Evaluation of a Clinic-Based, Electronic Social Determinants of Health Screening and Intervention in Primary Care Pediatrics.

OBJECTIVE: Social determinants of health (SDOH) significantly affect individuals' health outcomes, yet universal electronic SDOH screening is not standard in primary care. Our study explores the implementation of an electronic SDOH screening in the electronic health record (EHR) and follow-up intervention among primary care pediatric patients within an academic clinic. METHODS: Beginning in August of 2022, patients and their families determined to have at least one SDOH need qualified for an in-clinic referral to a coordinated care team member. We assessed the overall efficacy and feasibility of the implementation. RESULTS: Over the 4-month pilot, 1473 of 2064 (71.4%) eligible patients were screened, with 472 (32%) patients screening positive on at least one SDOH domain. Of the 472 screened positive, 48 (10.2%) declined a referral. Two hundred and forty-seven of the 424 (58.3%) received a referral to a care coordination team member. CONCLUSIONS: This study demonstrates the feasibility of a universal electronic SDOH screening tool within the EHR within an urban, academic-based clinic.

Variation in the Use of Targeted Temperature Management for Cardiac Arrest.

Targeted temperature management (TTM) is recommended for patients who do not respond after return of spontaneous circulation after cardiac arrest. However, the degree to which patients with cardiac arrest have access to this therapy on a national level is not known. Understanding hospital- and patient-level factors associated with receipt of TTM could inform interventions to improve access to this treatment among appropriate patients. Therefore, we performed a retrospective analysis using National Inpatient Sample data from 2016 to 2019. We used International Classification of Diseases, Tenth Edition diagnosis and procedure codes to identify adult patients with in-hospital and out-of-hospital cardiac arrest and receipt of TTM. We evaluated patient and hospital factors associated with receiving TTM. We identified 478,419 patients with cardiac arrest. Of those, 4,088 (0.85%) received TTM. Hospital use of TTM was driven by large, nonprofit, urban, teaching hospitals, with less use at other hospital types. There was significant regional variation in TTM capabilities, with the proportion of hospitals providing TTM ranging from >21% in the Mid-Atlantic region to <11% in the East and West South Central and Mountain regions. At the patient level, age >74 years (odds ratio [OR] 0.54, p <0.001), female gender (OR 0.89, p >0.001), and Hispanic ethnicity (OR 0.74, p <0.001) were all associated with decreased odds of receiving TTM. Patients with Medicare (OR 0.75, p <0.001) and Medicaid (OR 0.89, p = 0.027) were less likely than patients with private insurance to receive TTM. Part of these differences was driven by inequitable access to TTM-capable hospitals. In conclusion, TTM is rarely used after cardiac arrest. Hospital use of TTM is predominately limited to a subset of academic hospitals with substantial regional variation. Older age, female gender, Hispanic ethnicity, and Medicare or Medicaid insurance are all associated with a decreased likelihood of receiving TTM.