Characterization of Social Risk Factors Among Newborns Seen at an Urban Pediatric Primary Care Predictive of Appointment Nonattendance During the First 6 Months of Life

Purpose: Appointment attendance is critical in monitoring health and well-being of children. Low income Medicaid-insured families with newborns often experience social risks that may affect attendance. This project sought to characterize social risk factors present at first newborn visits predictive of future appointment nonattendance. Methods: Retrospective cohort study of minority and Medicaid-insured population at St. Christopher's Hospital for Children using a standardized social risk screener administered at first newborn visits as part of routine clinical care. In total, 720 survey responses between December 2016 and June 2017 were correlated with electronic health record-derived sociodemographic and appointment attendance data in the first 6 months of life. Nonattendance included missed and canceled appointments. Caregiver-reported social risk factors were included as covariates in linear regressions predicting proportion nonattendance outcomes. Results: Newborn caregivers identified many social risk factors including mental health diagnoses (14%), lack of child care support (45%), and food insecurity (9%). Approximately 74% had nonattendance with 41% missing or canceling a quarter or more appointments. Number of siblings (p<0.01) and maternal age (p<0.01) were most predictive for nonattendance, respectively. Other social risks were not significant except for maternal mental health (p=0.01) among those identifying number of risk factors above cohort average (16%). Conclusion: Screening of newborns at first medical visits can be used to characterize social risks. Most social risk factors at first visits were not strongly predictive of nonattendance, although our results suggested associations between non-attendance and maternal demographics, mental health and household makeup.