Initiating and Implementing Social Determinants of Health Data Collection in Community Health Centers

Abstract

Successfully incorporating social determinants of health (SDH) screening into clinic workflows can help care teams provide targeted care, appropriate referrals, and other interventions to address patients' social risk factors. However, integrating SDH screening into clinical routines is known to be challenging. To achieve widespread adoption of SDH screening, we need to better understand the factors that can facilitate or hinder implementation of effective, sustainable SDH processes. The authors interviewed 43 health care staff and professionals at 8 safety net community health center (CHC) organizations in 5 states across the United States; these CHCs had adopted electronic health record (EHR)-based SDH screening without any external implementation support. Interviewees included staff in administrative, quality improvement, informatics, front desk, and clinical roles (providers, nurses, behavioral health staff), and community health workers. Interviews focused on how each organization integrated EHR-based SDH screening into clinic workflows, and factors that affected adoption of this practice change. Factors that facilitated effective integration of EHR-based SDH screening were: (1) external incentives and motivators that prompted introduction of this screening (eg, grant requirements, encouragement from professional associations);(2) presence of an SDH screening advocate; and (3) maintaining flexibility with regard to workflow approaches to optimally align them with clinic needs, interests, and resources. Results suggest that it is possible to purposefully create an environment conducive to successfully implementing EHR-based SDH screening. Approaching the task of implementing SDH screening into clinic workflows as understanding the interplay of context-dependent factors, rather than following a step-by-step process, may be critical to success in primary care settings.

Addressing Social Determinants of Health Identified by Systematic Screening in a Medicaid Accountable Care Organization: A Qualitative Study

“…Participants noted the importance of having leadership support for this work, which has previously been identified as a facilitator of successful SDOH screening in community health centers. 26 Additionally, resource staff described how a trusting relationship with patients facilitated their ability to address social needs. A qualitative study of patients receiving assistance for SDOH from volunteers reported that the connection with the staff helped them to feel heard and supported.…”

Community Health Centers’ Performance in Cancer Screening and Prevention

“…25 CHC patients in particular face many adverse social determinants that impede their ability to seek needed preventive care, thus impacting clinical performance. Although CHCs screen for social needs more than non-CHC practices, 26 many barriers (e.g., inadequate reimbursement, resources) 27,28 to successful implementation and sustainability of social needs screening/referral exist. Health policies focusing on adequate reimbursement for screening and referral and financial assistance for staff training and resources are critical for sustaining this service.…”

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

“…Organizational readiness for social needs screening, including wide‐scale training of interprofessional teams, utilization of training modules, and strategic workflow design have been advocated as a more durable, pragmatic, and ethically sound approach to ED‐based social care 33‐35 . However, even a “perfect” social care system in the ED may fail at times, and most pediatric EDs remain without an integrated social care system as evidenced by our study.…”

“…[30][31][32][33] A crucial step in that evolution is as a more durable, pragmatic, and ethically sound approach to EDbased social care. [33][34][35] However, even a "perfect" social care system in the ED may fail at times, and most pediatric EDs remain without an integrated social care system as evidenced by our study. Although fellows were more likely to have received formal training in SDH or social needs screening and referral compared to PDs, both groups expressed very similar rates of low comfort with and high value of social care practice.…”