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Abstract
Background Social determinants of health (SDOH) significantly impact health and quality of life, with physical environment and socioeconomic circumstances accounting for 80% of factors affecting health. SDOH are an underlying cause of today’s health crises including obesity, heart disease, diabetes, and depression. Addressing inequities requires a reliable way of identifying them. This is difficult in a large enterprise spanning inpatient, specialty, and ambulatory care. This pediatric service line coordinated efforts across 11 unique teams to initiate SDOH screening.
Objectives The objectives developed and matured over 3 years, expanding from only a few divisions testing only the screening process to many divisions, more SDOH domains, and a bundled goal of screening with interventions (table 1). The goal is for 80% of target population encounters to be appropriately screened AND each for positive screen to successfully receive appropriate resource referral or intervention with EMR documentation. This will be achieved and maintained for at least 3 consecutive months (6 months in the second year) by October 31, 2023.
Methods The Model for Improvement and rapid cycle PDSAs provided the framework, including aim, measures, and Key Driver Diagram (figure 1). PDSA cycles sought the best fit for the environment being targeted, given each of the 11 divisions has a unique set of care team members and physical plant. Run charts evaluated performance and intervention effectiveness.
Results The teams improved from virtually zero screenings performed to 82% of patient visits meeting criteria of a screen with appropriate intervention at each visit or within 12 months prior (figure 2). Preliminary analysis demonstrates 41% of patients since April 2022 who had at least one positive screen responded most recently that this is no longer true.
Conclusions Many families have been helped with community resources who were unknown prior to this initiative (figure 3). This highly spreadable work helps build a more equitable, inclusive healthcare landscape.
Divisions and domains
Key driver diagram
SDOH screening data-bundle compliance October 2020 through March 2023
Flow map
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