A Health System-Wide Approach to Addressing Unmet Social Needs Among Children With Asthma

Rachel H. Margolis, Center for Translational Research, Children's National Research Institute, Washington, District of Columbia.
Shayla Stringfield, Center for Translational Research, Children's National Research Institute, Washington, District of Columbia.
Taylor Brewer, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Andrea Williams, Center for Translational Research, Children's National Research Institute, Washington, District of Columbia.
Terry Dean, Division of Critical Care Medicine, Children's National Hospital, Washington, District of Columbia.
Gwynne Latimer, Hassenfeld Children's Hospital at NYU Langone, New York, New York.
Scott Call, Division of Critical Care Medicine, Children's National Hospital, Washington, District of Columbia.
Amanda Jepson, America's Essential Hospitals, Washington, District of Columbia.
Mercedes Tate, DC International School, Washington, District of Columbia.
Kitman Wai, Division of Critical Care Medicine, Children's National Hospital, Washington, District of Columbia.
Gayle Gilmore, Department of Family Services, Children's National Hospital, Washington, District of Columbia.
Deepa Rastogi, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York.
Parisa Kaviany, Division of Pulmonary Medicine, Children's National Hospital, Washington, District of Columbia.
Sarah Hudock, Division of Pulmonary Medicine, Children's National Hospital, Washington, District of Columbia.
Kavita Parikh, Division of Hospital Medicine, Children's National Hospital, Washington, District of Columbia.
Shilpa J. Patel, Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia.

Document Type

Journal Article

Publication Date

6-1-2025

Journal

Hospital pediatrics

Volume

15

Issue

6

DOI

10.1542/hpeds.2024-008023

Abstract

It is well known that unhealthy housing, financial hardships, and lack of access to resources contribute to higher rates of asthma morbidity and health disparities. Despite extensive literature demonstrating that social factors drive health inequities in pediatric asthma, and although general social risk screening has been used in hospital settings to identify and address health-related social risks, asthma-specific screening models have not been well described. Furthermore, whereas social risk screening involves the identification of specific adverse conditions associated with poor health outcomes, social needs screening shifts the focus to patient and family preferences and priorities, which may facilitate more efficient, effective, and equitable provision of resources. Using the Exploration, Preparation, Implementation, and Sustainment framework, we describe the process of implementing a health system-wide, asthma-specific social needs checklist. The community-based asthma program at our institution had previously implemented social needs screening in 2018, and we report on the process of expanding its use to multiple settings at a single urban pediatric medical center. We evaluate the feasibility, acceptability, and sustainability of implementation in these new settings and describe the social needs of families of children with asthma at our institution. Screening was broadly acceptable to families. Feasibility and sustainability varied by site and was more successful at sites with leadership buy-in and dedicated staffing. Overall, screening revealed a high burden of unmet social needs. Future work includes addressing barriers to screening and studying the impact of a system-wide, longitudinal approach on patient experience and outcomes.

Department

School of Medicine and Health Sciences Student Works

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