620 - Leveraging Neighborhood Disadvantage and Social Needs to Inform Utilization-Based Interventions for Children with Medical Complexity

Publication Number: 3601.620

Erin Avondet, University of Utah School of Medicine, Salt Lake City, UT, United States; Adriana Martinez, Primary Children's Hospital, Herriman, UT, United States; Karine Romero, Intermountain Health/Primary Childrens Hospital, SLC, UT, United States; Carolyn C. Reynolds, Primary Children's Hospital, Salt Lake City, UT, United States

Background: Children with medical complexity (CMC) living in structurally disadvantaged neighborhoods face heightened health risks due to both medical needs and social and environmental barriers. The Child Opportunity Index (COI) and Area Deprivation Index (ADI) are validated measures of neighborhood-level disadvantage and have been associated with increased healthcare utilization and poorer outcomes. However, these indices are underutilized in care coordination strategies aimed at reducing acute care use for children, especially those with medical complexity.

Objective: To describe neighborhood disadvantage and individual social needs among children with medical complexity enrolled in an intensive care coordination program, and to examine how these factors relate to changes in acute care utilization, including emergency department visits and hospitalizations, before and after program enrollment.

Design/Methods: We conducted a retrospective descriptive analysis of patients enrolled in the Primary Children's Connector Service, an intensive care management program for CMC, from 2018 to the present. Neighborhood disadvantage was assessed using the COI and ADI, and social needs were evaluated at enrollment using an institutionally approved social need screening tool (Social Check). Utilization metrics, including emergency department (ED) visits and inpatient admissions, were compared 6 and 12 months before and after enrollment.

Results: Among enrolled patients, 43% lived in very low opportunity areas, and nearly 80% lived in areas of low to moderate opportunity. ADI distribution skewed toward high deprivation, with 60% of patients in the bottom five deciles (based on Utah state data). Social needs were highly prevalent at enrollment. Of all enrollees, 45% reported concerns about medical services, 41% reported food insecurity, 40% faced transportation barriers, and 39% had housing concerns. Despite these challenges, ED visits decreased by 22% and 25% at 6 and 12 months post-enrollment, respectively. Inpatient admissions declined by 46% and 52% over the same periods.

Conclusion(s): These findings highlight an opportunity to integrate the use of deprivation indices into care coordination planning and efforts to address both neighborhood-level disadvantage outcomes and individual social needs. Incorporating COI and ADI into utilization analyses can help identify high-need populations and guide resource allocation to areas where interventions are likely to yield the highest impact.

Area Deprivation Index
Depiction of ADI on state and national levels for patients enrolled in the Connector Service

Child Opportunity Index
Overall COI for enrolled patients with COI subcategories for education, healthy environment, and socioeconomic index

Utilization Review Data
Data showing ED utilization and inpatient admissions for enrolled patients 6 and 12 months pre- and post-enrollment