486 - Screening For Social Determinants Of Health In A NICU Follow Up Clinic

Poster Number: 486
Publication Number: 486.1675

Background: Social Determinants of Health (SDH) disproportionately affects families with preterm infants, who have higher risks of healthcare challenges and unmet basic needs than term newborns. Premature babies who experience unfavorable social conditions tend to have poorer neurodevelopmental outcomes.

Objective: Our study aimed to 1) Determine the frequency of SDH in a NICU follow-up clinic, 2) Determine if associations exist between unmet needs and sociodemographic attributes, and 3) Evaluate the success of strategies for screening and intervention.

Design/Methods: A self-administered paper questionnaire assessed various unmet needs and families' desire for assistance. Phase 1 was our pilot study to accomplish our first aim statement. Phase 2 began in January 2023, when quality improvement was utilized to track successful interventions to improve questionnaire completion and positive screening with intervention (social work [SW] referral).

Results: 1,270 families completed the questionnaire (64% of all families). The median questionnaire completion percentage shifted from 43% to 83% (Figure 1), and all families who requested assistance received a SW referral. In total, 36% of our families screened positive, and 21% of those families requested assistance (Table 1). After referral, 57% of families received a list of relevant resources and 30% received tangible help (gas card, access to food pantry, or payment of utility bills).

Families with Medicaid had a 1.5 times higher risk of screening positive (95% Cl 1.21-2.01) and 6.5 times more likely to request assistance (95% Cl 1.60-26.35) than children with private insurance. Non-white and non-English-speaking families had more than double the risk of requesting assistance (RR 2.4; 95% CI 1.05-5.66 and RR 2.7; 95% CI 1.33-5.42, respectively). Families who screened positive for more than one SDH category were twice as likely to be non-White (95% Cl 1.01-2.9), 2.5 times more likely to be non-English speaking (95% Cl 1.32-4.42), or have Medicaid (95% Cl 1.40-4.75).

Conclusion(s): A third of families seen in our NICU follow-up clinic have unmet basic needs. Insurance, primary language spoken, and race were associated with an increased risk of having unmet basic needs or requesting assistance. This study explored the feasibility of implementing an SDH screening tool. Nursing staff administration, clinic note incorporation, and a nurse practitioner as a project champion were key interventions allowing successful implementation. Next steps will focus on improving no-show rates, inpatient implementation, and exploring why some families that screen positive decline assistance.