TY - JOUR
T1 - Scaling-up social needs screening in practice
T2 - A retrospective, cross-sectional analysis of data from electronic health records from Bronx county, New York, USA
AU - Fiori, Kevin P.
AU - Heller, Caroline G.
AU - Flattau, Anna
AU - Harris-Hollingsworth, Nicole R.
AU - Parsons, Amanda
AU - Rinke, Michael L.
AU - Chambers, Earle
AU - Hodgson, Sybil
AU - Chodon, Tashi
AU - Racine, Andrew D.
N1 - Funding Information:
Funding This work was funded by the Doris Duke Charitable Foundation (grant 2018169) and the Agency for Healthcare Research and Quality (K12HS026396).
Publisher Copyright:
© 2021 BMJ Publishing Group. All rights reserved.
PY - 2021/9/29
Y1 - 2021/9/29
N2 - Objectives There has been renewed focus on health systems integrating social care to improve health outcomes with relatively less related research focusing on € real-world' practice. This study describes a health system's experience from 2018 to 2020, following the successful pilot in 2017, to scale social needs screening of patients within a large urban primary care ambulatory network. Setting Academic medical centre with an ambulatory network of 18 primary care practices located in an urban county in New York City (USA). Participants This retrospective, cross-sectional study used electronic health records of 244 764 patients who had a clinical visit between 10 April 2018 and 8 December 2019 across any one of 18 primary care practices. Methods We organised measures using the RE-AIM framework domains of reach and adoption to ascertain the number of patients who were screened and the number of providers who adopted screening and associated documentation, respectively. We used descriptive statistics to summarise factors comparing patients screened versus those not screened, the prevalence of social needs screening and adoption across 18 practices. Results Between April 2018 and December 2019, 53 093 patients were screened for social needs, representing approximately 21.7% of the patients seen. Almost one-fifth (19.6%) of patients reported at least one unmet social need. The percentage of screened patients varied by both practice location (range 1.6%-81.6%) and specialty within practices. 51.8% of providers (n=1316) screened at least one patient. Conclusions These findings demonstrate both the potential and challenges of integrating social care in practice. We observed significant variability in uptake across the health system. More research is needed to better understand factors driving adoption and may include harmonising workflows, establishing unified targets and using data to drive improvement.
AB - Objectives There has been renewed focus on health systems integrating social care to improve health outcomes with relatively less related research focusing on € real-world' practice. This study describes a health system's experience from 2018 to 2020, following the successful pilot in 2017, to scale social needs screening of patients within a large urban primary care ambulatory network. Setting Academic medical centre with an ambulatory network of 18 primary care practices located in an urban county in New York City (USA). Participants This retrospective, cross-sectional study used electronic health records of 244 764 patients who had a clinical visit between 10 April 2018 and 8 December 2019 across any one of 18 primary care practices. Methods We organised measures using the RE-AIM framework domains of reach and adoption to ascertain the number of patients who were screened and the number of providers who adopted screening and associated documentation, respectively. We used descriptive statistics to summarise factors comparing patients screened versus those not screened, the prevalence of social needs screening and adoption across 18 practices. Results Between April 2018 and December 2019, 53 093 patients were screened for social needs, representing approximately 21.7% of the patients seen. Almost one-fifth (19.6%) of patients reported at least one unmet social need. The percentage of screened patients varied by both practice location (range 1.6%-81.6%) and specialty within practices. 51.8% of providers (n=1316) screened at least one patient. Conclusions These findings demonstrate both the potential and challenges of integrating social care in practice. We observed significant variability in uptake across the health system. More research is needed to better understand factors driving adoption and may include harmonising workflows, establishing unified targets and using data to drive improvement.
KW - community child health
KW - general medicine (see internal medicine)
KW - health services administration & management
KW - primary care
KW - social medicine
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U2 - 10.1136/bmjopen-2021-053633
DO - 10.1136/bmjopen-2021-053633
M3 - Review article
C2 - 34588265
AN - SCOPUS:85116485902
SN - 2044-6055
VL - 11
JO - BMJ Open
JF - BMJ Open
IS - 9
M1 - e053633
ER -