Background: Advances in complex congenital cardiac care have promoted the survival of greater than 90% of pediatric patients. As adults with congenital heart disease (ACHD) have lifespans approaching that of the general population, there is a growing call to understand the experience of living with this childhood-onset chronic condition. Hospitalists are often the primary inpatient providers for ACHD patients and have the opportunity to support patients’ health-related social needs and promote health equity.
Methods: We are conducting a cross-sectional pilot study to assess the prevalence of unmet health-related social needs and comorbid mental health conditions within hospitalized ACHD patients at Texas Children’s Hospital. Our survey includes the Accountable Health Communities Health-Related Social Needs Screening Tool, Patient Health Questionnaire-9, General Anxiety Disorder-7, Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale, along with self-reported health status and clinical diagnoses from chart review. The survey is available in English and Spanish and administered on a tablet while patients are hospitalized. Summary statistics of the preliminary data were generated.
Results: Between June and November 2021, 40 ACHD patients were screened with our survey with median age 28.5 (23,38) and 63% male. Of participants screened, 55% had moderate and 45% had great complexity lesions. About one-third had completed higher education beyond high school and 50% had private insurance (3% uninsured). Seventy-three percent reported health-related social needs in > 3 domains (with stress, financial strain, cognitive disability, and difficulty with activities of daily living as the most prevalent needs). Symptoms of depression (75%) and anxiety (50%) were common. Eighty percent of participants had at least one prior ER visit and 75% had a procedure in the past year. To our knowledge, 35% of our participants have been rehospitalized since enrollment. Only 13% requested speaking with a social worker during their inpatient stay.
Conclusions: Screening for social needs in an inpatient cohort of ACHD patients showed the vast majority had health-related social needs in multiple domains. Mental health remains an area of great need and a minority of patients seek assistance through social work. Admissions for acute illness, chronic disease complications, and procedures are common which provides the hospital medicine team an important opportunity to identify and address health-related social needs. A multidisciplinary approach to mitigate risk is necessary but fraught with challenges.