154 - Detecting Disparities: A Randomized Trial of Social Determinants of Health Screening in the Emergency Department

Poster Number: 154
Publication Number: 154.411

Arianna Nassiri, Dell Children's Medical Center of Central Texas, Houston, TX, United States; Timothy Ruttan, University of Texas at Austin Dell Medical School; Dell Children's Medical Center of Central Texas; US Acute Care Solutions, Austin, TX, United States; Matthew Wilkinson, UT Austin Dell Medical School, Austin, TX, United States

Background: Social determinants of health (SDOH) are conditions in the environment where people are born, live, learn, work, play, and worship that affect a wide range of health and quality-of-life outcomes. National guidelines now recommend screening for SDOH in health care settings, and the Pediatric Emergency Department (PED) has high potential for SDOH screening given the patient volumes and its use as a replacement medical home for many children. Limited evidence exists to compare screening formats, family preferences, and follow-up rates in the PED for a comprehensive screening tool.

Objective: This study looked at the screening preference of caregivers electronically on a tablet versus a verbal interview. Secondarily, the study sought to investigate if families who were provided resources were able to access those resources at 1 month and 3 month follow-up phone calls and assess barriers to receiving social needs support and referrals.

Design/Methods: A screening tool previously used in local primary care clinics was used to screen all English and Spanish speaking caregivers present in the PED during screener availability from March 1-December 30, 2021. Subjects were allocated via block randomization and were enrolled unless acuity did not allow for study participation. Participants were consented, screened either electronically or verbally, and emailed a resource list for any self identified needs. At 1-month intervals, participants were contacted about their experience. Barriers to obtaining resources were also assessed, and further resources provided as needed. Any participant desiring further help was again contacted at 3 months.

Results: While no statistically important difference between the screening modalities were observed, we found that 94% of patients found their screening appropriate.  The most commonly identified needs in all groups were regarding preschool (11%), financial aid (11%), groceries (22%), housing (6%), utilities (22%), food stamps (11%), lowering debt/improving credit score (10%), and joining affordable sports activities (12%).Conclusion(s): These results suggest that the unique environment in the PED allows for screening either verbally or electronically. This may indicate that privacy and confidentiality may not be as important in the PED where there is not a long term relationship such as in a medical home. As PEDs begin increased SDOH screening efforts to detect and address social disparities, this suggests that sites can choose the best screening method for their local workflow.
Table 1: Demographics
Table 2: Social Disparities of Health Screening Questionnaire