is unknown. We aimed to determine the national prevalence and predictors of standardized SDH screening in US level 2 to 4 neonatal care units (NICUs), describe characteristics of SDH screening programs, and ascertain beliefs of clinical leaders about this practice in the NICU setting.
We randomly selected 100 hospitals with level 2 to 4 NICUs among each of 5 US regions (n = 500) and surveyed clinical leaders from January to November 2021 regarding standardized SDH screening. Responses were weighted for number of level 2 to 4 NICUs in each region and nonresponse.
Overall response rate was 34% (28%-40% by region). Twenty-three percent of US level 2 to 4 NICUs reported standardized SDH screening. We found no associations of hospital characteristics, such as region, size, or safety-net status, with implementation of this practice. Existing programs conducted systematic screening early in the hospitalization (84%), primarily led by social workers (92%). We identified practice variation regarding the type of screening tool, but there was substantial overlap among domains incorporated in the screening. Reported barriers to implementation included perceived lack of resources, inadequate referrals, and lack of an inpatient screening tool.
The prolonged neonatal hospitalization provides opportunities to systematically address SDH. Yet, only 23% of US level 2 to 4 NICUs have implemented this practice. To scale-up implementation, quality improvement may support adaptation of screening and referral processes to the NICU context.
美国儿科学会建议在临床就诊中进行普遍的社会决定因素健康（SDH）筛查，但目前尚不清楚这种做法在住院儿科环境中的实施程度。我们旨在确定美国 2 至 4 级新生儿重症监护病房（NICU）中标准化 SDH 筛查的全国流行率和预测因素，描述 SDH 筛查方案的特征，并确定临床领导者对 NICU 环境中这种做法的看法。
我们在 5 个美国地区随机选择了 100 家具有 2 至 4 级 NICU 的医院（n = 500），并于 2021 年 1 月至 11 月期间向临床领导者调查了标准化 SDH 筛查情况。对每个地区的 2 至 4 级 NICU 数量和未回复情况进行了回复权重。
总体回复率为 34%（地区为 28%-40%）。23%的美国 2 至 4 级 NICU 报告进行了标准化 SDH 筛查。我们发现，医院特征（如地区、规模或安全网状态）与该实践的实施无关联。现有的计划在住院早期进行系统筛查（84%），主要由社会工作者（92%）领导。我们发现，在筛查工具的类型方面存在实践差异，但纳入筛查的领域存在很大重叠。实施的障碍包括认为资源不足、转诊不足以及缺乏住院筛查工具。
新生儿住院时间较长，为系统解决 SDH 提供了机会。然而，只有 23%的美国 2 至 4 级 NICU 实施了这种做法。为了扩大实施范围，质量改进可能会支持对筛查和转诊流程进行调整，以适应 NICU 环境。
