P3B146: Improving Social Determinants of Health (SDoH) Screening in Pediatric Patients

Purpose/Objectives: Social Determinants of Health (SDoH) are factors that influence one’s quality of life outcomes. Healthy People 2030 identifies the following as key SDoH domains: education, economic stability, social/community context, environment/neighborhood conditions, and healthcare accessibility.

Screening for social determinants of health in pediatric populations is critical for identifying and addressing the external factors in a child’s environment that impact their growth and development. Barriers to proper screening include time restraints, provider/parent discomfort, and lack of established workflows. The purpose of this quality improvement (QI) project is to create a workflow for SDoH capture that will adequately identify and address the needs of pediatric patients/families at Hempstead Pediatrics (an Article 28 clinic and Patient-Centered Medical Home). We aim to increase the percentage of SDoH screenings completed for eligible patients from a baseline of 0% to more than 75% by December 2023.

Design/Methods: We created a multidisciplinary team that included residents, attendings, medical students, medical assistants (MAs), nurses, and social workers. Through rapid cycle plan-do-study-act cycles, SDoH screenings were implemented using the Health Leads Social Needs Screening Tool at 2-week, 3-year, 9-year, and 10-year-old wellness encounters. We chose ages with minimal additional screenings. The tool was provided in English or Spanish depending on the parent’s preferred language. MAs administered the screenings while rooming the patients. Providers reviewed the completed screen, uploaded the results into the chart, documented the results in their encounter note, and referred patients to the appropriate community-based resources based on the identified needs.

Intervention 1: Educate providers on screening tool and administration workflow.
Intervention 2: Create list of community-based resources (CBO) for positive screen.
Intervention 3: Create medical record documentation and referral tools. Data on proper documentation of screening implementation and resource distribution was collected through EMR chart review.

Results: For the first six months since the screenings were implemented, an average of 68.5% of eligible patients were screened. A total of 462 SDoH positives were identified, with most positives falling under education, food insecurity, and child-care. An average of 70.2% of patients with positive screenings were given community resources to follow up with.

Conclusion/Discussion: For the first six months of this project, we have been able to increase our percentage of SDoH screenings and community resource distribution. PDSA cycles have focused on optimizing workflow with controlled variation, educating staff on the importance of SDoH monitoring, and improving the referral process for patients with positive screenings. We plan to continue addressing barriers for screening by following up with patients to confirm that our community resources are effective, and by integrating the SDoH tool digitally into the EMR system.