Background: Social determinants of health (SDH) are living and work conditions which affect health and functioning. [1] Unmet social needs may contribute to increased medical utilization and worse health outcomes. For example, patients with sickle cell who report financial strain have more admissions and readmissions. [2] Adults with cancer and housing insecurity are more likely to miss cancer treatment appointments. [3] Presence of social risk factors is associated with increased mortality in infants and increased readmission in pediatric patients with congenital heart disease. [4] Further, programs established to connect patients with unmet social needs with resources have reduced utilization in high-utilizing populations. [5] Therefore, addressing SDH is an emerging priority as a means to improve health and decrease utilization. Despite the potential benefit from addressing SDH as a modifiable risk factor, inpatient screening of SDH is done infrequently in pediatric and adult inpatient medicine. [6,7]
Purpose: Young adults with chronic childhood-onset disease (CCOD) on our Med-Peds service line is a high-utilizing group. Baseline 30-day readmission rate for this population is approximately 33%, compared to ~15% for the entire general medicine service. We set out to establish SDH screening in our population to assess need and help inform future screening and referral processes.
Description: The Med-Peds service line is a team for young adults with CCOD which exists within the general medicine service at a large academic center. Data was collected from June 2019 to October 2020 on 270 patients who were admitted at least once to this service line. The physician or clinical assistant asked patients in person or over the phone SDH questions built into the electronic health record. Our population had an average age of 27 years, and 57% were female. Patient-reported race was 56% Black or African American (AA) and 33% Caucasian/White; ethnicity was reported as 93% not Hispanic or Latino. Most patients were insured, with 36% private insurance, 37% Medicaid, 19% Medicare, and 8% uninsured. During the data collection period, 59% of patients had 2 or more admissions to the hospital and 23% had 4 or more admissions. The most common primary diagnosis for admission were sickle cell disease with pain crisis (33%) and type 1 diabetes mellitus with complication (11%). Half of patients (50-53%) answered at least one screening question regarding SDH. Of these patients, 49% reported some level of financial strain to pay for basic needs or medical care. Financial strain was more commonly reported among Caucasian/White patients (67%) than Black or AA patients (47%). Half (50%) reported being unable to buy food in the last year, which was more commonly reported among Black or AA patients (55%) than Caucasian/White patients (41%). While 39% reported that lack of transportation prevented them from making medical appointments or obtaining medications in the last year, this was more commonly reported among Black or AA patients (44%) than Caucasian/White patients (33%).
Conclusions: Young adults with CCOD treated at our hospital have a high prevalence of unmet social needs. Food insecurity was the most common barrier that patients reported, with Black or AA patients more frequently reporting this need than other races. Caucasian/White patients more commonly reported financial strain. The inpatient setting was an opportune time to assess for SDH. In the future, work should be done to address identified social needs.