P3A292: A Quality Improvement Program to Improve Primary Care Providers’ Screening and Counseling on Injury and Social Risks

Purpose/Objectives: Injury remains the leading cause of death in US children and social determinants of health (SDOH) have been shown to play a critical role in health outcomes. The goal of this Quality Improvement (QI) project was to implement an electronic screening tool for injury and SDOH risk factors, enabling providers to address all potential risks and offer tailored anticipatory guidance and appropriate resources/referrals.

Design/Methods: Providers from the Ohio AAP and family medicine databases self-selected to participate. Two age-based screening tools, corresponding talking points, national, statewide and local resources for birth – 12 months and 13 months – 5-year-old children were developed for unintentional injury (car seat, home and sleep safety) and SDOH topics (family and social needs). Baseline data from medical charts was collected for well-child visits (WCVs) for the same months of the collaborative from the prior year. Practice teams participated in a virtual learning session and monthly action period calls during the collaborative. Caregivers were provided an injury prevention and SDOH screening tool using iPads during all WCVs for children  5 years of age. The office teams identified high-risk topics and providers documented counseling and resources provided. Between September 1, 2022 and January 31, 2023, data was pulled from the portal for each age category to review what risks were identified and if these risks were addressed by providers. Frequencies of counseling and resource distribution were calculated. Participating providers received ABP and ABFM Maintenance of Certification credit.

Results: 8 practices (20 healthcare providers) participated. At baseline, injury topics were addressed at an average rate of 1302/1564 (83%) and SDOH topics were addressed at an average rate of 550/1244 (44%). A total of 1258 caregivers completed the screening tool during the QI collaborative. On completed tools, injury 3129/3154 (99.2%) and SDOH 2520/2525 (99.8%) risks were identified and addressed by providers. Using t-test, a significant increase in asked and answered rates in QI compared to baseline for all topics (p < .01). The topic with the most significant change in discussion rate during the collaborative was home safety, with discussion increasing from 109/197 (55%) to 371/394 (94%). By the conclusion of the collaborative, resources for identified risks were shared with caregivers at an average rate of 259/265 (97.7%).

Conclusion/Discussion: Identifying injury and social risks and addressing needs by providers can be accomplished using QI methodology in the primary care setting. Providing these tools and resources could impact future behavior change to prevent injuries and impact social problems for families.