Process Development for Measuring Social and Behavioral Determinants of Health in the Inpatient Setting: A Feasibility Study

Abstract

Problem: Social and behavioral determinants of health (SBDH) are the conditions, in which children, youth, and families are born, grow up, live and work, as well as the quality and accessibility to health care. SBDH strongly influences health, and the development and management of chronic disease. Increasingly, they are recognized as a key factor in population health management analytics and value-based care as they help identify at-risk individuals and assist providers in implementing timely interventions. SBDH deficits often interfere with patient’s ability to maintain and improve their health post-discharge; hence, the assessment and use of SBDH are important inpatient activities, to support transitions of care in which nursing will play a key role. To date, SBDH assessment has been largely conducted and tested in ambulatory healthcare settings versus inpatient; consequently, the SBDH deficits have not been routinely assessed or documented in the electronic health record (EHR) nor used during the inpatient admission to prepare patients for discharge. Project Aim: The purpose of this project was to 1) develop the procedures and methods to implement a standardized nursing process of SBDH assessment within the acute care setting, and 2) assess the feasibility of incorporating an SBDH assessment in an inpatient care unit. Project Method: This exploratory descriptive study utilized quantitative and qualitative methods to examine the feasibility of SBDH assessment and data capture in an inpatient setting (The University of Kansas Health System). The PRAPARE assessment tool was selected for this project as it aligns with national initiatives prioritizing SBDH. Initial pilot data were collected during a three-month period with the goal of assessing 30 patients prior to discharge. Process feasibility was examined using three methods of PRAPARE data assessment by monitoring the time required to complete the assessment including, (1) patient self-assessment and data entry via REDCap, patient self-assessment using pen and paper, and RN interview and data entry via primary investigator interview. Resource feasibility explored patient willingness, comfort, and satisfaction with the PRAPARE assessment process. Patient interviews were recorded, transcribed, and analyzed using NVivo software and classical content analysis. Data were analyzed using descriptive statistics performed using SPSS software. Similarities and differences between group themes are described. Project Results: A total of 44 patients participated in the study. Fifteen patients were assigned to the REDCap study arm, 15 patients were assigned to the RN interview study arm, and 14 patients were assigned to the pen & paper study arm. All 44 patients participated in the feasibility assessment following the completion of the PRAPARE assessment tool. Through administration of the PRAPARE assessment tool, it was discovered that the most frequent social needs among CF patients were transportation (20.4%), followed by healthcare - medical, dental, mental health, vision (15.9%), and utility (13.6%). All three methods of PRAPARE assessment tool administration proved to be feasible for inpatient workflow with overall education to completion time ranging from 5-10 minutes. All three methods of administration (REDCap, RN interview, and pen & paper) received positive feedback from respondents. However, differences in administration method (RN administered versus electronic self-administered) did result in a variation on the impact of time commitment from the RN. Conclusions: SBDH deficits often interfere with patient’s ability to maintain their health post-discharge. This study has illustrated that slowing the problem of growing readmission rates and increased inpatient utilization may, in fact, lie with addressing SBDH. Designing the nursing workflows to include these assessments will require nurses in various roles – both clinical and administrative - to advocate for the needs of patients and to be innovative in the application of these assessment tools.