Utilizing a Tailored Approach to Standardized Screening of Health-Related Social Needs.

Despite the increased awareness of social determinants of health (SDoH), integrating social needs screening into health care practice has not consistently occurred. No social needs screening using recommended standardized questions was available at an outpatient hemodialysis clinic. Plan-Do-Study-Act cycles, based on the Model for Improvement, were used to implement the Core 5 SDoH screening tool, a staff referral process, and an evaluation of the implementation process. A standardized social needs screening tool and a staff referral process were implemented. An evaluation of the implementation process also occurred. Of 73 patients screened, 21 reported 32 unmet social needs; all received referrals to community resources. Nurses demonstrated high acceptance and usability of the tool and the referral process. Implementing a standardized screening and referral process customized to clinical workflow enhanced the identification of social needs in patients undergoing hemodialysis.

Wright QC ，Wiencek CA ，Williams IC 《-》

Screening for the social determinants of health: Referring patients to community-based services.

Screening patients for the social determinants of health (SDOH) allows clinicians to identify those needs and tailor referral efforts. Due to constraints on clinic time and monetary resources, a simple screening tool incorporated into existing clinic workflow increases its usefulness and impact. Our free, nurse-led, mobile health clinic (MHC) needed an enhanced process or tool for screening patients for SDOH. The purpose of this quality-improvement project was to screen adult patients in the MHC for SDOH needs and to increase volunteer staff perceptions of their knowledge and confidence in referring patients to relevant community-based services. A screening process and tool was developed using guidelines from the Health Leads to identify patients' SDOH needs and related requests for assistance. The tool was introduced to and tested among volunteer staff through pretest/posttest surveys. Patients who visited the clinic were screened for the SDOH within the project period, and volunteer staff were surveyed about their perceptions of the screening tool. Sixty-four patients were screened for SDOH needs. Twenty-three percent reported food insecurity, 27% housing insecurity, 14% difficulty obtaining utilities, and 17% difficulty obtaining transportation; 28% requested assistance with their reported SDOH needs. Seventeen percent of patients reported two or more SDOH needs. At posttest, 100% of volunteer staff ( N = 9) indicated satisfaction with the SDOH screening questions, reported feeling knowledgeable about resources to use for patient referrals, and were confident in referring patients to needed resources. The screening tool aptly guided practice and was evaluated as "easy to use" for clinic patients and volunteer staff.

Mullen LG ，Oermann MH ，Cockroft MC ，Sharpe LM ，Davison JA ... -  《-》

Implementing screening for social determinants of health using the Core 5 screening tool.

Social determinants of health (SDOH) have been documented to underpin 80% of overall health and are being increasingly recognised as key factors in addressing tertiary health outcomes. Yet, despite the widespread acceptance of the association of SDOH with health outcomes, more than two-thirds of hospitals do not screen for social risk factors that indicate individual-level adverse SDOH. Such screening for social risk factors represents the first step in connecting patients with resources and documents the prevalence of social needs. The aim of this project was to implement the Core 5 social risk screening tool and evaluate its efficacy and usability in identifying social risk factors in a presurgical spine population. Prior to this implementation, screening for social risk had not been performed. The Model for Improvement provided a framework for implementing and evaluating the Core 5 social risk screening tool. Methods included implementation of a patient self-report social risk screening tool, referral workflow to connect patients with needed resources and evaluation of staff feasibility in using the Core 5 tool. The results indicated that the screening tool identified patients with social risk factors and staff reported perceptions of efficacy and usability in clinical workflow. Overall, 52 of 88 (59%) of subjects in the presurgical spine population were effectively screened. Of these, five patients (10%) had identified social needs that needed to be addressed prior to surgery. The staff usability survey for the Core 5 tool demonstrated high acceptance and usability, with an average score of 4.4 (out of 5). Future work should evaluate the efficacy of the screening tool in other ambulatory and tertiary settings.

Bradywood A ，Leming-Lee TS ，Watters R ，Blackmore C ... -  《-》

Provider and Staff Feedback on Screening for Social and Behavioral Determinants of Health for Pediatric Patients.

Screening and referral for Social and Behavioral Determinants of Health (SDOH) are increasingly recommended in clinical guidelines and consensus statements. It is important to understand barriers and facilitators to implementation of standardized SDOH screening and referral practices, as well as the scope of current existing SDOH screening. We conducted a mixed-methods study to understand the current state of SDOH screening and to assess the barriers and facilitators to implementing a standardized SDOH screening and referral practice in Boston community health centers (CHCs) for pediatric patients. We requested all SDOH screening documents from 15 Boston CHCs and conducted provider and staff focus groups at intervention sites of an SDOH implementation pilot in Boston. All CHCs screened in some form for SDOH, but there was no agreement on which domains to screen. Participating CHCs screened for a mean of 8 SDOH domains (range, 5 to 16). Overall, 16 SDOH domains emerged. From the focus groups, 5 themes emerged: 1) provider perspectives, 2) work flow, 3) prior experience, 4) site resources and staffing, and 5) sustainability. There was little agreement among participants within each theme, as all were seen as barriers and facilitators depending on the respondent. This study highlights the various SDOH screening methods currently used in Boston CHCs, and the need for workflow and process individualization of SDOH screening and referral. Providers and clinical staff should be part of the discussion when implementing SDOH screening and referral procedures to ensure appropriate work flow, staff buy-in, and to maximize resources available.

Byhoff E ，Garg A ，Pellicer M ，Diaz Y ，Yoon GH ，Charns MP ，Drainoni ML ... -  《-》

Implementing Social Determinants of Health Screening at Community Health Centers: Clinician and Staff Perspectives.

Herrera CN ，Brochier A ，Pellicer M ，Garg A ，Drainoni ML ... -  《-》