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Predicting the preventable: Social drivers of health on pediatric readmissions and emergency department visits
Kristen A Torres1, Doris Valenzuela-Araujo1, Michael A Harris1
1Department of Pediatrics, Oregon Health & Science University.
Insights
Many pediatric emergency visits and hospital readmissions are preventable. Social factors like discrimination and caregiver education significantly influence these preventable acute medical events (AMEs).
Area of Science:
- Pediatric healthcare research
- Social determinants of health
- Healthcare quality improvement
Background:
- Pediatric emergency department visits and hospital admissions represent significant healthcare utilization.
- Identifying preventable acute medical events (AMEs) is crucial for improving child health outcomes and resource allocation.
Purpose of the Study:
- To determine the preventability of pediatric emergency department visits and admissions.
- To investigate whether caregiver-reported social factors predict future preventable AMEs.
Main Methods:
- A predischarge survey was administered to caregivers of hospitalized children (N=249) to collect data on health care utilization and social drivers of health.
- Chart reviews were conducted 365 days postdischarge to identify and quantify AMEs, including readmissions and emergency department visits.
- Three distinct methods were employed to assess the preventability of AMEs and analyze their association with medical status, demographics, and social factors.
Main Results:
- Over two-thirds (67%) of AMEs were classified as preventable by at least one assessment method.
- Predictors of preventable AMEs included young age (<1 year), complex/chronic medical conditions, other children with health concerns, and neurocognitive disorders.
- Higher caregiver education was associated with fewer preventable events, while child mental health conditions, deceased caregivers, and experiences of racial/ethnic discrimination were linked to more preventable readmissions.
Conclusions:
- A significant proportion of pediatric acute medical events are potentially preventable.
- Integrating caregiver-reported social factors into risk assessments is essential for developing targeted interventions and personalized discharge plans.
Objective:
This study aimed to examine the extent to which pediatric emergency department visits and admissions are preventable and whether caregiver-reported social factors predict future preventable visits.
Method:
Caregivers of hospitalized children (N = 249) completed a predischarge survey regarding health care utilization and social drivers of health (e.g., adverse childhood experiences and experiences of racial discrimination). Chart reviews were conducted 365 days postdischarge to capture the presence and frequency of acute medical events (AMEs; i.e., readmissions and emergency department visits). Three methods of determining the preventability of AMEs were used to examine the relationship between preventable AMEs and medical status, demographic characteristics, and social drivers of health.
Results:
Of the youth who experienced an AME, over half (67%) experienced one or more events classified as "preventable" by at least one method. Statistically significant predictors associated with preventable events included age under 1 (OR = 4.17), complex/chronic medical status (OR = 3.03), other children in the home with health concerns (OR = 1.85), and the presence of a neurocognitive disorder (OR = 2.97). Higher caregiver education (incidence rate ratio [IRR] = 0.31) was related to fewer preventable events overall. Child mental health condition (IRR = 18.62), having a deceased caregiver (IRR = 4.35), and child experiences of racial or ethnic discrimination (IRR = 6.01) were related to more preventable readmissions.
Conclusion:
A substantial number of AMEs may be preventable. Caregiver reports of social factors should be included in risk assessments to inform tailored interventions and discharge plans based on unique family characteristics. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
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