How 6 Organizations Developed Tools and Processes for Social Determinants of Health Screening in Primary Care

LaForge, Kate; Gold, Rachel; Cottrell, Erika; Bunce, Arwen; Proser, Michelle; Hollombe, Celine; Dambrun, Katie; Cohen, Deborah J.; Clark, Khaya D.

doi:10.1097/jac.0000000000000221

Cited by 152 publications

(157 citation statements)

References 21 publications

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“…The SDH domains themselves continue to be redefined as health care organizations strive to create comprehensive screening tools. 29 Further progress requires screening tools that cover multiple domains but are sensitive, valid and concise. While our understanding of the harms of adverse SDH grows, we need to continue to gather evidence showing which primary care initiatives truly improve health outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…In response to this inconsistency in the availability and usability of tools, health care organizations are developing comprehensive screening tools covering an array of SDH domains. 29 The Institute of Medicine has identified 11 potential SDH domains for inclusion in the electronic health record. 29 Positive SDH screens call for referral and linkage to resources with follow up and care coordination.…”

Section: Discussionmentioning

confidence: 99%

“…29 The Institute of Medicine has identified 11 potential SDH domains for inclusion in the electronic health record. 29 Positive SDH screens call for referral and linkage to resources with follow up and care coordination. 15,18,23 Medical homes might also choose alternative strategies like direct deployment of programs to at-risk populations or interventions that foster the protective potential of resilience and family support.…”

Section: Discussionmentioning

confidence: 99%

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Screening for Social Determinants of Health in Pediatric Resident Continuity Clinic

Morgenlander¹,

Tyrrell

Garfunkel

et al. 2019

Academic Pediatrics

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BACKGROUND: The American Academy of Pediatrics and the Academic Pediatric Association have published guidelines supporting screening and referral for social determinants of health (SDH) in pediatric primary care. Despite this charge, little is known about the current prevalence of screening practices taking place in medical homes across the country.OBJECTIVE: The objective of this study is to describe current practices for systematically screening for social determinants of health in nationwide pediatric continuity clinics enrolled in the CORNET network. METHODS: We recruited 144 pediatric resident continuity clinics enrolled in the ContinuityResearch Network (CORNET) of the Academic Pediatric Association. Continuity clinic directors at 75 sites agreeing to participate received an electronic survey instrument requesting clinic demographics and information on screening and educational practices for fifteen social determinants of health. RESULTS:In the sixty-four clinic sites that responded to the survey, the range of SDH being screened for was 0-15 with a mean of 7. The most commonly screened SDH were maternal depression (86%), child education (84%), food insecurity (71%) and firearm exposure (65%).Most commonly, screening instruments are paper documents original to the clinic. Primary iii providers, nurses or medical assistants administer the majority of screens on rooming or during the encounter. Clinics not currently screening have plans to begin screening for nearly a quarter of those SDH not currently being screened within the next 3 years. Clinic directors most often cited lack of time (63%), lack of resources to address positive screen (50%) and inadequate training (46%) as barriers to SDH screening. Less than 10% of resident continuity clinic directors cited lack of indication or evidence for screening as barriers. CONCLUSIONS: Screening for SDH in pediatric resident continuity clinics has not yet been universally implemented. Screening practices are variable reflecting the complex nature of screening and the heterogeneity of the various SDH. Characteristics of commonly screened SDH include validated, concise screening tools, longstanding Bright Futures recommendations, literature suggesting benefit, and identifiable interventions. The major barriers to SDH screening are lack of time and lack of resources to address positive screens. A variety of measures including comprehensive, concise screening tools, up-to-date community resource guides, streamlined referral processes, embedded multidisciplinary teams, and strong community partnerships could mitigate these barriers.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Screening for Social Determinants of Health in Pediatric Resident Continuity Clinic

