Dashboard Portrays SDOH Factors Affecting Children With Severe Asthma

A recent pilot program in an emergency department in California showed how a dashboard can help identify patients—in this case, children with severe asthma—who need additional services due to poor social determinants of health (SDOH).

The grant-funded project, at Rady Children’s Health Network (RCHN), Rancho Santa Fe, California, was presented earlier this month at the 2022 AAP National Conference & Exhibition.

Researchers developed an Asthma Health Equity Index to redefine how they capture and display equity-related data to address a need for a standardized approach to measure and track health equity-related improvements. The researchers said the index has the potential to help other areas identify and assist such populations.

The population around the hospital has a disproportionate number of barriers to achieving good health, including poverty, air quality, and other factors.

Patients are primarily Hispanic (56.1%) and Non-Hispanic Black or other (23.2%).

To test the index, a patient care coordinator called households where children living with poorly controlled asthma were recently seen in the ED to identify disparities through SDOH screenings for food insecurity, housing, transportation, and tobacco use while also ensuring the families had adequate follow-up and asthma education.

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 interventions for 100% of children seen in the Rady Children's ED for asthma. The real-time index includes location (geo-mapping), race and ethnicity, language, payor type, household income, prior ED visits, SDOH factors, and school information.

Race/ethnicity was strongly linked with food insecurity, unstable housing, and tobacco use (all P <.001). Language was strongly associated with food insecurity and unstable housing (both P <.001) as well as transportation issues (P = .05)

When compared with White patients, patients who were Hispanic, Black, or other were 3 to 5 times more likely to experience unstable housing (P <.001); Hispanic patients were 3 times more likely to experience food insecurity (P <.001) and transportation issues. Black patients were twice as likely to experience tobacco use or have smoke exposure.

Spanish-speaking patients were 4.6 times more likely to experience food insecurity and twice as likely to experience unstable housing and transportation issues compared with patients who speak English.

“When managing the health of a child and, in particular, any chronic condition such as asthma, it is critical to acknowledge the profound importance that social determinants, race, ethnicity, and language barriers play in the life of that child and family,” Keri L. Carstairs, MD, vice president of network operations and clinical integration and the chief population health officer at Rady Children’s, said in a statement. “By committing to an understanding of those needs that extend beyond the health care setting, we can have a greater impact on the health of children by designing necessary interventions to support these needs through the development of a collaborative community ecosystem with community partnerships that can support vulnerable populations.”