Pediatric Critical Care Medicine Physician Akron Children's Hospital Akron, Ohio, United States
Background: Critically ill children have higher risk of health disparities which may be worsened during hospitalizations. Inpatient social workers (SW) can address health disparities by providing emotional support and social resources (SR). We described the characteristics of patients receiving SR during their PICU hospitalizations. Objective: We hypothesized children receiving SR would have fewer 6-month hospital readmissions and reduced healthcare costs. Design/Methods: A single-center retrospective study of all PICU encounters January 1, 2023-December 31, 2023. There were no set criteria or screening to determine SW involvement. Demographics and hospitalization characteristics associated with resource provision were described. To analyze the effect of social work resource provision on unplanned readmissions, the cohort was matched 1:1 by nearest-neighbor propensity for resource administration on demographics, illness severity, and length of stay. Results: There were 1,499 PICU hospitalizations. 1,125 (75%) met with PICU SW and 458 (31%) received at least 1 SR. Children with SW engagement had higher proportions of public insurance (65% p 0.023) and lived in zip-codes with lower median household income (MHI) ($53,768 [$44,494-64,797] vs $57,217 [$46,601-68,160] p 0.01). Food resources were provided most frequently, to 327 (22%) children, followed by housing resources to 176 (12%). Children who received resource(s) were younger (2 [0.6-11] years vs. 5 [1.3-13] years p < 0.001), had a higher proportion of complex chronic conditions (66% vs. 52% p < 0.001), public insurance (68% p < 0.001), and lived in zip-codes with lower MHI ($53,316 [$41,261-$4,729] vs. $55,337 [$46,875-$66,884] p 0.001) with lower neighborhood opportunity (32.5% versus 24.2% from very low childhood opportunity index p 0.005). These children had increased severity of illness (PELOD-2 1 [0-10] vs. 10 [0-11] p < 0.001, higher mortality (5.5% vs. 1.6% p < 0.001) and higher hospital cost ($37,044 [$14,937-$84,578] vs. $15,620 [$9,369-$33,984] p < 0.001). There were 1253 (84%) PICU survivors with complete 6-month follow up data for propensity matching, of whom 650 were matched. After matching, children with social resource provision were less likely to be readmitted within 6 months (marginal risk ratio 0.76 [95% CI 0.59-0.98]). Estimated cost avoidance was $2,342 (95% CI $130-5,512) per patient receiving SR.
Conclusion(s): Critically ill children are at high risk for social needs on presentation to the PICU. Providing SR during PICU hospitalization may reduce readmission rates and healthcare costs.
