Implementing a Social Determinants of Health Screening Tool at a Community Health Clinic

Abstract

Implementing a Social Determinants of Health Screening Tool to Increase Provider Referrals to Community Services Erin Floyd, RN, BSN Specialty Area: Family Nurse Practitioner Committee Chair: Janet D. Pierce, PhD, APRN, CCRN, FAAN Committee Member: JoAnn M. Peterson, DNP, APRN, FNP-BC Problem: Social determinants of health (SDOH) are the structural determinants and conditions in which patients are born, grow, live, work, and age. They include factors such as access to healthcare, employment, education, the physical environment, and socioeconomic status. These SDOH have a significant influence on the health and well-being of an individual. Patients with poor SDOH have worse health care outcomes because of many factors such as poverty, medication underuse, and inadequate disease management. Poverty is a contributing factor to most SDOH needs. These issues of concern affect many of the patients at the Duchesne Clinic (DC). Providers at the DC care for patients who are uninsured and who are 150% at or below the federal poverty line. However, there was no formal process for SDOH screening at the DC prior to this project. Project Aim: The aim of this project was to implement a SDOH screening tool to increase provider referral rates to community services for patients cared for at the DC. Project Method: For this quality improvement project the Health Leads screening tool was administered to assess for unmet social needs of adult patients 18 years and older at the DC in Kansas City, Kansas. Patients who screened positive for one or more SDOH needs were referred to either the Community Health Council of Wyandotte County (CHC) or to El Centro (EC). Both existing referral partners provide an in-depth evaluation of patient needs and assist with resolution of needs. After one month of using the SDOH screening tool, pre and post data from the Health Leads tool were analyzed, and referral rates to the CHC and EC were examined. Results: A total of 416 patients were invited to participate in the project. There were 233(56%) patients who completed the Health Leads screening tool at the DC over one month of data collection. Of those who participated, 146(63%) screened positive for at least one need, and 87(37%) screened negative for any needs. The Health Leads screening tool identified a total of 347 needs for this sample. There was an average of 1.5 needs per patient for the total number of participants, however for those who screened positive there was an average of 2.4 needs per patient. Overall, there were a total of 44 referrals placed to the CHC, and 7 referrals were made to EC. This was a significant improvement when compared to the previous monthly average referral rate of 11 to the CHC. Conclusion: The referral practices of the providers at the DC were greatly improved after the implementation of the Health Leads screening tool. The systematic use of the Health Leads screening tool increased provider referral rates, which may help the DC patients with social needs. The DC plans to continue use of the Health Leads screening tool as part of its annual evaluation process for patients being seen at the clinic.