Association of Patient and System-Level Factors With Social Determinants of Health Screening

Abstract

Background: Health systems are increasingly recognizing the importance of collecting social determinants of health (SDoH) data. However, gaps remain in our understanding of facilitators or barriers to collection. To address these gaps, we evaluated a real-world implementation of a SDoH screening tool. Methods: We conducted a retrospective analysis of the implementation of the SDoH screening tool at Mayo Clinic in 2019. The outcomes are: (1) completion of screening and (2) the modality used (MyChart: filled out on patient portal; WelcomeTablet: filled out by patient on a PC-tablet; EpicCare: data obtained directly by provider and entered in chart). We conducted logistic regression for completion and multinomial logistic regression for modality. The factors of interest included race and ethnicity, use of an interpreter, and whether the visit was for primary care. Results: Overall, 58.7% (293,668/499,931) of screenings were completed. Patients using interpreters and racial/ethnic minorities were less likely to complete the screening. Primary care visits were associated with an increase in completion compared with specialty care visits. Patients who used an interpreter, racial and ethnic minorities, and primary care visits were all associated with greater WelcomeTablet and lower MyChart use. Conclusion: Patient and system-level factors were associated with completion and modality. The lower completion and greater WelcomeTablet use among patients who use interpreters and racial and ethnic minorities points to the need to improve screening in these groups and that the availability of the WelcomeTablet may have prevented greater differences. The higher completion in primary care visits may mean more outreach is needed for specialists.

Patient and Care Team Perspectives on Social Determinants of Health Screening in Primary Care

“…Completion rates differed in this study (3.8%) from previous research (58.7%) 7 also examining systemwide SDOH screening implementation. This may be related to study duration, timing (intra–COVID-19 pandemic vs pre–COVID-19 pandemic), or implementation (recommendation for all primary care patients vs preassigned screening).…”

“…This may be related to study duration, timing (intra–COVID-19 pandemic vs pre–COVID-19 pandemic), or implementation (recommendation for all primary care patients vs preassigned screening). 7 Based on qualitative interviews, our study completion rates may be affected by the desire to receive more resources to support patient referrals.…”

“…Given the personal nature and limited evidence guiding SDOH screening adoption, it is critical to understand stakeholder perspectives. Prior research indicates that health care professionals recognize the importance of addressing patient SDOH needs and strive to adopt patient-centered approaches but face ethical and time-related challenges .…”

“…Prior research indicates that health care professionals recognize the importance of addressing patient SDOH needs and strive to adopt patient-centered approaches but face ethical and time-related challenges . Existing work reports greater SDOH screening uptake in primary care vs specialist visits and lower completion among patients requiring interpreters and patients with racial and ethnic minority status . Studies on patient and caregiver perspectives have documented SDOH screening acceptability and preferences .…”

“… 8 , 11 , 12 Existing work reports greater SDOH screening uptake in primary care vs specialist visits and lower completion among patients requiring interpreters and patients with racial and ethnic minority status. 7 Studies on patient and caregiver perspectives have documented SDOH screening acceptability and preferences. 13 The role of practice and care team characteristics in screening uptake has not been assessed within a multistakeholder analysis.…”