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Social and Medical Care Integration Practices Among Children's Hospitals
Matthew S Pantell1,2, A Jay Holmgren3,4, Jana C Leary5
1Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California.
Insights
Most children's hospitals screen for social determinants of health (SDOH) and have strategies to address them, but practices vary widely. This variability highlights the need for ongoing monitoring of SDOH care in hospitals.
Area of Science:
- Healthcare Management
- Public Health
- Pediatric Care
Background:
- Growing evidence links social risk factors to adverse health outcomes.
- Hospitals face new incentives to screen for social determinants of health (SDOH).
- Limited data exists on current social risk-related care practices in children's hospitals.
Purpose of the Study:
- To describe social risk-related care practices in a national sample of children's hospitals.
- To identify variations in screening, intervention strategies, and community partnerships.
- To assess the evaluation of SDOH interventions.
Main Methods:
- Analysis of the 2020 American Hospital Association Annual Survey data.
- Calculation of prevalence for SDOH screening, strategies, and partnerships.
- Comparison of practices by hospital characteristics using weighted data and chi-squared tests.
Main Results:
- 79.6% of children's hospitals screened for social needs; 96.0% had strategies to address at least one social risk.
- Partnerships were more common for patient-level risks than community-level initiatives.
- 39.2% of hospitals assessed the effectiveness of SDOH interventions.
Conclusions:
- Significant variability exists in social risk-related care practices among children's hospitals.
- Practices differ based on SDOH domain and hospital characteristics (ownership, Medicaid population).
- Findings provide a baseline for monitoring changes in response to new healthcare incentives.
Objectives:
In response to evidence linking social risk factors and adverse health outcomes, new incentives have emerged for hospitals to screen for adverse social determinants of health (SDOH). However, little information is available about the current state of social risk-related care practices among children's hospitals. To address outstanding knowledge gaps, we sought to describe social risk-related care practices among a national sample of children's hospitals.
Methods:
We analyzed responses to the 2020 American Hospital Association Annual Survey. Among children's hospitals, we calculated the prevalence of screening for social needs, strategies to address social risks/needs, partnerships with community-based organizations to address social risks/needs at the individual and community level, and rates of impact assessments of how social risk-related interventions affect outcomes. We also used χ2 tests to compare results by hospital characteristics. We weighted results to adjust for nonresponse.
Results:
The sample included 82 children's hospitals. A total of 79.6% screened for and 96.0% had strategies to address at least 1 social risk factor, although rates varied by SDOH domain. Children's hospitals more commonly partnered with community-based organizations to address patient-level social risks than to participate in community-level initiatives. A total of 39.2% of hospitals assessed SDOH intervention effectiveness. Differences in social risk-related care practices commonly varied by hospital ownership and Medicaid population but not by region.
Conclusions:
We found wide variability in social risk-related care practices among children's hospitals based on the risk domain and hospital characteristics. Findings can be used to monitor whether social risk-related care practices change in the setting of new incentives.
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