Social determinants of health (SDH) are the conditions in which people are born, grow, work, live and age that contribute to health outcomes across the lifespan. Adverse SDH, such as housing instability and food insecurity, occur more often among families living in poverty or near poverty and are associated with worse child health and health care utilization.
In 2016 the American Academy of Pediatrics (AAP) recommended universal screening for adverse SDH and referrals to community resources when needed at pediatric clinical care visits. However the extent to which these screenings occur in inpatient settings caring for high risk infants such as neonatal intensive care units (NICUs) is unknown.
In what is believed to be the first study to examine the prevalence of standardized SDH screening and referral among a nationally representative sample of level 2 to 4 neonatal NICUs in the U.S., researchers from Boston University Chobanian & Avedisian School of Medicine found only 23 percent of NICUs had implemented this recommended practice.
"Given the extended opportunities for provider-family interaction over the prolonged neonatal hospitalization, this represents a missed opportunity to address the high burden of unmet social needs among families of high-risk infants," said first author Erika Cordova Ramos, MD, assistant professor of pediatrics.
The researchers randomly selected 100 hospitals with level 2 to 4 NICUs among each of the five U.S. regions and surveyed clinical leaders from January to November 2021 regarding standardized SDH screening. The higher the NICU level, the more comprehensive care (surgery) is provided to more seriously ill newborns.
Although many clinical leaders believed that addressing SDH was feasible, beneficial for infants and families and a priority for neonatal care, less than one quarter of the units reported standardized SDH screening and referral processes.
According to the researchers, reported barriers to implementation included perceived lack of resources, inadequate referrals and lack of an inpatient screening tool. "Further investigation of optimal implementation strategies of SDH screening in U.S. NICUs is needed," added Cordova Ramos, who also is a neonatologist at Boston Medical Center.
These findings appear online in the journal Hospital Pediatrics.
Funding for this study was provided by the W.K. Kellogg Foundation (P0131665 PI Parker) and the Evans Center for Implementation and Improvement Sciences (CIIS Department of Medicine, Boston University School of Medicine. Dr Cordova-Ramos is supported by BU-CTSI grant 1KL2TR001411. This work used Research Electronic Data Capture (REDCap) database, which was made available by Q:4 the Boston University CTSI supported by 1UL1TR001430.
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