Health Care Professionals' Perspectives on Universal Screening of Social Determinants of Health: A Mixed-Methods Study

Kostelanetz, Sophia; Pettapiece-Phillips, Mariah; Weems, Jacy; Spalding, Tamarra; Roumie, Christianne L.; Wilkins, Consuelo H.; Kripalani, Sunil

doi:10.1089/pop.2021.0176

Cited by 45 publications

(58 citation statements)

References 19 publications

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“…The positive association between physician perspective and ED organization among this study's population also likely reflects integration of social care at multiple levels, including into a value‐based ED mission statement, logistically into ED throughput, and operationally into ED workforce training and community partner networking. While multiple studies have documented patient and family preference for electronic, self‐administered screening, 20,31,32 providers including physicians, nurses, social workers, case managers, and administrators share favorable views of systematic universal screening and referral platforms incorporated into clinical workflow 6,13,16,33,34 . As ED social care process models continue to be developed nationally and are assessed for feasibility and sustainability, we argue that physician perspective, and likely that of other providers including nurses and social workers, is an important measure for success 3,11–13,35 …”

Section: Discussionmentioning

confidence: 95%

“…While multiple studies have documented patient and family preference for electronic, self-administered screening, 20,31,32 providers including physicians, nurses, social workers, case managers, and administrators share favorable views of systematic universal screening and referral platforms incorporated into clinical workflow. 6,13,16,33,34 As ED social care process models continue to be developed nationally and are assessed for feasibility and sustainability, we argue that physician perspective, and likely that of other providers including nurses and social workers, is an important measure for success.…”

Section: Discussionmentioning

confidence: 99%

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Pediatric emergency department organization and social care practices among U.S. fellowship programs

Assaf¹,

Doucet

Graff

2022

AEM Education and Training

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Background: Social care has become increasingly relevant to the emergency physician and includes activities that address health-related social risk and social needs. The literature has consistently documented substantial health care provider challenges in incorporating social care into routine practice. Yet, interventions on the health care organizational level hold promise to bring about more widespread, sustainable impact. Methods: This study was a subanalysis of the 2021 National Social Care Practices Survey data set among pediatric emergency medicine (PEM) program directors (PDs) and fellows. The purpose was to investigate the association between health care organizational factors and PEM physician social care practices and perceptions among PEM PDs and fellows. We performed binary and ordinal logistic regressions of organizational factors and five specific PEM physician social care perspective and practice outcomes. Results:The sample population included 153 physicians-44 PDs (49% response rate) and 109 fellows (28%). PDs and fellows with access to a social care systematic workflow in their pediatric emergency department (PED) had higher odds of comfort assessing social risk (odds ratio [OR] 2.1%, 95% confidence interval [CI] 1.1-4.0), valuation of social care (OR 3.2, 95% CI 1.3-7.9), preparedness to assist families (OR 2.4, 95% CI 1.1-5.2), screening tendency (OR 2.2, 95% CI 1.1-4.5), and ability to refer to community resources (OR 2.3, 95% CI 1.2-4.6). A similarly directed, but less pronounced pattern was noted with access to a community resource database for referrals and 24-h access to a social worker in the PED.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Pediatric emergency department organization and social care practices among U.S. fellowship programs

Assaf¹,

Doucet

Graff

2022

AEM Education and Training

View full text Add to dashboard Cite

show abstract

“…and general pediatric faculty and trainee physicians alike. 7,14,15,[25][26][27][28][29][36][37][38][39][40] Institution name was not collected to protect respondent pri-…”

Section: Discussionmentioning

confidence: 99%

“…Generalizability of our geographically and demographically diverse national sample (Table 1) to the larger population is supported by a consistency across numerous contemporary studies demonstrating similar findings of a perceived high value, low preparedness in social care among emergency medicine. and general pediatric faculty and trainee physicians alike 7,14,15,25‐29,36‐40 …”

Section: Limitationsmentioning

confidence: 99%

Social care practices and perspectives among U.S. pediatric emergency medicine fellowship programs

