Health Equity/Social Determinants of Health
Health Equity/Social Determinants of Health 7
Jillian E. Heckman, MD (she/her/hers)
Resident Physician, PGY-2
Johns Hopkins Children's Center
Baltimore, Maryland, United States
Social determinants of health (SDoH) widely impact health outcomes, and the American Academy of Pediatrics recommends screening for SDoH in all patient encounters. While SDoH screening has been successfully implemented in emergency and ambulatory settings, less than 30% of hospitals report formal inpatient screening. Screening is often conducted by non-physician staff, which may lead to gaps in provider ability to conduct and address screens. As pediatric residents have reported low rates of inpatient SDoH screening, further research is needed to characterize attitudes and self-efficacies in this area.
We aimed to evaluate the attitudes, experience, confidence, and knowledge of pediatric residents surrounding SDoH screening in the inpatient setting.
We conducted a prospective study of residents who completed their 4-week inpatient community pediatrics rotation between July and December 2022. Residents participated in a voluntary, non-incentivized survey at the start of the rotation. Surveys included demographics and baseline attitudes about, experience with, and confidence with community pediatrics activities on a 5-point Likert scale. Residents also reported if they knew of at least one resource for each domain of a positive SDoH screen. Data were analyzed using descriptive statistics.
Results: Twenty-four out of 32 eligible residents (75%) completed the survey (Table 1). Most residents identified screening for SDoH (86.3%) and referring patients to resources to address SDoH (95.4%) as very or extremely important activities during residency training, but less than one-third reported moderate or substantial experience screening for SDoH (22.7%) or providing resources based on positive screens (31.8%). 40.7% reported feeling confident or very confident in screening for SDoH, and only 3.7% were confident or very confident in referring patients to resources (Table 2). The percentage of residents who reported knowledge of a resource for a positive screen varied widely among SDoH domains, ranging from 3.7% (“Concerns regarding immigration status”) to 74.1% (“Food insecurity”).
Although most residents report that addressing SDoH in the inpatient setting is an important skill in residency, experience with and confidence in these activities is low at baseline, and knowledge of resources to address positive SDoH screens is variable. Future directions include design, implementation, and assessment of interventions to improve learner outcomes, as well as evaluation of the impact of inpatient screening on patient care.