Feasibility of systematic screening for unmet social determinants of health (SDoH) needs and associated resource utilization in ambulatory oncology.

Abstract

6535 Background: Addressing unmet SDoH needs may reduce interruptions to cancer care caused by ED visits and hospitalizations (EDH). We aimed to determine feasibility of systematic screening for unmet patient-reported SDoH needs within a large tertiary academic comprehensive cancer center and association of unmet needs with EDH. Methods: We conducted a cross-sectional analysis of SDoH needs among new oncology patient (pts) consults from 5/15-9/21 at Dana-Farber Cancer Institute (DCFI). Pts completed an intake questionnaire including demographics, disease, and SDoH needs of financial distress, health literacy/numeracy, social isolation on a dichotomous or 5-point Likert scale. We ran bivariate and multivariable models on the association between demographics, SDoH and EDH within 30 days of consult using robust generalized estimating equations controlling for clustering by consult provider. Results: 125,997 unique new consults were seen from 5/15 – 9/21 of which 20,913 completed the intake questionnaire and were alive at 30 days after consult. Respondents were age 40-64 (50%), female (60%), non-Hispanic (84%), White (90%) and English speaking (97%), and 7% had an EDH within 30 days of consult. The most reported SDoH need was limited health numeracy (26%). In bivariate analysis, factors associated with ED visits were: non-English language, lung or GU/GYN cancer, living > 25 mi from DFCI and limited health literacy and numeracy (all p < 0.05). Demographics associated with hospitalizations included: White race and English as a primary language (EPL) (both p < 0.05). Multivariable analysis showed female gender (OR 1.53, p < 0.01), lung (OR 3.22*) and GU/GYN (OR 2.21*) (p < 0.05 for both) cancer, and living > 25 mi from DFCI (OR 2.50, p < 0.0001) were associated with increased likelihood of ED visit while EPL (OR 1.80, p < 0.05) and GU/GYN (OR 1.65, p < 0.01*) cancer were associated with increased likelihood of hospitalization. Conclusions: It is feasible to systematically screen for unmet SDoH which are associated with increased frequency of ED visits. Differences in characteristics associated with ED vs. hospitalization could indicate possible bias or suggest SDoH needs as a reason for avoidance of costly medical care. Further study will expand SDoH screening and measure impact of resource matching to reduce disruptions to cancer care. [Table: see text]

Examining disparities in large‐scale patient‐reported data capture using digital tools among cancer patients at clinical intake

“…Prior studies demonstrate that collecting patient‐reported data can improve health outcomes, reduce adverse events, and expand access to care. 4 , 5 , 6 Specifically, some cancer centers have developed enterprise‐wide 7 , 8 , 9 or clinic‐specific 10 intake forms to collect pertinent patient‐reported data prior to a patient's first visit. Equitable participation in these data collection efforts is essential for ensuring that all patients receive patient‐centered care.…”