332 - Evaluation of SDOH electronic screening and referral program among pediatric patients and their families

Poster Number: 332
Publication Number: 332.447

Christina Fok, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Kaitlyn Stark, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Mallika Mathur, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Ethan T. Hunt, Texas Tech University Health Sciences Center School of Public Health, Austin, TX, United States; Sarah Cavenaugh, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Yen-Chi L. Le, The University of Texas Health Science Center at San Antonio Joe R. and Teresa Lozano Long School of Medicine, Houston, TX, United States; Sandra McKay, McGovern Medical School at the University of Texas Health Science Center at Houston, Missouri City, TX, United States

Background: Social determinants of health (SDOH) are nonclinical, external conditions that have significant impacts on health outcomes among individuals with unmet needs. Addressing these needs early and effectively during routine primary care checkups may improve overall health outcomes by providing access to resources in a timely manner. Additional protocols are needed in primary care settings to ensure consistent SDOH screening and follow up for patients and their families. 

Objective: This quality improvement study aims to (1) screen all patients for SDOHs and provide resources based on unmet needs using the electronic health record (EHR) system, and (2) evaluate the feasibility of implementing SDOH screening and referral through the EHR system.

Design/Methods: The SDOH screening consisted of 12 validated questions measuring 5 domains: food insecurity, housing instability, transportation issues, financial strain, health literacy, and legal support (Table 1). Questions were piloted among patients, 0–21 years, during well-child visits between August 22, 2022-September 16, 2022, at UT Physicians, the practice plan of UTHealth Houston. Patients/caregivers of patients with checkups were prompted to complete the screening either before or during the visit. Positive responses were automatically flagged in the EHR to allow for quicker and more visible distribution of resources and referrals to social workers, case managers, or community health workers. Descriptive statistics (frequency and proportions) of eligible patients screened, positive screens, and resources received were captured. In addition, a sample of caregivers and healthcare workers completed a survey to assess the feasibility of the screening and subsequent referrals.  

Results: 373 of 442 (84%) eligible patients were screened. 34% (N=120) of patients screened positive on at least one SDOH domain, of which 53% requested and received resources and/or a referral (Figure 1). 14% (N=52) screened positive on two or more SDOH domains. Financial strain and food insecurity were the most prevalent concerns (Figure 2). Most caregivers found the SDOH screening easy to use (97%, N=37), of which 95% found the resources provided helpful. Of the 23 surveyed providers and staff, 95% reported that the screening took 5 minutes to complete, and resources were easy to locate in the EHR. 

Conclusion(s): The use of the EHR system was feasible and effective in screening and quickly addressing SDOH concerns among patients and their families. Pediatricians can help provide more comprehensive care by implementing systematic SDOH screening.