96 - Social Determinants of Health Are Associated With Pediatric Emergency Department Presentation for Ambulatory Care Sensitive Conditions

Poster Number: 96
Publication Number: 96.211

Kristol Das, Nationwide Children's Hospital, Columbus, OH, United States; Deena J. Chisolm, Nationwide Children's Hospital, Columbus, OH, United States; Amanda J. Onwuka, Nationwide Children's Hospital, Columbus, OH, United States

Background: Population health experts have long chronicled the link between social factors and health, but few studies clearly link specific social needs to disease processes. Nationwide Children’s Hospital (NCH) implemented a universal, annual screener for social determinants of health (SDH) in 2018. Early analyses have shown that patients identifying an SDH need were more likely to have an emergency department (ED) or inpatient stay and less likely to have a well child visit in the 6 months surrounding the expressed need.

Objective: The objective of this study is to identify links between SDH and likelihood of ED presentation for ambulatory care sensitive conditions (ACSCs). ACSCs, as defined by the Agency for Healthcare Research and Quality, are conditions for which good outpatient care can potentially prevent the need for hospitalization, or for which early intervention can prevent complications or more severe disease.

Design/Methods: This was a retrospective observational study of children aged 0-21 receiving care at NCH from 2018-2021 that completed the screening tool for SDH. Acute care utilization within 6 months of screener completion, as well as other sociodemographic and clinical data were collected. Patients that completed the screening tool for the first time in the ED or urgent care setting were excluded to minimize selection bias. Logistic regression was employed to analyze the association between ED presentation for ACSCs and SDH needs.

Results: 185,516 social determinants screeners were eligible for inclusion with 8% of screeners identifying a need. Four percent of the population expressed food needs, 3% transportation needs, 3% utility needs, and 1% housing needs. Fourteen percent of patients had an ED visit for an ACSC, with the most common complaints being upper respiratory infections and asthma. Having any SDH need was associated with ED visits for ACSCs (OR: 1.14, 95% CI:1.09-1.20). Needs in all domains were significantly associated with increased visits for ACSCs; of note, patients with housing needs had the highest odds of utilization (OR:1.17, CI:1.04-1.30). Further, each additional SDH need was associated with a 9% increase in the odds of ED utilization for ACSC, such that multiple needs were associated with higher utilization than one need (OR: 1.09, CI:1.06-1.12).Conclusion(s): The odds of ED presentation for ACSCs are higher in patients with expressed social needs. Further delineating the connections between specific social determinants of health and health outcomes can inform timely and appropriate interventions.
CVCV.12.2021.pdf
Sample Characteristics