Outcomes from a health-related social needs screening initiative in pediatric orthopaedic patients: A prospective study

BACKGROUND: Health-related social needs (HRSN), which include unmet transportation, food, housing, financial, and utility needs, have been associated with poor outcomes in pediatric orthopaedic patients. This study aims to report outcomes from a prospective, quality improvement (QI) study that aimed to address this issue by screening for social risk factors and referring patients to resource management programs. 

METHODS: This was a prospective QI study implemented at a tertiary care center's pediatric orthopaedic clinic. Patients (ie, their families/caregivers) were given an institutional social risk survey, which is derived from the Accountable Health Communities' HRSN Screening Tool. Data collected post-initiative over a 9-month period were compared with a 3-month period pre-initiative. We analyzed demographic characteristics, screening completion rates, the prevalence of specific social needs, and the rate of successful referral and enrollment in resource management services. Multivariable logistic regression was used to identify associations between patient factors and screening completion/referral status. 

RESULTS: In total, 735 patients were evaluated (224 pre-initiative; 511 post-initiative). The initiative significantly increased screening rates from 38% pre-initiative to 65% post-initiative ( P <0.001). The highest rate increase was among fracture/dislocation patients (37% pre-initiative to 76% post-initiative, P =0.004). Among prospective respondents, 70 patients (21%) screened positive for at least one social need, with the highest rates of financial (13%) and food insecurity (11%). In regression analysis, female patients had higher odds of a completed screening (aOR: 1.53, P =0.03), and Medicaid insurance was associated with higher odds of social need (aOR: 3.56; 95% CI: 1.65-8.01; P =0.002). Post-initiative, 87% of patients with a social need received a referral, and 61% were successfully enrolled in services, a significant increase from the pre-initiative enrollment rate of 25% ( P =0.005). 

CONCLUSIONS: This study suggests that implementation of a systematic HRSN screening initiative in pediatric orthopaedics is feasible, and orthopaedic encounters may serve as a touch point to screen for unmet social needs and connect families with resource management programs.