A pilot mixed‐methods randomized controlled trial of verbal versus electronic screening for adverse social determinants of health

Abstract

Objectives: Examining the social risks that influence the health of patients accessing emergency care can inform future efforts to improve health outcomes. The optimal modality for screening in the emergency department (ED) has not yet been identified. We conducted a mixed methods evaluation of the impact of screening modality on patient satisfaction with the screening process. Methods:Patients were enrolled at a large urban academic ED and randomized to verbal versus electronic modalities following informed consent. Participants completed a short demographic survey, a brief validated health literacy test, and a social need and risk screening tool. Participants were purposively sampled to complete qualitative interviews balanced across 4 groups defined by health literacy scores (high vs limited) and screening modality. Quantitative outcomes included screening results and satisfaction with the screening process; qualitative questions focused on experience with the screening process, barriers, and facilitators to screening. Results:Of 554 patients assessed, 236 were randomized (115 verbal, 121 electronic).Participants were 23% Hispanic, 6% non-Hispanic Black, 58% non-Hispanic White, 38% publicly insured, and 57% privately insured. Two-thirds (67%) identified social needs and risks and the majority (81%) reported satisfaction with the screening.Screening modality was not associated with satisfaction with screening process after adjustment for language, health literacy, and social risk (adjusted odds ratio, 0.74; 95% confidence interval, 0.32, 1.71). Conclusion:Screening modality was not associated with overall satisfaction with screening process. Future strategies can consider the advantage of multimodal screening options, including the use of electronic tools to streamline screening and expand scalability and sustainability.

In-person versus electronic screening for social risks among carers of pediatric inpatients: A mixed methods randomized trial

“…To power a trial to detect 4% difference in disclosure would require > 1200 participants (alpha 5%, power 80%). Similarly, our qualitative findings about the acceptability of screening are consistent with other US-based studies involving screening [ 19 , 20 ]. It is difficult to compare the current findings with European and UK contexts, as those studies commonly occur in primary care where populations, screening and referral workflows differ to inpatient settings.…”

Screening tools to address social determinants of health in the United States: A systematic review

“…Six screening tools were administered to pediatric patients [ 27 , 29 – 31 , 37 , 47 ]. One was designed to assess pregnant patients [ 34 ], and the remaining tools ( n = 18) were utilized for general screening purposes in clinical settings, such as hospitals or clinical offices [ 13 , 25 , 26 , 28 , 32 , 33 , 35 , 36 , 38 – 46 , 48 – 53 ] Six tools were administered by healthcare professionals [ 13 , 25 , 30 , 32 , 46 , 49 ]; while 12 tools were completed by patients (or parents) either electronically or on paper [ 13 , 28 , 29 , 34 , 36 , 37 , 44 , 45 , 47 , 48 , 50 , 52 ]; six tools were administered verbally or were self-administered at the patient’s request [ 26 , 27 , 31 , 33 , 35 , 53 ]; The number of questions in any given SDoH assessment tool varied considerably and ranged from 5 in Health Leads (2018) and the North Carolina toolkit [ 36 ], as well as the Core 5 social risk tool [ 28 ] to 50 in the health system’s EPIC electronic health records screening tool [ 33 ]; overall, the mean number of questions in any given SDoH screening tool assessment was 16.6 (Table 2 ).…”

“…Six screening tools were administered to pediatric patients [27,[29][30][31]37,47]. One was designed to assess pregnant patients [34], and the remaining tools (n = 18) were utilized for general screening purposes in clinical settings, such as hospitals or clinical offices [13,25,26,28,32,33,35,36,[38][39][40][41][42][43][44][45][46][48][49][50][51][52][53] Six tools were administered by healthcare professionals [13,25,30,32,46,49]; while 12 tools were completed by patients (or parents) either electronically or on paper [13,28,29,34,36,37,44,45,47,48,50,52]; six tools were administered verbally or...…”

A family-centered approach to social needs awareness in the pediatric emergency department

“…In-person HRSN screening and referral faces multiple challenges, including funding/sustainability; staff availability, training, and bias; and universal application, making digital modalities an attractive, light touch option [ 25 ]. Pediatric and adult studies have demonstrated similar or even greater patient/family HRSN disclosure, acceptability, and comfort with tablet-based screening compared to that of face-to-face, likely due to perceived screening anonymity [ 5 , 6 , 13 , 26 ]. There is currently no clear recommendation for screening and referral modality, although in general, social risk screening itself has been shown to be widely acceptable by patients/families [ 13 , [26] , [27] , [28] , [29] ].…”

“…Pediatric and adult studies have demonstrated similar or even greater patient/family HRSN disclosure, acceptability, and comfort with tablet-based screening compared to that of face-to-face, likely due to perceived screening anonymity [ 5 , 6 , 13 , 26 ]. There is currently no clear recommendation for screening and referral modality, although in general, social risk screening itself has been shown to be widely acceptable by patients/families [ 13 , [26] , [27] , [28] , [29] ]. While our study demonstrated family preference for digital means of reporting and receiving HRSN information, it is important from a health equity standpoint to include alternative written means for those who may not have access to a smartphone or computer.…”