Social needs resource provision in critically ill children may reduce hospital readmissions

Abstract

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Background: Critically ill children have higher risk of health disparities which may be worsened during hospitalizations. Inpatient social workers can address health disparities by providing emotional support and social resources (SR).

Objective: Describe characteristics of patients receiving SR during PICU hospitalizations. Hypothesized children receiving SR would have fewer 6–month hospital readmissions.

Methods: Single–center retrospective study of PICU encounters 1/1/23–12/31/23. No set criteria to determine social work involvement. Demographics and hospitalization characteristics associated with resource provision described. To analyze the effect of social work resource provision on readmissions, the cohort was matched 1:1 by nearest–neighbor propensity for resource administration on demographics, illness severity, and length of stay.

Results: There were 1507 PICU hospitalizations. 1130 (75%) met with PICU SW and 459 (30.5%) received SR. Children receiving resources were younger (2 vs. 5 years, p < 0.001), had a higher proportion of complex chronic diseases (65.6% vs. 52.3%, p < 0.001), lower zip–code median household income ($53,316 vs. $55,337 p = 0.001), and childhood opportunity index (very low 32.5% vs. 24.2%, p = 0.006). These children had longer PICU LOS (2 vs. 1 day, p < 0.001), higher PELOD–2 scores (10 vs. 1, p < 0.001), higher mortality (5.4% vs. 1.6%, p < 0.001) and higher hospitalization cost ($36,935 vs. $15,656, p < 0.001). 827 resources were provided across 459 encounters with food resources provided most. There were 1104 encounters without in–hospital mortality with complete follow–up data for propensity matching, of whom 612 were matched. After matching, children with SR provision were less likely to be readmitted within 6 months (marginal risk ratio 0.768 [95% CI 0.579, 0.987]). The estimated cost avoidance was $828 (95% CI: $41, $2078) per child for whom SR were provided.

Conclusions: Critically ill children are at high risk for social needs on presentation to the PICU. Providing SR during PICU hospitalization may reduce readmission rates.