571 - Exploring Equity in a Pediatric Emergency Department Infant Supply Insecurity Screening and Distribution Program

Publication Number: 571.4650

Ashley F. Maras, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Lindsey Arenberg, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Elena Chen, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Hannah C.. King, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Ashlyn McRae, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Elizabeth N. Laska, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Karen Mangold, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Doug Lorenz, University of Louisville, Louisville, KY, United States; Megan O. Barrera-Lessinger, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Susana Marchan-Rojo, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Selina Varma Thomas, Northwestern University The Feinberg School of Medicine, Wheaton, IL, United States; Megan M. Attridge, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: Infant supply insecurity is a prevalent issue for families with young children in the U.S. To meet these needs in our pediatric emergency department (PED), we started an infant supply (IS) insecurity screening and distribution program.

Objective: To evaluate equity within the program, we aimed to evaluate patient and encounter characteristics associated with IS insecurity screening, positivity for IS insecurity, and offering of resources.

Design/Methods: We evaluated encounters of patients under 36 mo. presenting to the PED from August 2023 – July 2024. Caregivers of children under 36 mo. were eligible for diaper need screening; caregivers of children under 12 mo. were eligible for formula need screening. Social work offered resources to caregivers that screened positive for IS insecurity. We collected characteristics from the electronic medical record including interpreter need, sex, race and ethnicity, insurance status, acuity, and shift of presentation. We used logistic regression to examine patient and encounter characteristics associated with screening for IS insecurity, positivity for IS insecurity, and offering of resources.

Results: There were 20,050 encounters for patients under 36 mo., of which 10,389 (52%) were screened for diaper need, 467 (4.5%) screened positive, and 69 (15%) were offered resources. There were 9,138 encounters for patients under 12 mo., of which 4,726 (52%) were screened for formula need, 200 (4%) screened positive, and 15 (7%) were offered resources (Table 1). After adjusting for patient and encounter characteristics, encounters during the evening and higher acuity encounters had lower odds of being screened for IS insecurity. Increased odds of IS insecurity were associated with interpreter need, Hispanic ethnicity, non-Hispanic Black race, and public and self-pay insurance. There were no significant associations between patient and encounter characteristics and offering of resources (Tables 2&3).

Conclusion(s): Lower odds of IS insecurity screening was associated with higher acuity and evening shift of presentation, suggesting that screening needs should be emphasized for these encounters. Interpreter need, Hispanic ethnicity and non-Hispanic Black race, and public and self-pay insurance were associated with higher odds of IS insecurity. Further investigation into the barriers facing these groups could help shape future public health interventions to lessen IS insecurity. Lastly, while offering of resources was low overall among encounters screening positive for IS insecurity there were no significant associations with patient and encounter characteristics.

Table 1: Characteristics of Emergency Department Encounters from August 2023-July 2024
Caption: Encounter characteristics for patients presenting from August 2023 to July 2024. Caregivers were eligible for diaper need or formula need screening based on patient age, with patients under 36 months eligible for diaper need screening and patients under 12 months eligible for formula need screening (ESI = Emergency Severity Index)

Table 2: Regression Analysis of Patient and Encounter Characteristics and Association with Diaper Need Screening, Presence of Diaper Need, and Offering of Diapers
In addition to diapers, caregivers are also offered a list of diaper pantries. Adjusted odds ratios are adjusted for interpreter use, patient sex, age, race and ethnicity, insurance status, acuity, and shift of presentation.
*Indicates that the 95% confidence interval does not cross 1
(aOR = adjusted odds ratio; CI = confidence interval; ESI = Emergency Severity Index)

Table 3: Regression Analysis of Patient and Encounter Characteristics and Association with Formula Need Screening, Presence of Formula Need, and Offering of Formula
In addition to formula, caregivers are also offered information on the Special Supplemental Nutrition Program for Women, Infants, and Children. Adjusted odds ratios are adjusted for interpreter use, patient sex, age, race and ethnicity, insurance status, acuity, and shift of presentation.
*Indicates that the 95% confidence interval does not cross 1
(aOR = adjusted odds ratio; CI = confidence interval; ESI = Emergency Severity Index)

Table 1: Characteristics of Emergency Department Encounters from August 2023-July 2024
Caption: Encounter characteristics for patients presenting from August 2023 to July 2024. Caregivers were eligible for diaper need or formula need screening based on patient age, with patients under 36 months eligible for diaper need screening and patients under 12 months eligible for formula need screening (ESI = Emergency Severity Index)

Table 2: Regression Analysis of Patient and Encounter Characteristics and Association with Diaper Need Screening, Presence of Diaper Need, and Offering of Diapers
In addition to diapers, caregivers are also offered a list of diaper pantries. Adjusted odds ratios are adjusted for interpreter use, patient sex, age, race and ethnicity, insurance status, acuity, and shift of presentation.
*Indicates that the 95% confidence interval does not cross 1
(aOR = adjusted odds ratio; CI = confidence interval; ESI = Emergency Severity Index)

Table 3: Regression Analysis of Patient and Encounter Characteristics and Association with Formula Need Screening, Presence of Formula Need, and Offering of Formula
In addition to formula, caregivers are also offered information on the Special Supplemental Nutrition Program for Women, Infants, and Children. Adjusted odds ratios are adjusted for interpreter use, patient sex, age, race and ethnicity, insurance status, acuity, and shift of presentation.
*Indicates that the 95% confidence interval does not cross 1
(aOR = adjusted odds ratio; CI = confidence interval; ESI = Emergency Severity Index)