The First Step Is Knowing: Quantifying Social Need Through Screening in a Pediatric Surgery Clinic

Patient characteristics such as race, ethnicity, household income, and insurance status predict morbidity and mortality disparities for numerous pediatric surgical disease processes. Health-related social need (HRSN) screening is increasingly utilized in primary care to connect patients with support services and mitigate health disparities. The purpose of this study was to assess the impact of a novel HRSN screening program in a pediatric surgery clinic.

We implemented screening for all new patient encounters in our pediatric surgery ambulatory practice, excluding patients screened elsewhere in our health system within the preceding 12 mo. Patients or caregivers completed a comprehensive screening questionnaire up to 1 mo before their clinic visit and could elect to receive need-specific referrals and institutional resources. Using institutional clinic-level data, we evaluated the screening program's results using descriptive statistics.

We screened 1410 patients in the program's first 24 mo. Patients were predominantly male (788 of 1410, 55.9%), Caucasian (1098 of 1410, 77.9%), and under age 10 (773 of 1410, 54.8%). One in five patients (241 of 1410, 17.1%) screened positive for at least one unmet social need. Virtual care access issues and food insecurity were most frequently reported within the cohort (24.9% and 22.3%, respectively). Respondents who screened positive for unmet need rarely requested assistance (82 of 241, 34.0%). Only 5.8% (82 of 1410) of screenings generated a referral.

Pediatric surgery patients in our catchment area experience high rates of unmet social need. Standardized screening is feasible in an ambulatory surgical care setting and may facilitate early identification of intervenable social risk factors. Further investigation is needed to understand why families frequently declined assistance.