June 21, 2019

As Social Determinant of Health Screening Gains National Attention, Implementation May Require Local Discretion

A new paper finds that factors affecting SDOH screening use vary by clinic, suggesting that local clinicians merit say-so in implementation.

THE BOTTOM LINE  |  It’s a positive development that more organizations are taking interest in standardized, EHR-based social determinants of health (SDOH) screening. However, this research suggests that tailored approaches may be most successful due to their ability to address the unique workflows and differing patient needs and attitudes that local care teams face.

CONTEXT   |  Screening for SDOH has garnered increased attention from providers and policymakers, as evidence of the health impact of SDOH mounts. Organizations such as the American Academy of Pediatrics have published guidelines supporting SDOH screening, and the federal government has funded a pilot program to test comprehensive screening and innovative service-delivery models for social needs such as unstable housing and food insecurity. However, efforts to scale SDOH screening have been challenged by the lack of standardization in screening tools and the complexities of individual care settings.

STUDY OBJECTIVE  |  Understand the current state of SDOH screening and assess which factors, if any, better equip clinicians for carrying out SDOH screening and referrals.

THE DETAILS  |  Researchers surveyed 15 community health centers (CHCs) in Boston on their use of SDOH screenings, the domains they screened for, how and when they delivered the screenings, and the factors that clinicians perceived to facilitate or impede the use of social needs screenings. Additionally, researchers conducted focus groups with three clinics that used a specific protocol, the WE CARE screener.

FINDINGS  |  As a whole, SDOH screenings and referrals were broadly adopted across the clinics involved in this study, but there wasn’t uniformity in screening domains. Different CHCs screened for as few as five or as many as 16 SDOH domains. In addition, no one factor — such as having patient navigators or experiencing time constraints — was found to make screenings and referrals easier or more difficult across the board. Instead, the barriers and facilitators to implementation tended to vary from site to site.

PULL QUOTE  “With increasing focus on SDOH screening and referral interventions, it is critically important to establish implementation best practices.”

Source. Byhoff E, et al. (2019). Provider and Staff Feedback on Screening for Social and Behavioral Determinants of Health for Pediatric PatientsThe Journal of the American Board of Family Medicine.

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