Incorporating Community Member Perspectives to Inform a Resident Health Equity Curriculum.

Background There are few published resources to guide content of health disparities curricula. To train physicians to effectively address disparities, the needs and expectations of the local community need to be considered. Objective To obtain community insight about factors influencing health disparities and important components of a health disparities curriculum for residents. Methods This qualitative study consisted of 5 focus groups held in 2019; 4 included local community members, and the fifth was of leaders from local agencies serving these communities. Each focus group was professionally led and transcribed. Using an inductive approach to content analysis, the authors created codes from the transcripts. They then categorized the codes to support the development of themes. Results Sixty-five community members participated in the 4 focus groups, and 10 community leaders participated in the fifth. Overall, 6 themes emerged from the data: (1) A healthy community is a community with access; (2) system-inflicted stress weighs heavily on health; (3) communities have internal strengths; (4) racism affects care delivery; (5) respectful bedside manner is necessary to build trust and better health outcomes; and (6) experience the community to learn and appreciate strengths and needs. Conclusions This study illustrates that the community's input provides insights on what to include in a health disparities curriculum and serves as a model for incorporation of the community perspective in curriculum development.

Social Determinants of Health ICD-10 Code Use in Inpatient Pediatrics.

BACKGROUND AND OBJECTIVES: The American Academy of Pediatrics endorses screening for social determinants of health (SDOH) and providing families resources for unmet needs. A systematic response to unmet needs requires identification, documentation, and provision of resources. Our goal was to compare SDOH International Classification of Diseases, 10th Revision (ICD-10), code use for pediatric inpatients after policy changes in 2018 permitting coding by nonphysicians. METHODS: We conducted a retrospective cohort study comparing data from the 2016 and 2019 Kid's Inpatient Database for patients <21 years old. The primary variable was the presence of an SDOH code, defined as an ICD-10 Z-code (Z55-Z65) or 1 of 13 ICD-10 codes recommended by the American Academy of Pediatrics. We compared overall SDOH code usage between 2016 and 2019, and by Z-code category, demographic, clinical, and hospital characteristics using χ2 tests and odds ratios. Using logistic regression, we examined hospital-level characteristics for hospitals with >5% of discharges with an SDOH code. RESULTS: SDOH code documentation increased from 1.4% in 2016 to 1.9% in 2019 (P < .001), with no notable differences based on Z-code category. In both periods, SDOH code documentation was more common in adolescents, Native Americans, and patients with mental health diagnoses. The number of all hospitals using any SDOH code increased nearly 8% between 2016 and 2019. CONCLUSIONS: ICD-10 codes remain underused to track SDOH needs within the inpatient pediatric setting. Future research should explore whether SDOH code documentation is associated with increased response to unmet social needs and, if so, how to improve use of SDOH codes by all providers.

Parent Preferences on Screening for Social Determinants of Health in Hospitalized Children.

BACKGROUND: Although there has been much research on screening families for social determinants of health (SDOH) at pediatric outpatient visits, there is little data on family preferences about SDOH screening during hospitalization. This is of critical importance because unmet SDOH, also known as social needs, are associated with poor health outcomes. OBJECTIVE: Our objective was to assess caregiver preferences for social needs screening in the inpatient pediatric setting. METHODS: We surveyed a sample of caregivers of admitted patients at our freestanding tertiary-care children's hospital between March 2021 and January 2022. Caregivers were surveyed with respect to the importance of screening, their comfort with screening, and which domains were felt to be acceptable for screening. RESULTS: We enrolled 160 caregivers. More than 60% of caregivers were comfortable being screened for each of the social needs listed. Between 40% and 50% found screening acceptable, even if resources were unavailable. Forty-five percent preferred to be screened in private, 9% preferred to be screened by a health care team member, and 37% were comfortable being screened either in private or with a health care team member. Electronic screening was the most preferred modality (44%), and if by a health care team member, social workers were preferred over others. CONCLUSIONS: Many caregivers reported the acceptance of and comfort with social needs screening in the inpatient setting. Our findings may help inform future hospital-wide social needs screening efforts.

Barriers to Firearm Injury Research.

INTRODUCTION: Firearm injuries and motor vehicle injuries are 2 leading causes of fatal injury in the U.S., each accounting for approximately 35,000 deaths annually. Research on firearm injuries is under-represented compared with research on motor vehicle collisions. This study seeks to identify perceived barriers to firearm injury research versus motor vehicle injury research. METHODS: This was a mixed-methods survey of corresponding authors of a minimum of 1 study, archived in PubMed, related to firearm injury or motor vehicle injury between 2014 and 2018. Analyses were performed in 2019. Electronic surveys included both closed- and open-ended questions to assess barriers to research. Bivariable and multivariable logistic regression was performed to identify differences in perceptions to barriers between the 2 groups. Qualitative analysis of free-text responses was performed through inductive derivation of themes. RESULTS: Surveys were distributed to 113 firearm injury researchers (42% response rate) and 241 motor vehicle injury researchers (31.5% response rate). After adjustment, firearm injury researchers were less likely to cite institutional support (AOR=0.3, 95% CI=0.1, 0.8) as a factor contributing to their success, than motor vehicle injury researchers. Firearm injury researchers were more likely to report fear of personal threats (AOR=10.4, 95% CI=2.4, 44.4) and experiencing personal threats (AOR=16.1, 95% CI=1.6, 165.4). Thematic analysis revealed 4 themes: career, political, funding, and harassment. CONCLUSIONS: When compared with motor vehicle injury researchers, firearm injury researchers are significantly more likely to report limited support and threats to personal safety as barriers to research. Further research to understand the impact of these barriers and methods to overcome them is needed.

Screening for Social Determinants of Health in Hospitalized Children.

OBJECTIVES: Outpatient screening for social determinants of health (SDH) improves patient access to resources. However, no studies have examined if and how inpatient pediatric providers perform SDH screening. We aimed to identify inpatient pediatric provider screening practices for SDH, barriers to screening, and the acceptability of screening for hospitalized patients. METHODS: We conducted a multicenter descriptive study at 4 children's hospitals surveying inpatient hospitalists and nurses on the general wards about their SDH screening practices. A survey instrument was developed on the basis of literature pertaining to SDH, content expert review, cognitive interviews, and survey piloting. Descriptive statistics and logistic regression analyses are reported. RESULTS: Results from 146 hospitalists and 227 nurses were analyzed (58% and 26% response rate, respectively). Twenty-nine percent of hospitalists and 41% of nurses reported screening for ≥1 SDH frequently or with every hospitalized patient. Only 26% of hospitalists reported consistently communicating SDH needs with primary care providers. Most respondents (97% of hospitalists and 65% of nurses) reported they do not use a specific screening tool, and only 34% of hospitalists and 32% of nurses reported feeling competent screening for SDH. Lack of time, resources, and a standardized inpatient screening tool were reported as barriers to screening. CONCLUSIONS: Hospitalization provides an opportunity for SDH screening and connecting patients to resources; however, a minority of pediatric providers currently report screening. Professional development activities training inpatient providers in SDH screening, using a screening instrument, and communicating identified needs to primary care providers may improve the effectiveness of SDH screening in the hospital.