Abstract: Addressing Social Determinants of Health in an Ambulatory Pediatric Diabetes Clinic; Examining Data by Race and Ethnicity
Emily DeWit, Brent Lockee, Mitchell Barnes, Katelyn Evans, Mark Clements, Kelsee Halpin, Shilpi Relan
Children's Mercy Kansas City Kansas City, Missouri, USA
Background/Objective: The American Diabetes Association has recommended screening for social determinants of health (SDOH) and addressing social barriers to health for all individuals with diabetes. Our aim was to implement a SDOH screening tool in a pediatric type 1 diabetes (T1D) clinic, then analyze the completion and positivity rates by race and ethnicity.
Methods: In September 2021, we implemented a SDOH screening survey in clinic intake forms. We completed 10 Plan Do Study Act cycles by July 1, 2022. Cycles tested delivering a resource list to those with positive screens, providing a link to a web-based platform with comprehensive resources, and providing personalized guidance to connect to vetted community resources. We also modified language to give families a rationale for taking the survey and to articulate that guidance service was free.
Results: The survey was completed by 3370 out of 4071 families attending clinic appointments from September 1, 2021 to July 1, 2022. Overall, 4.42% of screens were positive. Whites completed 78.9% of surveys yet made up 43.62% of positive screens. In contrast, Black individuals completed 7.83% of surveys yet accounted for 28.19% of positive screens. Hispanic/Latinos completed 9.17% of surveys while accounting for 14.77% of positive screens.
Conclusions: Black and Hispanic patients are disproportionately affected by SDOH barriers. This disparity illustrates the need for screening and addressing barriers to SDOH. Screening for SDOH should drive the development of cost-effective, culturally customized programs to support diabetes care and promote health equity.
Keywords: racial disparities, social determinants of health, type 1 diabetes