Lessons Learned: Social Determinants of Health Screening Pilot in 2 Urology Clinics

Abstract

Introduction: Unmet social needs lead to adverse health outcomes and contribute to health inequities. Efforts to screen for social determinants of health (SDOH) have occurred primarily within primary care. Here, we describe the feasibility of implementing a workflow for SDOH screening within 2 urology clinics in Charlotte, North Carolina. Methods: Our pilot was adapted from the WE CARE Model, which integrates a referral to community resources for patients identified with social needs and an optional followup with a navigator for additional assistance. Patients were screened with the validated Healthy Opportunities SDOH tool to assess food, housing, utilities, transportation and physical safety needs; 40 patients were screened at 2 urology clinics, totaling 80 patients. Surveys were sent to 16 clinicians and staff who participated in the pilot to assess feasibility of implementation.Results: In all, 24/80 patients (30%) were screened for 1 or more social needs, with food and housing being the most frequent; 20/24 patients with social need (83%) successfully received a community resource guide, and 13 of those patients also requested a referral. All survey respondents either agreed or strongly agreed that screening was valuable and allowed them to better understand the needs of their patients. They also felt that understanding SDOH aligns with departmental goals and mission.Conclusions: Our results suggest that SDOH screening within a urological setting is feasible, and dedicated support staff should be available to ensure adequate followup for patients with unmet needs. Future work is needed to expand resources for patients and optimize workflow for clinicians.

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 ).…”

“…Health Begins [ 49 ], Help Steps surveys [ 47 ]. Tools such as Accountable Health Communities Health-Related Social Needs (AHC HRSN) [ 27 ], Welcome, Engage, Communicate, Ask, Reassure, Exit (WE CARE) [ 26 ], Social Determinants of Health in Pregnancy Tool (SIPT) [ 34 ], Core 5 social risk screening [ 28 ], Accountable Health Communities (modified) [ 29 ], North Carolina [ 51 ], and Bright Future [ 52 ] examined 5 domains of SDoH (26.3%). Four screening tools (16%) evaluated at least 10 (52.6%) different SDoH domains (Well Rx [ 50 ], NLP [ 13 ], IHELP [ 45 ], MASQ [ 44 ]), while the remaining screening tools ( n = 21, 84%) evaluated fewer SDoH domains (Table 3 ).…”

“…Twelve screening tools identified patient preferences toward receiving supplementary assistance relative to the SDoH identified. If the response was affirmative, referral to relevant social workers was made based on the positive domain that had been identified on screening [ 13 , 26 – 28 , 30 , 32 – 34 , 36 , 37 , 39 , 50 ]. Interestingly, three separate studies proposed interventions grounded in sports [ 38 ], sleep health [ 40 ], and developing a national agenda aimed at homelessness and homeless individuals to address SDoH [ 43 ].…”

“…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...…”

“…Of note, 18 studies not only screened SDoH but also proposed specific interventions aimed at addressing SDoH (Supplemental Table 1) [13,[26][27][28]30,[32][33][34][36][37][38][39][40][41][42][43]47,50]. Twelve screening tools identified patient preferences toward receiving supplementary assistance relative to the SDoH identified.…”