Social Risk Screening Changes Medical Decision-Making in a Complex Outpatient Pediatric Antibiotic Therapy Program.

Abstract

Complex outpatient antibiotic therapy (COpAT) programs facilitate the treatment of serious infections at home, shorten inpatient stays, and improve patient satisfaction when compared to inpatient care [1]. However, COpAT delivery can be complicated by antibiotic side effects and vascular access problems, the management of which can become particularly difficult when attempted in the context of high social risk in the home and community [2]. The use of standardized social risk screening for optimizing infectious disease (ID) discharge plans is largely unexplored. We tested the feasibility and implementation of a novel social risk screening tool for COpAT and described alterations in care plans generated based on social risk information. A COpAT social risk screening tool was created by adapting publicly available social determinants of health screening toolkits [3, 4] to focus on social risks previously identified as prevalent in our patient population and relevant to our COpAT delivery system [5, 6] (Figure 1). From March to October 2019, the COpAT physician assistant assessed social risks for 29 of 40 (73%) consecutively eligible parents/caregivers. Results of social risk screening and COpAT modifications were documented in the patient’s EMR as a progress note. To assess changes made as a result of screening, we retrospectively compared the original COpAT plan by the inpatient consulting ID team to the final COpAT plan. We tabulated changes in COpAT plans using six predefined, a priori categories of change: (1) antibiotic use; (2) caregiver education; (3) COpAT follow-up plans; (4) social work referral; (5) new inpatient consultation; and (6) hospital length of stay. The study was deemed quality improvement and IRB oversight was waived.