Using State Administrative Data To Identify Social Complexity Risk Factors for Children
Screening for social determinants of health is challenging but critically important for optimizing child health outcomes. We aimed to test the feasibility of using an integrated state agency administrative database to identify social complexity risk factors and examined their relationship to emergency department (ED) use.
We conducted a retrospective cohort study among children younger than 18 years with Washington State Medicaid insurance coverage (N = 505,367). We linked child and parent administrative data for this cohort to identify a set of social complexity risk factors, such as poverty and parent mental illness, that have either a known or hypothesized association with suboptimal healthcare use. Using multivariate analyses, we examined associations of each risk factor and of number of risk factors with the rate of ED use.
Nine of 11 identifiable social complexity risk factors were associated with a higher rate of ED use. Additionally, the rate increased as the number of risk factors increased from 0 to 5 or more, reaching approximately twice the rate when 5 or more risk factors were present in children aged younger than 5 years (incidence rate ratio = 1.92; 95% CI, 1.85-2.00) and in children aged 5 to 17 years (incidence rate ratio = 2.06; 95% CI, 1.99-2.14).
State administrative data can be used to identify social complexity risk factors associated with higher rates of ED use among Medicaid-insured children. State agencies could give primary care medical homes a social risk flag or score to facilitate targeted screening and identification of needed resources, potentially preventing future unnecessary ED use in this vulnerable population of children.
Overview of article
- Many state agencies–including Medicaid agencies–already collect administrative data that could potentially be used to identify adverse childhood experiences and other social determinants of health (SDOH) for children and their parents, generate a flag or score indicating social risk, and potentially be shared with the child’s primary care clinician to prompt targeted screening to verify the presence of risk factors and assess the need for services or referrals to community resources
- This study sought to use state administrative data to identify children’s social complexity risk factors, which the study defined as a set of co-occurring individual, family, or community characteristics that can have a direct impact on health outcomes or an indirect impact by affecting a child’s access to care and/or a family’s ability to engage in recommended medical and mental health treatments
- This study tested the feasibility of identifying these risk factors using a cross-system integrated database in Washington State and examined the associations of both specific risk factors and number of risk factors with the rate of emergency department (ED) visits not resulting in inpatient admission
Methods of article
- The researchers conducted a retrospective cohort study among children younger than 18 years with Washington State Medicaid insurance coverage (N = 505,367). The study linked child and parent administrative data for this cohort to identify a set of social complexity risk factors, such as poverty and parent mental illness, that have either a known or hypothesized association with suboptimal healthcare use. Using multivariate analyses, the study examined associations of each risk factor and of number of risk factors with the rate of ED use
- 80% of the study population had a social risk factor, the most prevalent being a parent involved in the criminal justice system (44%). Other common risks were parent mental illness and child abuse or neglect
- For children’s 4 years or younger, severe poverty was the factor highest associated with increased ED use. Moreover, as the number of risk factors increased in this subpopulation, so did the rate of ED use
- For children 5-17 years old, criminal justice involvement and child abuse were the social complexity factors associated most to higher rates of ED use. Similar to the 4 and younger subpopulation, rates of ED use increased with additional social complexity factors
- Study found that it is feasible to use Medicaid claims data to identify social complexities by linking children and their biological parents
- This study supports a greater need for support or services for children with multiple social complexity risk factors
- Using such identification, state agencies could flag at-risk children for their providers without disclosing specific risk factors, allow providers to screen and collect social history and screening data in their EHR to most appropriately move forward (e.g., proper refers, steps for coordinated care)
- Community resources are also essential (e.g., vouchers for transportation) to providing coordinated care
- An important consideration moving forward is the feasibility of integrating data from multiple claims databases to identify social risk factors
- Limitations include difficulty reproducing the study, inability to identify all social risk factors, and inability to consider variability in defined social complexity factors
- Future research may consider narrower definitions of social risk factors and inclusion of uninsured children and children on commercial plans