In a recently released article in Pediatrics, Dr. Sheree Schrager (peds.2015-3787) and colleagues demonstrate that use of state administrative data can identify social risk as successfully as caregiver surveys. Why does this matter? It makes intuitive sense that a family burdened by risk factors such as severe poverty, severe caregiver mental illness or physical disability or very limited English proficiency might end up relying on Emergency Room visits rather than timely adherence to well care for their children’s medical needs, and in fact this has been well documented. The authors propose that if such families, and specifically their children, could be identified using administrative claims data rather than individual provider surveys, more children could be identified more readily and intervention provided.
In a remarkable tour de force of recruitment and enrollment, the authors were able to obtain completed telephone surveys from 460 of 2,625 eligible low-income (state Medicaid-enrolled) families, and compared social risk factors measured on these surveys with those in the Minnesota health Care Programs public health care claims and encounter database. Several, in fact most, specific risk factors showed good concordance between the survey and database, and Table 1in this article carefully describes each social risk factor, and presents its definition in both the administrative data and in the caregiver survey, i.e. the survey question. Parents were asked if they needed care coordination, and in the unadjusted analysis, social risk was associated with this need.
Much work has focused on children with special health care needs and their families’ needs for care coordination. One of the several strengths of this study is that the authors enrolled children with a “non-complex chronic” condition, who likely outnumber those with more complex health care needs. And while participants technically had access to care, i.e. they had been seen in a clinic in the past 14 months, the authors shed light on the difference between “potential access” and “realized access” to care, in that over 1/3 of parents endorsed a need for care coordination or help with getting care. This study opens up a whole new world of possibilities. If large administrative databases can be put to work for the good of families, and can be used to pre-identify or flag families in need of specific additional help, then outreach workers can jump start the conversation and help bring families into care and into the clinic, where culturally competent medical care can continue rather than just begin.