Barber‐Doucet

Assaf²,

Graff

2022

AEM Education and Training

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Background The emergence of social emergency medicine—the incorporation of social context into the structure and practice of emergency care—has brought forth greater embracement of the social determinants of health by medical professionals, yet workforce practices and training have remained elusive. Academic literature particularly in the field of pediatric emergency medicine (PEM) fellowship training is lacking relative to general pediatrics and adult emergency medicine. Methods The primary objective of this study was to assess the social care knowledge, perspectives, and training of PEM program directors (PDs) and fellows across a national cross‐sectional sample. A secondary aim was to uncover key actionable areas for the development of social care curricula in PEM training programs. A social care practices assessment tool was developed via snowball sampling interviews among clinician researcher experts and disseminated to PEM PDs and fellows nationally in accredited academic PEM training institutions. Results A total of 153 participants—44 PDs (49% response rate) and 109 fellows (28%)—completed the assessment tool. Responses among PDs and fellows were highly concordant. Only 12% reported regular use of a standardized social needs screening tool. The majority felt unprepared to assist families with social needs and less than half felt comfortable talking to families about social need. At the same time, social care was highly valued by 73% of participants. All participants felt that providing social care training during PEM fellowship would be beneficial. PDs and fellows identified five priority areas for PEM curricular development. Conclusions PEM PDs and fellows have an overall favorable perception of social care yet report significant deficits in current practice organization and training. This study is part of a larger national collaborative advocacy project to organize and advance social care delivery across academic PEM training institutions through evidence‐based approaches, best practices, and expert consensus.

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“…However, until guidelines were updated in 2019, obscurity regarding who could utilize these codes led to infrequent application in healthcare settings. In addition, the overwhelming volume of medical codes, the potential lack of provider knowledge of SDoH, limited time with patients, and confusion around appropriate referrals serve to further inhibit standard use (17,18). Given these barriers, health service administrators and support organizations, such as the American Hospital Association, have worked to promote the use of Z codes to improve individual patient health outcomes and guide intervention at the community and population levels (19).…”

Section: Introductionmentioning

confidence: 99%

Examining Social Determinants of Health During a Pandemic: Clinical Application of Z Codes Before and During COVID-19

Yang

Yelton

Chen

et al. 2022

Front. Public Health

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Recognition of the impact of social determinants of health (SDoH) on healthcare outcomes, healthcare service utilization, and population health has prompted a global shift in focus to patient social needs and lived experiences in assessment and treatment. The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) provides a list of non-billable “Z codes” specific to SDoH for use in electronic health records. Using population-level analysis, this study aims to examine clinical application of Z codes in South Carolina before and during the COVID-19 pandemic. The study population consists of South Carolina residents who had a healthcare visit and had their COVID-19 test result reported to the state's Department of Health and Environmental Control before January 14, 2021. Of the 1,190,531 individuals in the overall sample, Z codes were used only for 14,665 (1.23%) of the patients, including 2,536 (0.97%) COVID-positive patients and 12,129 (1.30%) COVID-negative patients. Compared with hospitals that did not use Z codes, those that did were significantly more likely to have higher bed capacity (p = 0.017) and to be teaching hospitals (p = 0.03), although this was significant only among COVID-19 positive individuals. Those at inpatient visits were most likely to receive Z codes (OR: 5.26; 95% CI: 5.14, 5.38; p < 0.0001) compared to those at outpatient visits (OR: 0.07; 95%CI: 0.06, 0.07; p < 0.0001). There was a slight increase of Z code use from 2019 to 2020 (OR: 1.33, 95% CI: 1.30, 1.36; p < 0.0001), which was still significant when stratified by facility type across time. As one of the first studies to examine Z code use among a large patient population, findings clearly indicate underutilization by providers. Additional study is needed to understand the potentially long-lasting health effects related to SDoH among underserved populations.

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Health Care Professionals' Perspectives on Universal Screening of Social Determinants of Health: A Mixed-Methods Study

Cited by 45 publications

References 19 publications

Pediatric emergency department organization and social care practices among U.S. fellowship programs

Pediatric emergency department organization and social care practices among U.S. fellowship programs

Social care practices and perspectives among U.S. pediatric emergency medicine fellowship programs

Examining Social Determinants of Health During a Pandemic: Clinical Application of Z Codes Before and During COVID-19

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