361 - Association between Declining to Respond to Social Risk Screening and Readmission among Hospitalized Children

Publication Number: 4354.361

Nathan Tran, UCSF, San Francisco, CA, United States; Matthew S. Pantell, University of California, San Francisco, School of Medicine, San Francisco, CA, United States

Background: Social risks, like food insecurity and housing instability, are associated with a variety of negative health outcomes among children. Consequently, standards setting organizations including The Joint Commission and the National Committee for Quality Assurance support screening for social risks in hospital settings. Patients generally find social risk screening acceptable; however, a small proportion of patients decline social risk screening. While screening positive for social risks is associated with worse health outcomes compared to those screening negative, little is known about health outcomes among those that decline screening.

Objective: To explore how declining social risk screening is associated with hospital readmissions among children.

Design/Methods: We conducted an analysis of children admitted to 3 pediatrics wards in 2 urban hospitals from 1/1/24-7/31/25. Wards had protocols to screen all children's families for food insecurity, housing instability, transportation needs, and utilities needs upon admission. We constructed a Kaplan-Meier survival curve and used a log-rank test to assess associations between time to readmission through 120 days after discharge among the following populations: children screening negative for all social risks, children screening positive for any social risk, and children declining social risk screening for at least 1 domain (and not screening positive for any other domain). We used logistic regression to compare odds of being readmitted while controlling for covariates.

Results: Characteristics of the sample are in Table 1. Among 4,694 admissions, 16.7% screened positive for at least 1 social risk and 1.6% consisted of families declining social risk screening. Time to readmission did not vary by population (P=0.256; Figure 1). Compared to children whose families declined social risk screening, those screening negative were slightly less likely to be readmitted (odds ratio [OR] 0.92, 95% confidence interval [CI] 0.47-1.78) and those screening positive were slightly more likely to be readmitted (OR 1.12, 95% CI 0.56-2.22), although these results were not significant (Table 2).

Conclusion(s): In our sample, children whose families declined social risk screening did not substantially differ in their likelihood of readmission compared to those screening negative or positive for social risks. While reassuring that these children do not have a worse readmission rate than their counterparts, more research is needed to explore reasons for declining screening to inform patient-centered social and medical care integration activities.

Table 1. Sample Characteristics


Figure 1. Kaplan-Meier Survival Curve of Time to Readmission in Days by Screening Response


Table 2. Logistic Regression Predicting Readmission within 120 Days