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Evaluating the Impact of a Pediatric Inpatient Social Care Program in a Community Hospital
Jana C Leary1, Hannah Bagley2, Iris T Chan3
1Department of Pediatrics, Tufts Medicine Pediatrics with Boston Children's Hospital.
Insights
Implementing a stakeholder-informed social care program increased social risk identification and social work consultations in a community hospital. This initiative improved the timeliness of consultations and communication of social risks in discharge summaries.
Area of Science:
- Healthcare Management
- Public Health
- Social Determinants of Health
Background:
- Social risks significantly impact patient health outcomes.
- Effective screening and referral systems are crucial for addressing social determinants of health in pediatric care.
- Community hospitals play a vital role in integrating social care into healthcare delivery.
Purpose of the Study:
- To evaluate the impact of a stakeholder-informed social risk screening and referral system.
- To assess changes in social risk identification and social work intervention post-implementation.
- To determine improvements in the timeliness and documentation of social care in a pediatric setting.
Main Methods:
- Implementation of a stakeholder-informed social care program in a community hospital.
- Comparative analysis of pediatric patients (0-17 years) pre- and post-implementation (1 year each).
- Manual data extraction for process measures and outcomes; statistical analysis using chi-square, Wilcoxon rank tests, and logistic regression.
Main Results:
- Increased identification of social risks (17.4% vs 7.8%, P < .01) and social work consults (13.8% vs 5.6%, P < .01) post-implementation.
- Improved timeliness of social work consultations (median 19 hours vs 25 hours, P = .03).
- Enhanced communication of social risks in discharge summaries (46.8% vs 8.2%, P < .001).
Conclusions:
- Stakeholder-informed social care programs effectively increase social risk identification in hospitals.
- Implementation led to more frequent and timely social work interventions.
- Improved documentation of social risks in discharge summaries facilitates better care coordination.
Objectives:
To evaluate the impact of implementing a stakeholder-informed social risk screening and social service referral system in a community hospital setting.
Methods:
We implemented a stakeholder-informed social care program at a community hospital in April 2022. The evaluation included patients aged 0 to 17 years admitted to the pediatric unit between April 2021 and March 2022 (1 year preimplementation) and between April 2022 and March 2023 (1 year postimplementation). For a random subset of 232 preimplementation and 218 postimplementation patients, we performed manual data extraction, documenting program process measures and preliminary effectiveness outcomes. We used χ square and Wilcoxon rank tests to compare outcomes between the preimplementation and postimplementation groups. Multivariable logistic regression was used to assess the preliminary effectiveness of the social care program in identifying social risks.
Results:
Screening rates were higher in the postimplementation group for nearly all social domains. Compared with preimplementation, the postimplementation group had higher rates of social risks identified (17.4% vs 7.8% [P < .01]: adjusted odds ratio 2.9 [95% confidence interval 1.5-5.5]) on multivariate testing. Social work consults were completed more frequently and earlier for the postimplementation group (13.8.% vs 5.6% [P < .01]) and median (19 hours vs 25 hours [P = .03]), respectively. Rates of communication of social risks in discharge summaries were higher in the postimplementation group (46.8% vs 8.2% [P < .001]).
Conclusions:
The implementation of a stakeholder-informed social care program within a community hospital setting led to the increased identification of social risks and social work consultations and improved timeliness of social work consultations and written communication of social risks in discharge summaries for primary care providers.
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