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.
Pediatric overweight and obesity is a grave public health issue in the United States. With overweight and obesity come significant physical health problems, psychological problems, social problems, and school problems. In 2007, the American Academy of Pediatrics published clinical practice guidelines for the treatment of overweight and obesity in children and adolescents. However, health care providers are not using these guidelines due to a variety of barriers already identified in the literature. Treatment of overweight and obese students in SBHCs presents unique problems; however, this has not been assessed in the existing literature. This project identified unique barriers to treatment in SBHCs, including lack of parent or guardian presence and difficulties in promoting continuity of care between the SBHCs and PCPs. From this work, we can begin to develop interventions to help address these issues within the school-based clinical setting. Identifying barriers to guideline implementation will empower school-based health providers to address these barriers, perhaps leading to the implementation of changes that transform these barriers into facilitators. These actions may improve the quality of care provided to overweight and obese pediatric patients, which could also lead to positive impacts on BMI and may improve health outcomes for overweight and obese children.
A multicomponent intervention was attempted in a pediatric emergency department to increase reporting of workplace aggression committed by patients and visitors. Overall reporting decreased from 53% to 47% (P = .06). Reasons for reporting were severity of incident and being asked to report. Reasons for not reporting were incidents being too minor and no action would be taken. Future change efforts need to consider multiple modes of communication to promote adoption of reporting and inclusion of administrators in efforts to improve reporting.
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