Enhancing Clinical Decision-Making at Dayton Children’s Hospital

Research shows there are wide racial and ethnic inequities in child health, leading to unintended inequitable treatment across pediatric specialties, including primary care, emergency medicine, inpatient and critical care, surgery, neonatology, developmental disabilities and mental health care. Children’s hospitals are increasingly taking actions to reduce barriers to children’s health, and many are looking at children’s neighborhoods—an important social determinant of health—to inform care providers and target interventions. 

Dayton Children’s Hospital in Ohio has a stated commitment to pursuing optimal health for children, which includes researching, implementing and evaluating interventions that can address health disparities and increase healthy outcomes. One way they work toward that goal is through data-driven, personalized care that considers “the diverse experience and unique situations of each family.” Social needs screenings work hand-in-hand with a data infrastructure that identifies health risks and disparities, in order to help providers best serve patients. 

As part of this work, Dayton Children’s Hospital is leading the way in integrating the Child Opportunity Index (COI) into its data analytics and patient care practices. For example, one persistent challenge in health care and outcomes relates to hospital readmissions. Research using the COI has shown that children from lower opportunity neighborhoods are more likely to revisit the emergency department or be readmitted soon after a hospital discharge (Akande et al 2023, Bettenhausen et al 2022, Rodriguez et al 2019), which has significant monetary, social and logistical costs. For physicians and nurses caring for a hospitalized child, measures of a patient’s social determinants of health—including measures of their neighborhood context—can help providers personalize care appropriately during a first hospital stay, and potentially prevent a future one. 

Dayton Children’s data analytics team has created a model for predicting patient readmission, and one of the variables included is the COI-derived Child Opportunity Score (state-normed) of the child’s neighborhood. Using the patient’s address, the COI provides a single, consistent measure of resources in the child’s neighborhood, from housing to education to the poverty level, simplifying data collection on social determinants of health. A very low Opportunity Score is one input that helps flag a patient as high risk for a complex discharge and, accordingly, hospital readmission.

Once a patient has been flagged, nurse care managers prioritize discharge planning assessments that can identify and mitigate barriers that, if left unmanaged, could contribute to the patient returning to the hospital in the near future. “In collaboration with the patient, their family and the interdisciplinary medical team, I address these obstacles, establish appropriate follow-up care, provide education regarding the discharge plan and facilitate connections to community resources or home health services as indicated,” says Nicole Schneider, RN Care Manager. “This coordinated approach fosters an effective transition of care and promotes optimal post-discharge outcomes."

The goal, says Clinical Analytics Manger Justin Stebbins, “is to improve a patient’s experience in the hospital while also improving their health outcomes.” 

For example, if the model shows that a child lives in a very low-opportunity neighborhood, then nurses who are caring for that child are coached on understanding that the child’s neighborhood may not have the best conditions and resources to promote their health. Many families in that child’s neighborhood may have incomes below the poverty line, low rates of preschool participation and/or limited access to healthy food.

The data analytics team has also explored how to use the COI in other areas of decision-making. Providers and analysts who focus on pediatric asthma are interested in adding the COI to a model that assesses the likelihood of asthma emergency department visits and hospitalizations. The body of research on the COI and its association with asthma, other health conditions and health care utilization supports the inclusion of the COI into these models. 

These uses of the COI in the healthcare system are one step in a larger movement of using data to promote health equity—not just for research, but as a clinical tool to understand a patient’s social determinants of health, suggest important topics to discuss with the patient’s family, and address their needs appropriately. A wealth of research on the social determinants of health has made medical professionals increasingly focused on considering patients’ social needs. Many in pediatric care, though, were trained before addressing social needs was a major consideration, and there are few institutional resources to educate professionals on how to use data on social determinants of health in clinical work. Dayton Children’s work demonstrates that the COI can be a helpful tool for overcoming these barriers. 

Photo property of Dayton Children's Hospital. Republished with permission.