Obstetric triage as a gateway to social care: Social needs, disparities, and implications for advancing equity

OBJECTIVES: To estimate the prevalence and distribution of social needs among obstetric triage patients at ChristianaCare; examine associations with patient characteristics and insurance status; and identify implementation and policy implications for integrating social determinants of health (SDOH) screening into obstetric care in Delaware. 

METHODS: We conducted cross-sectional SDOH screening among patients aged ≥18 years presenting to the obstetric triage unit at Christiana Hospital (November 2019-February 2020). An 11-item tool covering 10 social-need domains was administered; 326 (82%) patients participated, and 317 unique patients were analyzed. Descriptive statistics estimated social-need prevalence. Age-adjusted logistic regression assessed associations of race/ethnicity and insurance (Medicaid/self-pay vs other) with each domain and with cumulative needs. Screeners completed brief debriefs on feasibility and workflow. 

RESULTS: Participants had a mean age of 30.2 years; 49.5% were White, 38.4% Black, and 10.7% Hispanic/Latine; 39.1% had Medicaid or were self-pay. Overall, 46.1% reported ≥1 social need and 7.0% reported ≥4 needs. Financial strain, food insecurity, and housing and transportation challenges were among the most frequently endorsed domains. Black and Hispanic/Latine patients and those with Medicaid or self-pay coverage experienced significantly higher odds of multiple social-need domains and ≥4 needs (all p<0.05). Screening was feasible and acceptable but required attention to privacy, timing, and referral pathways. 

CONCLUSIONS: Nearly half of obstetric triage patients reported unmet social needs, with marked inequities by race/ethnicity and insurance. Triage-based SDOH screening is feasible and can connect patients to social, legal, and community supports. Public Health and Policy Implications: Integrating SDOH and food insecurity screening into obstetric triage, linking patients to social, legal, and Food is Medicine supports, and advancing upstream policies on wages, housing, and racism may narrow racial and socioeconomic gaps in maternal and infant outcomes and advance reproductive justice in Delaware.