457 - Understanding the impact of social deprivation and identified social needs on Emergency Department Utilization in the Pediatric Emergency Department.

Poster Number: 457
Publication Number: 457.321

Background: Understanding Pediatric Emergency Department (PED) utilization patterns is important in the provision of quality healthcare, optimizing resource utilization and mitigating the cost of healthcare delivery. Three to 14% of PED users are frequent PED users (≥ 4 visits per year), and account for 9% to 42% of all PED visits. Known risk factors for frequent PED utilization include infant age, chronic medical illness and socioeconomic factors.

Objective: To determine the association between sociodemographic characteristics, Social Determinants of Health (SDOH) screening, and social work consults, and frequency of PED visits with the future aim of developing a predictive tool for ED utilization.

Design/Methods: We performed a retrospective cohort study at one academic and two community PEDs from January 1 to December 31, 2019. Variables of interest were sociodemographic, social work consults, SDOH screening and clinical visit characteristics. The primary outcome was frequency of ED visits. Data were summarized using descriptive statistics and multivariate regression analyses. P < 0.05 was considered as statistically significant.

Results: There were 35,685 unique patients included for 49,920 unique ED visits. Children aged 1 to 4 years (n=11,145; 31.23%) accounted for the majority of patients, most patients were black (16,221; 45.46%), and lower acuity designations (Emergency Severity Index 4 or 5) were the most frequent (57.55%) (Table 1). There were 1280 (3.59%) children with ≥4 ED encounters. In unadjusted analyses (Table 2), children with frequent ED encounters were more likely to be Black (53.75%), Hispanic or Latino (21.41%), infants (27.97%), to have had a SDOH screen (97.97%), and to be in the highest Area Deprivation Index (ADI) decile (33.17%), indicating more disadvantage (p < 0.001). In multivariate regression analyses, the odds of frequent ED visits remained increased with Black race (OR 1.60; 1.36-1.88), Hispanic or Latino ethnicity (OR 1.53; 1.22-1.93), most disadvantaged ADI decile (OR 1.31; 1.15-1.50), any social work consult (OR 1.86; 1.48-2.33) and any SDOH screen (OR 1.33; 1.14-1.56) (Table 2).

Conclusion(s): We demonstrated that children from historically marginalized populations, from the most disadvantaged ADI deciles, and triaged as lower acuity, were most likely to seek medical care frequently in the PED. A predictive model of ED utilization applied prospectively to PED encounters may help identify which child would benefit from connection to social resources, ultimately guiding institutional investment in PED and community-based social resources.