159 - Health-Related Social Needs in a Pediatric Emergency Department

Poster Number: 159
Publication Number: 159.411

Gauthami Soma, Yale School of Medicine, West Hartford, CT, United States; Veronika Shabanova, Yale School of Medicine, New Haven, CT, United States; Treysi G. Vargas, Yale-New Haven Children's Hospital, Sacramento, CA, United States; Mona Sharifi, Yale School of Medicine, New Haven, CT, United States; Marina Gaeta, Yale School of Medicine, New Haven, CT, United States; Giselle Carlotta-McDonald, Yale-New Haven Children's Hospital, New Haven, CT, United States; Millie G. Landock, Yale-New Haven Children's Hospital, New Haven, CT, United States; Karamo Kourouma, Yale New haven Hospital, Cheshire, CT, United States; Beth Emerson, Yale School of Medicine, New Haven, CT, United States; Gunjan Tiyyagura, yale university school of medicine, New Haven, CT, United States

Background: The pediatric emergency department (PED) serves as a safety net for vulnerable children, but efforts to describe and intervene upon health-related social needs (HRSNs) in this setting are limited.

Objective: 1. To describe the burden of HRSNs in publicly insured children who present to a tertiary care PED.2. To examine the extent to which HRSNs are associated with PED utilization. Utilization was dichotomized as high (accessing the PED > 2 times) vs. regular (accessing the PED once) within the past 12 months.3. To describe the impact of patient navigation (PN) on the burden of HRSNs in a group of high-frequency PED utilizers.

Design/Methods: We conducted a cross-sectional survey of Medicaid beneficiaries presenting to a tertiary care PED between November 2018 and May 2019. The Accountable Health Communities tool was used to screen for five core areas of HRSN: housing instability, food insecurity, transportation needs, utility needs, and personal safety. Self-reported PED utilization was also collected. Surveys were completed on tablets by caregivers of patients < 13 years of age and by patients if > 13 years of age and were offered in English and Spanish.  Patients with high PED utilization were offered PN for one year to connect with community resources based on identified needs.
T-tests and Chi-square analyses were used to summarize the association between HRSNs and PED utilization. Logistic regression was used to investigate these relationships. One-year outcomes of PN on the resolution of HRSNs are reported.

Results: 1046 patients or caregivers were screened for the study and 906 (86.6%) consented to participation. Most families (56.0%) had unmet HRSNs (Table 1). Patients with HRSN were more likely Spanish speaking (19.8% vs. 14.4%, p = .04), and had an annual family income < $25,000 (40.5% vs. 20.7%, p< .01) compared to patients without HRSN. Patients without HRSN more often identified as White non-Hispanic (10.4% vs. 3.9%, p< .01) compared to patients with HRSN. The most common HRSN identified was food insecurity (36.3%), followed by housing instability (30.1%), utility needs (29.5%), transportation needs (18.4%), and concern for personal safety (0.7%).
Patients with HRSN were more likely to be high PED utilizers (58.4% vs. 51.5%; OR = 1.30; 95% CI, 0.99 - 1.72) (Figs 1a, 1c) and an increasing number of HRSN was associated with high frequency PED utilization (p < .01) (Fig 1b).  Of those who received PN, 50% of HRSNs were resolved (Fig 2).  Conclusion(s): There is a high burden of HRSN in the PED and a burden of HRSN may predict high-frequency PED utilization. PN can help to alleviate these needs.
GauthamiSomaCV11.30.pdf
HRSN and PED Utilization1. Panel A: Bivariate analysis of HRSN type in Regular vs. High-frequency PED utilizes. P-values by chi-squared analysis.
2. Panel B: Bivariate analysis of numerical HRSN burden in Regular vs. High-frequency PED utilizes. P-value by the Cochrane-Armitage Test for Trend, p < .01.
3. Panel C: Unadjusted Odds Ratios and Confidence Intervals of High PED utilization by type of HRSN.