639 - Social Determinants of Health Screening: Gap Between Need & Resource Referral Acceptance

Publication Number: 3619.639

Nisha Sridhar, Doernbecher Children's Hospital at Oregon Health & Science University, Portland, OR, United States; Gergana Alteva, Doernbecher Children's Hospital at Oregon Health & Science University, Portland, OR, United States; Paige Ehrenhart, Doernbecher Children's Hospital at Oregon Health & Science University, Portland, OR, United States; Benjamin Sanders, Doernbecher Children's Hospital at Oregon Health & Science University, Portland, OR, United States

Background: Social determinants of health (SDOH) profoundly impact pediatric health outcomes, and a growing number of pediatric clinics are implementing SDOH screening. Literature on adult SDOH screening demonstrates a notable discrepancy between self-reported SDOH needs and acceptance of referrals to connect families to resources for their needs. Examining this relationship in pediatric primary care may highlight opportunities to improve families' access to resources.

Objective: To identify how SDOH need compares to acceptance of referrals in a pediatric primary care setting.

Design/Methods: SDOH survey results were extracted from the EHR for visits with children aged 1 month to 18 years in an urban general pediatrics clinic between June 15, 2022 and July 8, 2024. For patients with surveys from multiple encounters, we retained only the most recent survey. Caregivers of patients self-reported SDOH needs in a 9-item survey, which concluded with a question for which caregivers accepted or declined a referral to connect them to resources. Presence of need was calculated for four SDOH domains: food, finance, housing, and transportation. Rates of SDOH need and referral acceptance were computed. Logistic regression was used to evaluate the contribution of each domain to the likelihood of referral acceptance. Analyses were conducted using Microsoft Excel and RStudio.

Results: 797 (63.6%) of all 1,253 surveys reported at least one need. Of those, 207 (26.1%) respondents accepted the resource referral. Financial need was the most frequently reported (637, 50.8%), followed by food (420, 33.5%), housing (350, 27.9%) and transportation (186, 14.8%). In logistic regression, when controlling for all other domains, financial (AOR 6.75; 95% CI, 3.5-12.9), housing (AOR 6.2, 4.0-9.6), food insecurity (AOR 2.96, 1.9-4.7) and transportation (AOR 1.76, 1.1-2.8) needs were each independently associated with referral acceptance. Domains were not found to be collinear.

Conclusion(s): In our study, 64% of caregivers self-reported at least one unmet SDOH need, yet only one-quarter of these caregivers accepted referrals; this represents a substantial shortcoming in connecting families with appropriate resources. Acceptance was highest among those with unmet financial and housing needs and lowest for transportation needs. These findings underscore the work needed to understand referral acceptance hesitancy, in addition to structural barriers, to more effectively support families with their SDOH needs.

Figure 1
Study Selection Flowchart