168 - Evaluation of Electronic Health-Related Social Needs Screening Among Caregivers of Hospitalized Children

Publication Number: 168.4901

Anne K. Jackson, Cincinnati Childrens Hospital Medical Center, Cincinnati, OH, United States; Kenna K. Sheak, Cincinnati Children's Hospital Medical Center, Mason, OH, United States; Avni Shah, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Amanda Howell, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Zenique M. Johnson, Cincinnati Children's Hospital, Florence, KY, United States; Dianna N. Bosse, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Zephon L. Price, Cincinnati Children's Hospital Medical Center, Montgomery, OH, United States; Ngozi Ndekwu, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Emily Johnson, Cincinnati Children's Hospital Medical Center, Erlanger, KY, United States; Andrew F. Beck, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Anita Shah, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Health-related social needs (HRSNs) influence health outcomes and drive disparities. In October 2022, we started screening caregivers of hospitalized children for HRSNs on one Hospital Medicine (HM) unit at a U.S. quaternary care children’s hospital. Our institution’s 11-question screener is administered electronically or verbally with responses documented in the electronic health record (EHR).

Objective: To evaluate our HRSNs screening program by assessing screening frequency and results.

Design/Methods: We performed cross-sectional analyses of EHR data of all hospitalized children on one HM unit from 10/2022–9/2024. We assessed who was screened for any of the core domains of HRSNs (financial resources, food, housing, transportation, and caregiver health). We compared sociodemographic characteristics among those who were screened and not screened using chi-squared testing. Among those screened, we described who had positive and negative screens and the frequency of identified HRSNs. We assessed outcomes of inpatient social work (SW) consultation and 30-day rehospitalization to HM. Chi-squared testing was used to compare groups with positive and negative screens.

Results: Among 8605 hospitalized children during the study period, 2907 (34%) were screened (Table 1). We identified differences in caregivers screened by children’s race (p <.0001), preferred language (p <.001), and insurance type (p=.01). Among those who were screened, 71% were identified as White and 19% as Black, 95% preferred English, and 51% had public/no insurance, compared with 64% White, 23% Black, 92% preferred English, and 58% with public/no insurance among those who were not screened. Among the 2907 screened, 703 (24%) had a positive screen for at least one HRSN (Table 2). Financial resources were the most frequent HRSN domain identified (17%, Figure 1). Screening positivity differed by race (p <.0001) and insurance type (p <.0001). Over two-thirds (68%) of those with positive screens had public/no insurance, compared to 46% with negative screens. SW consultation occurred for 39% with positive screens and 14% with negative screens (p <.0001). We found no difference in rehospitalization by screening positivity.

Conclusion(s): We screened almost 3000 caregivers of children hospitalized on one HM unit in two years. Screening positivity reflected known inequities, driven by systemic racism and poverty, in our community. Our rates of screening and SW consultation for those with identified HRSNs indicate an important opportunity to enhance universal screening and response efforts.

Table 1. Characteristics of Hospitalized Children by Caregiver Screening Status on One Hospital Medicine Unit (October 2022–September 2024)
a. Screened is defined as: answered >=1 of 11 questions about 5 domains of Health-Related Social Needs (Financial resource, Food, Housing, Transportation, Caregiver health)
b. Excludes those with missing/unknown ethnicity

Table 2. Characteristics of Hospitalized Children and Screening Results Among Caregivers who were Screened on One Hospital Medicine Unit (October 2022–September 2024)
a. A positive screen is defined as a response to any of the 11 questions in the screener that indicates a need
b. Excludes those with missing/unknown ethnicity

Figure 1. Positive Domains of Health-Related Social Needs among Caregivers of Hospitalized Children who were Screened (October 2022–September 2024)
N = number who responded to a question within that HRSN domain