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Published on: February 5, 2019
Outcomes From a Health-Related Social Needs Screening Initiative in Pediatric Orthopaedic Patients: A Prospective
Devika A Shenoy1, Evan Schrader, Kathryn Radulovacki
1Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC.
Insights
Screening for health-related social needs (HRSN) in pediatric orthopaedics improved identification and enrollment in services. This quality improvement initiative successfully connected families with unmet needs to vital resources.
Area of Science:
- Pediatric Orthopaedics
- Health-Related Social Needs (HRSN)
- Quality Improvement (QI)
Background:
- Unmet health-related social needs (transportation, food, housing, financial, utility) are linked to adverse outcomes in pediatric orthopaedic patients.
- A prospective quality improvement (QI) study was designed to address this by implementing systematic screening and referral processes.
Purpose of the Study:
- To evaluate the feasibility and outcomes of a systematic screening initiative for health-related social needs (HRSN) in a pediatric orthopaedic clinic.
- To assess the impact of the initiative on screening rates, identification of social needs, and successful enrollment in resource management services.
Main Methods:
- A prospective QI study conducted at a tertiary care pediatric orthopaedic clinic.
- Implementation of an institutional social risk survey based on the Accountable Health Communities' HRSN Screening Tool.
- Comparison of data from a 9-month post-initiative period with a 3-month pre-initiative period, including demographic analysis and multivariable logistic regression.
Main Results:
- Screening rates significantly increased from 38% to 65% post-initiative (P<0.001), particularly for fracture/dislocation patients (37% to 76%).
- Among screened patients, 21% reported at least one social need, with financial insecurity (13%) and food insecurity (11%) being most prevalent.
- Referral rates increased to 87% and successful enrollment in services rose from 25% to 61% post-initiative (P=0.005).
Conclusions:
- Systematic screening for health-related social needs (HRSN) is feasible within pediatric orthopaedic settings.
- Orthopaedic encounters provide a valuable opportunity to identify families with unmet social needs and facilitate connections to essential resources.
Background:
Health-related social needs (HRSN), which include unmet transportation, food, housing, financial, and utility needs, have been associated with poor outcomes in pediatric orthopaedic patients. This study aims to report outcomes from a prospective, quality improvement (QI) study that aimed to address this issue by screening for social risk factors and referring patients to resource management programs.
Methods:
This was a prospective QI study implemented at a tertiary care center's pediatric orthopaedic clinic. Patients (ie, their families/caregivers) were given an institutional social risk survey, which is derived from the Accountable Health Communities' HRSN Screening Tool. Data collected post-initiative over a 9-month period were compared with a 3-month period pre-initiative. We analyzed demographic characteristics, screening completion rates, the prevalence of specific social needs, and the rate of successful referral and enrollment in resource management services. Multivariable logistic regression was used to identify associations between patient factors and screening completion/referral status.
Results:
In total, 735 patients were evaluated (224 pre-initiative; 511 post-initiative). The initiative significantly increased screening rates from 38% pre-initiative to 65% post-initiative ( P <0.001). The highest rate increase was among fracture/dislocation patients (37% pre-initiative to 76% post-initiative, P =0.004). Among prospective respondents, 70 patients (21%) screened positive for at least one social need, with the highest rates of financial (13%) and food insecurity (11%). In regression analysis, female patients had higher odds of a completed screening (aOR: 1.53, P =0.03), and Medicaid insurance was associated with higher odds of social need (aOR: 3.56; 95% CI: 1.65-8.01; P =0.002). Post-initiative, 87% of patients with a social need received a referral, and 61% were successfully enrolled in services, a significant increase from the pre-initiative enrollment rate of 25% ( P =0.005).
Conclusions:
This study suggests that implementation of a systematic HRSN screening initiative in pediatric orthopaedics is feasible, and orthopaedic encounters may serve as a touch point to screen for unmet social needs and connect families with resource management programs.
Level Of Evidence:
Level II.
