Screening for Social Determinants of Health in Hospitalized Children

Background/Objective: In the United States, about 18% of children less than 18 years of age were living in poverty in 2016, and about 16 million children (21%) live in households lacking consistent access to food (Coleman-Jensen, 2015; Jessica Semega, Fontenot, Kayla, & Kollar, Melissa, 2017). Even after controlling for multiple risk factors, studies have shown that children who are food insecure have poorer overall health, are more likely to be hospitalized more frequently and recover from illness more slowly (Cook et al., 2013; Ma, Gee, & Kushel, 2008). These statistics are striking, and raise the question of whether we are missing the opportunity to screen for other social determinants of health (SDH) in the inpatient setting, where we as a medical community could have the opportunity to intervene. The objective of this study is to identify inpatient healthcare providers' current practices for SDH screening, to identify barriers to screening, and to determine the acceptability of screening in hospitalized patients. To our knowledge there have been no other studies examining if or how providers are screening for SDH in the pediatric inpatient setting. Designs/methods: This is a multi-center descriptive survey-based study on the current SDH screening practices of inpatient hospitalist providers and nurses on the general pediatric wards. A survey instrument was developed based on review of the literature pertaining to social determinants of health with revisions made based on content expert review, cognitive interviews and survey piloting. The survey has been introduced at two tertiary care children's hospitals at time of abstract submission, and will be introduced at two additional hospitals shortly after. Results: Preliminary survey results from 49 hospitalist providers were analyzed. Among hospitalist physicians, 16% (n=8) report screening for one of more SDH frequently or with almost every hospitalized patient. The majority of hospitalist respondents (96%, n=45) reported not using a specific screening tool when screening for SDH. When asked what would cause hospitalist physicians to screen for SDH more frequently, 79% (n=38) reported needing more access to resources to offer help and 71% (n=34) said if they had more time. Further results from our multi-center study will investigate barriers to screening and previous education on SDH among physicians and nurses. Conclusions/Discussion: The inpatient setting may provide a unique opportunity for SDH scree