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

BACKGROUND: There 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...

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Autores principales: Berkowitz, Rachel L., Bui, Linh, Shen, Zijun, Pressman, Alice, Moreno, Maria, Brown, Stephanie, Nilon, Anne, Miller-Rosales, Chris, Azar, Kristen M. J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8708511/
https://www.ncbi.nlm.nih.gov/pubmed/34952582
http://dx.doi.org/10.1186/s12875-021-01598-3
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author Berkowitz, Rachel L.
Bui, Linh
Shen, Zijun
Pressman, Alice
Moreno, Maria
Brown, Stephanie
Nilon, Anne
Miller-Rosales, Chris
Azar, Kristen M. J.
author_facet Berkowitz, Rachel L.
Bui, Linh
Shen, Zijun
Pressman, Alice
Moreno, Maria
Brown, Stephanie
Nilon, Anne
Miller-Rosales, Chris
Azar, Kristen M. J.
author_sort Berkowitz, Rachel L.
collection PubMed
description BACKGROUND: There 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. METHODS: The 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. RESULTS: Two-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. CONCLUSION: Use 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12875-021-01598-3.
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spelling pubmed-87085112021-12-27 Evaluation of a social determinants of health screening questionnaire and workflow pilot within an adult ambulatory clinic Berkowitz, Rachel L. Bui, Linh Shen, Zijun Pressman, Alice Moreno, Maria Brown, Stephanie Nilon, Anne Miller-Rosales, Chris Azar, Kristen M. J. BMC Fam Pract Research Article BACKGROUND: There 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. METHODS: The 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. RESULTS: Two-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. CONCLUSION: Use 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12875-021-01598-3. BioMed Central 2021-12-24 /pmc/articles/PMC8708511/ /pubmed/34952582 http://dx.doi.org/10.1186/s12875-021-01598-3 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Berkowitz, Rachel L.
Bui, Linh
Shen, Zijun
Pressman, Alice
Moreno, Maria
Brown, Stephanie
Nilon, Anne
Miller-Rosales, Chris
Azar, Kristen M. J.
Evaluation of a social determinants of health screening questionnaire and workflow pilot within an adult ambulatory clinic
title Evaluation of a social determinants of health screening questionnaire and workflow pilot within an adult ambulatory clinic
title_full Evaluation of a social determinants of health screening questionnaire and workflow pilot within an adult ambulatory clinic
title_fullStr Evaluation of a social determinants of health screening questionnaire and workflow pilot within an adult ambulatory clinic
title_full_unstemmed Evaluation of a social determinants of health screening questionnaire and workflow pilot within an adult ambulatory clinic
title_short Evaluation of a social determinants of health screening questionnaire and workflow pilot within an adult ambulatory clinic
title_sort evaluation of a social determinants of health screening questionnaire and workflow pilot within an adult ambulatory clinic
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8708511/
https://www.ncbi.nlm.nih.gov/pubmed/34952582
http://dx.doi.org/10.1186/s12875-021-01598-3
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