PM2078: Creating a System to Identify Social Determinants of Health and Achieve Equitable Health Outcomes for Children with Asthma

Background: Rady Children’s Health Network (RCHN) was awarded a grant to develop an Asthma Health Equity Index to redefine how we capture and display equity related data to address a need for a standardized approach to measure and track health equity related improvements. RCHSD piloted this index on the severe asthma population recently seen in the Emergency Department (ED) as it is a population disproportionally experiencing more barriers. Many of the children live in neighborhoods with inequities related to poverty, air quality and socioeconomic and cultural factors. Patients are primarily Hispanic (56.1%) and Non-Hispanic Black or Other (23.2%) (Table 1). The index stratifies ED data, demographic data, and Social Determinants of Health (SDOH) to identify gaps and interventions with the shared belief that disparities represent preventable harm, and work to identify systemic processes and structures that promote disparities.

Methods: To test the index, we targeted children living with poorly controlled asthma recently seen in the ED to conduct telephonic outreach via a Patient Care Coordinator to identify disparities through SDOH screenings for food insecurity, housing, transportation, and tobacco use. A Population Health Clinical Informaticist compiled SDOH data with demographic data to build a health equity index to identify, track, and prioritize care gaps and develop appropriate interventions for 100% of children seen in the Rady Children's ED for asthma. The index offers valuable insights detailing location (geo-mapping), race and ethnicity, language, payor type, household income, Prior ED visits, SDOH, and school information. This tool provides real-time information to target specific equity gaps and develop interventions.

Results: Race/Ethnicity was strongly associated with food insecurity (p <.001), unstable housing (p <.001), and tobacco use (p <.001). Language was strongly associated with food insecurity (p <.001), unstable housing (p <.001), and transportation issues (p=.05)When compared to Non-Hispanic (NH) Whites, patients who were Hispanic, NH Black and NH Other were 3-5 times more likely to experience unstable housing (p <.001); Hispanic patients were 3 times more likely to experience food insecurity ( <.001) and transportation issues ( <.001); NH Blacks were 2 times more likely to experience tobacco use/smoke exposure ( <.001) (Table 2). When compared to those who speak English, Spanish-speaking patients were 4.6 times more likely to experience food insecurity ( <.001), and 2 times more likely to experience unstable housing ( <.001) and transportation issues (.03) (Table 2).

Conclusion: This program and informatics tool allows for the application of a health equity lens to understand social determinants of health, identify interventions, and track outcomes for children living with asthma. In our population, we noted that children living with asthma were at higher risk for SDOH if they were Hispanic and were from Spanish-speaking families. The design is scalable to other conditions and populations to identify high risk populations and aids in community ecosystem development for resource connections.