A study led by Dr. Sydney Leibel at the Rady Children’s Hospital in San Diego analyzed how addressing social determinants of health (SDH) could improve outcomes for children with severe asthma. Specifically, Dr. Leibel was interested in learning how this approach could affect health care utilization. His work recognizes the impact SDH have on asthma disparities, particularly for impoverished minority children.
The study participants included 74 children, ages 2 to 18, with poorly controlled asthma and 2 or more asthma-related emergency department visits in the past 6 months or hospitalizations in the past year. Of these participants, 55% were Hispanic, 19% were Black and 63% were insured by Medicaid. The change in emergency department visits and hospitalization days was analyzed pre-and-post multidisciplinary and SDH visits.
During a severe asthma clinic (SAC) visit, participants met with a physician, nurse, respiratory therapist, pharmacist, bilingual community health worker and social worker. With this team, each participant’s asthma needs were assessed and managed.
Participants with Medicaid insurance also received home visits and follow-up calls to address SDH. The most common unmet social, behavioral and health needs identified fell within basic needs: shelter, food and utilities. Utilities was the most pressing need, affecting 37% of the group. The home visits addressed these needs via environmental assessments and interventions and needs assessments and community referrals.
The study ultimately found that the SAC visits were associated with a significant reduction in ED visits (75% reduction; p < 0.001) and hospitalization days (73% reduction; p < 0.001). The home visits, follow-up calls and SDH interventions were also associated with a significant reduction in ED visits (90% reduction; p = 0.002) and a decreasing trend in hospitalization days (77% reduction; p = 0.125).
The study concluded that addressing social determinants of health in children with severe asthma can help to decrease health care utilization and, thus, improve health outcomes. A call to action is made to support multidisciplinary and SDH interventions for impoverished minority children with severe asthma.
Leibel, S., Geng, B., Phipatanakul, W., Lee, E., & Hartigan, P. (2020). Screening Social Determinants of Health in a Multidisciplinary Severe Asthma Clinical Program. Pediatric Quality & Safety, 5(5), e360. https://doi.org/10.1097/pq9.0000000000000360