P3.O300: Exploring the Relationship between Patient- and Neighborhood-Level Factors and Caregiver-Reported Unmet Social Needs and Interest in Community Resource Referral during Pediatric Emergency Department Visits

Background: Unmet social needs (USNs) are common among families in the pediatric emergency department (PED) and contribute to poor health outcomes. Health inequities are associated with both patient- and neighborhood-level factors. However, there is limited understanding of the relationship between these factors and caregivers' reported USNs and interest in community resource referral (CRR) identified during a PED visit.

Methods: This was a retrospective 1.5-year cohort analysis from an ongoing prospective study of children 0-17 years old with a completed social needs screener during a PED visit at a quaternary-level children’s hospital. USNs were defined as one or more social needs reported on the electronic, self-administered p-SINCERE tool provided to caregivers during PED visits. Interest in CRR was also noted in the questionnaire. All caregivers who noted interest in CRR were contacted by the local United Way 211 within 48 hours. A comprehensive chart review was conducted on patients’ electronic health records to extract demographic data and visit characteristics. We utilized the child opportunity index (COI) to assess the neighborhood-level factors. The primary outcomes were 1) the presence of USNs and 2) the interest in CRR. Descriptive statistics were used to summarize patient demographics, clinical characteristics, and the COI. Bivariate comparisons and odds ratios were utilized to assess the association of individual- and neighborhood-level factors with 1) the presence of USNs and 2) the interest in CRR.

Results: From 09/27/21 to 04/30/23, 4280 patients met the inclusion criteria for chart review. 2065 caregivers reported USNs, while only 515 caregivers requested CRR (Table 1). The presence of USNs and interest in CRR significantly varied by preferred language, interpreter usage, insurance, lacking a PCP, and COI levels (p < 0.01, Table 1). Increased odds of having USNs and interest in CRR were associated with language other than English, interpreter needed but not used, non-private insurance, lack of PCP, ED discharge, and lower COI (p < 0.01, Table 2). Additionally, there were increased odds of having USNs for patients of Non-Hispanic White race/ethnicity status and patients with lower emergency severity index (ESI) triage levels. However, the effect of these factors on interest in CRR was not statistically significant.

Conclusion: Although USNs are common among patients/caregivers in a PED, presence does not equate to caregiver interest in referral. The disparities present in historically marginalized and vulnerable populations are evident in our sample and highlight the need for processes in healthcare settings, including the PED, that help mitigate the negative systemic impacts faced by these populations. Using both individual- and population-level data, like the COI, can improve CRR and PCP referrals for patients in need.