Social Determinants of Health Impact Pediatric EMS Transport

Researchers have found a significant association among social determinants of health (SDOH), prehospital pediatric encounters, and EMS transport decisions.

Screening children for SDOH has become more common in recent years as the impacts of SDOH are being more rigorously studied and addressed. However, research evaluating the effect SDOH have on children is still lagging in many areas.

One of these areas is pediatric EMS transport. EMS transport and patient care are major components to ensuring care access and improving health outcomes for many patients, but EMS can be especially important for improving community health and addressing SDOHs.

Thus, the research team set out to retrospectively analyze the presence of SDOH in EMS clinician free text notes using natural language processing (NLP), a type of artificial intelligence that allows researchers to gather and sort unstructured data.

Researchers evaluated data from 1,322 EMS agencies regarding 9-1-1 responses for patients under the age of 18 from January 1, 2019 to December 31, 2019. Patients who suffered cardiac arrests, were pronounced dead on the scene, or were in law enforcement custody were excluded from the analysis due to differences in transportation protocols and transport authority decision dynamics for these individuals.

The remaining cohort’s information related to EMS dispatch, patient characteristics, clinical assessments, and prehospital treatments rendered was given to the NLP algorithm for analysis. The algorithm extracted information related to various SDOH categories, including income insecurity, food insecurity, housing insecurity, insurance insecurity, poor social support, and child protective services involvement.

Associations among SDOH, prehospital encounters, and EMS transport decisions were then assessed via logistic regression.

Overall, the research team evaluated 325,847 pediatric EMS encounters. Roughly 35 percent of these encounters resulted in a non-transport, and the average age of the patient was 10 years old. SDOH documentation in the patients’ records was rare among the encounters evaluated.

The two most common SDOH categories found in the EMS free text notes were child protective services involvement and housing insecurity. Child protective services involvement, housing insecurity, insurance security, and poor social support were associated with greater odds of EMS transport.

These findings, the researchers state, indicate that more research is needed to investigate how and why SDOH are associated with EMS transport decisions, optimize EMS documentation of SDOH, and address the causes of those SDOH to enhance EMS resource utilization and improve patient outcomes.

Other efforts to evaluate and address childhood SDOH have also appeared in recent years.

In 2019, Manatt Health and the Center for the Study of Social Policy (CSSP) outlined new guidance for Medicaid and the Children’s Health Insurance Plan (CHIP) to help support primary care providers by creating social and emotional health programming to address childhood SDOH.

In 2018, Nemours Children's Health partnered with a Delaware school district to use school-based behavioral health to address care gaps and SDOH.