Morgenlander¹,

Tyrrell

Garfunkel

et al. 2019

Academic Pediatrics

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“…Prior studies have documented the challenges of effectively using information from self-reported screening instruments on social determinants of health such as housing instability. [20][21][22][23][24] These challenges fall into two broad categories: (a) determining how to resolve the logistical, resource, and workload issues associated with the collection of information about housing instability and other social factors from patients; and (b) optimizing procedures for taking action on such information. With respect to the first set of challenges, evidence suggests that workload concerns are barriers to the effective implementation of screening tools.…”

Section: Byrne Et Almentioning

confidence: 99%

“…The HSCR is part of an ambitious primary prevention approach to address housing instability; however, the existence of the HSCR alone is insufficient to improve housing stability. Prior studies have documented the challenges of effectively using information from self‐reported screening instruments on social determinants of health such as housing instability . These challenges fall into two broad categories: (a) determining how to resolve the logistical, resource, and workload issues associated with the collection of information about housing instability and other social factors from patients; and (b) optimizing procedures for taking action on such information.…”

Section: Introductionmentioning

confidence: 99%

Predictive modeling of housing instability and homelessness in the Veterans Health Administration

Byrne

Montgomery

Fargo

2018

Health Services Research

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Objective To develop and test predictive models of housing instability and homelessness based on responses to a brief screening instrument administered throughout the Veterans Health Administration (VHA). Data Sources/Study Setting Electronic medical record data from 5.8 million Veterans who responded to the VHA's Homelessness Screening Clinical Reminder (HSCR) between October 2012 and September 2015. Study Design We randomly selected 80% of Veterans in our sample to develop predictive models. We evaluated the performance of both logistic regression and random forests—a machine learning algorithm—using the remaining 20% of cases. Data Collection/Extraction Methods Data were extracted from two sources: VHA's Corporate Data Warehouse and National Homeless Registry. Principal Findings Performance for all models was acceptable or better. Random forests models were more sensitive in predicting housing instability and homelessness than logistic regression, but less specific in predicting housing instability. Rates of positive screens for both outcomes were highest among Veterans in the top strata of model‐predicted risk. Conclusions Predictive models based on medical record data can identify Veterans likely to report housing instability and homelessness, making the HSCR screening process more efficient and informing new engagement strategies. Our findings have implications for similar instruments in other health care systems.

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How Should Clinicians Ally With Patients Whose Health Is Unlikely to Be Improved by Even Numerous Clinical Encounters?

2022

AMA Journal of Ethics

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Patients experiencing homelessness and mental illness face conditions and circumstances that deserve focused ethical and clinical attention. The first commentary on the case applies insights from qualitative research about social determinants of health to these patients' care and dignity. The second commentary describes 3 kinds of power wielded by physicians-charismatic, social, and Aesculapian-each of which is considered in terms of whether and to what extent physicians' power should be owned, aimed, or shared.Case JJ is a 27-year-old man with schizophrenia, who is brought to the clinic by staff members from a local shelter. JJ does not adhere well to his antipsychotic medication, has experienced several inpatient psychiatric civil commitments and other encounters with numerous clinicians in the region's health care system, and does not have reliable access to shelter, food, water, or hygiene. You, JJ's caregiver in the clinic right now, empathize with him, staff from the shelter, and others trying to help JJ avoid poor health outcomes for which he is at such high risk.You refilled JJ's medication and reviewed his laboratory values, but you know there is little you can do for JJ that can counter the myriad and well-known social determinants undermining the effectiveness of even the most skilled intervention any clinician could offer JJ during a clinical encounter. You wonder how to make the most of this moment you have with JJ on his life journey.

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How 6 Organizations Developed Tools and Processes for Social Determinants of Health Screening in Primary Care

Cited by 152 publications

References 21 publications

Screening for Social Determinants of Health in Pediatric Resident Continuity Clinic

Screening for Social Determinants of Health in Pediatric Resident Continuity Clinic

Predictive modeling of housing instability and homelessness in the Veterans Health Administration

How Should Clinicians Ally With Patients Whose Health Is Unlikely to Be Improved by Even Numerous Clinical Encounters?

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