Evaluation of a social determinants of health screening questionnaire and workflow pilot within an adult ambulatory clinic

BMC Family Practice

Chris Miller-Rosales¹  Rachel L. Berkowitz²  Stephanie Brown³  Linh Bui⁴  Zijun Shen⁵  Alice Pressman⁵  Maria Moreno⁵  Kristen M. J. Azar⁶  Anne Nilon⁷ 

[1] Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, 02115, Boston, MA, USA;Department of Public Health and Recreation, College of Health and Human Sciences, San José State University, One Washington Square, 95192, San José, CA, USA;Sutter Health Institute for Advancing Health Equity, 2121 N. California Blvd, 94596, Walnut Creek, CA, USA;Sutter Health Institute for Advancing Health Equity, 2121 N. California Blvd, 94596, Walnut Creek, CA, USA;Alta Bates Summit Medical Center, Sutter Health, 350 Hawthorne Ave., 94609, Oakland, CA, USA;Berkeley Emergency Medical Group, 2450 Ashby Ave., 94705, Berkeley, CA, USA;Sutter Health Institute for Advancing Health Equity, 2121 N. California Blvd, 94596, Walnut Creek, CA, USA;Department of Nursing, School of Natural Sciences, Mathematics, and Engineering, California State University, Bakersfield, 9001 Stockdale Highway, 93311, Bakersfield, CA, USA;Sutter Health Institute for Advancing Health Equity, 2121 N. California Blvd, 94596, Walnut Creek, CA, USA;Sutter Health Center for Health Systems Research, 2121 N. California Blvd, 94596, Walnut Creek, CA, USA;Sutter Health Institute for Advancing Health Equity, 2121 N. California Blvd, 94596, Walnut Creek, CA, USA;Sutter Health Center for Health Systems Research, 2121 N. California Blvd, 94596, Walnut Creek, CA, USA;Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St., Second Floor, 94158, San Francisco, CA, USA;Sutter Health Population Health Services, 2121 N. California Blvd, 94596, Walnut Creek, CA, USA;

关键词: Social determinants of health screening;    Ambulatory setting;    Evaluation;    RE-AIM;    Implementation science;    Intervention;   

DOI  :  10.1186/s12875-021-01598-3

来源: Springer

【 摘 要 】

BackgroundThere is increased recognition in clinical settings of the importance of documenting, understanding, and addressing patients’ social determinants of health (SDOH) to improve health and address health inequities. This study evaluated a pilot of a standardized SDOH screening questionnaire and workflow in an ambulatory clinic within a large integrated health network in Northern California.MethodsThe pilot screened for SDOH needs using an 11-question Epic-compatible paper questionnaire assessing eight SDOH and health behavior domains: financial resource, transportation, stress, depression, intimate partner violence, social connections, physical activity, and alcohol consumption. Eligible patients for the pilot receiving a Medicare wellness, adult annual, or new patient visits during a five-week period (February-March, 2020), and a comparison group from the same time period in 2019 were identified. Sociodemographic data (age, sex, race/ethnicity, and payment type), visit type, length of visit, and responses to SDOH questions were extracted from electronic health records, and a staff experience survey was administered. The evaluation was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.ResultsTwo-hundred eighty-nine patients were eligible for SDOH screening. Responsiveness by domain ranged from 55 to 67%, except for depression. Half of patients had at least one identified social need, the most common being stress (33%), physical activity (22%), alcohol (12%), and social connections (6%). Physical activity needs were identified more in females (81% vs. 19% in males, p < .01) and at new patient/transfer visits (48% vs. 13% at Medicare wellness and 38% at adult wellness visits, p < .05). Average length of visit was 39.8 min, which was 1.7 min longer than that in 2019. Visit lengths were longer among patients 65+ (43.4 min) and patients having public insurance (43.6 min). Most staff agreed that collecting SDOH data was relevant and accepted the SDOH questionnaire and workflow but highlighted opportunities for improvement in training and connecting patients to resources.ConclusionUse of evidence-based SDOH screening questions and associated workflow was effective in gathering patient SDOH information and identifying social needs in an ambulatory setting. Future studies should use qualitative data to understand patient and staff experiences with collecting SDOH information in healthcare settings.

【 授权许可】

CC BY