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Social Risk Screening in Pediatric Primary Care Anticipates Acute Care Utilization
Insights
Pediatric social risk screening during well-child visits identifies families with increased emergency department (ED) or urgent care (UC) utilization. Early identification can inform targeted interventions to reduce acute care use.
Area of Science:
- Pediatric Health
- Social Determinants of Health
- Healthcare Utilization
Background:
- Social risk factors significantly impact child health and healthcare access.
- Standardized screening tools are increasingly used in pediatric primary care to identify these risks.
- Understanding the link between social risks and acute care visits is crucial for resource allocation.
Purpose of the Study:
- To determine if positive responses on a social risk screen during pediatric well-child visits (WCV) correlate with subsequent emergency department (ED) or urgent care (UC) utilization.
- To quantify the association between the number of reported social risks and acute care visits.
Main Methods:
- Retrospective cohort study of 26,509 children under 13 years old.
- Data collected from well-child visits between January 2012 and December 2013.
- Exposure: positive responses on a standardized social risk screening questionnaire; Outcome: ED or UC visits in the 12 months post-WCV.
Main Results:
- Over 20% of children screened positive for at least one social risk.
- Children with any social risk had higher rates of ED/UC visits (46.7%).
- Each additional social risk increased ED utilization by 4% and hospitalizations by 16%.
Conclusions:
- Families reporting social concerns during WCVs exhibit increased acute care utilization.
- Screening for social risks can identify vulnerable populations.
- This identification may facilitate the development of targeted preventive strategies to mitigate future healthcare utilization.
Objective:
The aim of the study was to assess whether responses to a standardized social risk screen administered during pediatric well-child visits (WCV) were associated with emergency department (ED) or urgent care (UC) utilization.
Methods:
This was a retrospective cohort study of 26,509 children younger than 13 years with a WCV between January 1, 2012, and December 31, 2013. Exposure was positive response(s) on a standardized social risk screening questionnaire at the index WCV. Primary outcome was number of ED or UC visits in the 12 months after the WCV.
Results:
The cohort was 50.9% male and 65.7% black, with a median age of 3.6 years. More than 20% had a positive response to at least one question on the social risk screen. For those reporting any social risk, 46.7% had 1 or more EDs or UC visit within 12 months. Each additional reported risk was associated with a 4% increase in the rate of ED utilization (incidence rate ratio = 1.04, 95% confidence interval = 1.02-1.07) and a 16% increase in the rate of hospitalizations (incidence rate ratio = 1.16, 95% confidence interval = 1.08-1.24). Similar patterns were noted for those visiting the ED 4 times or more (adjusted odds ratio = 1.09, 1.03-1.15) and hospitalization 2 times or more (adjusted odds ratio = 1.19, 1.04-1.35) in the year after the WCV. Those who screened positive on food insecurity, safety, and desire to meet with a social worker questions also had higher odds of ED or UC utilization.
Conclusions:
Families reporting a social concern on a standardized screen during a WCV had increased acute care utilization in the subsequent year. Identifying socially at-risk families may allow for the creation of more effective strategies to prevent future utilization.
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