Healthcare utilization following implementation of a pediatric social needs screening program

OBJECTIVE: This study evaluated differences in healthcare utilization among a pediatric primary care population following implementation of a universal social needs screening and referral program. It was hypothesized that emergency, sick, and hospitalization visits would decrease post-implementation, with stable or increased preventive care. 

METHODS: A retrospective, observational study was conducted using electronic health record data from 2 cohorts at different time periods at a large academic pediatric primary care clinic. The pre-implementation group included patients with a well-child visit from 08/2021 to 07/2022; the post-implementation group included patients from 09/2022 to 08/2023. Healthcare utilization measures of emergency department visits, hospitalizations, sick visits, and subsequent well-child visits were assessed from the index visit through the end of the group period. Differences in healthcare utilization were compared between cohorts using Mann-Whitney U (MW) tests, and associations of visit counts with social needs and care coordination referrals were examined using backwards-selected Zero-inflated Poisson regression models. 

RESULTS: The study included 3889 pre-implementation and 3813 post-implementation patients. Post-implementation patients had fewer emergency visits (≥1 visit: 15.5% vs 13.1%; MW P = .002) and sick visits (≥2 visits: 29.3% vs 24.3%; MW P < .001). Well-child visits did not differ (MW P = .981). Hospitalization rates were 2.5% pre-implementation and 2.0% post-implementation (MW P = .120). 

CONCLUSIONS: Implementation of a universal social needs screening program was associated with improved patterns of pediatric healthcare utilization.