Resident Documentation of Social Determinants of Health: Effects of a Teaching Tool in the Outpatient Setting

Abstract

Social determinants of health (SDH) significantly affect the health of children and thus, screening is important in pediatric primary care. We assessed the use of a formal social history taking tool after a 2-phase intervention. The first phase (P1) was a teaching module describing SDH and community resources and the second phase (P2) consisted of visual reminders to use the tool. Patient charts (n = 322) were reviewed pre- and postintervention. Residents had higher documentation rates of Women, Infants, and Children (WIC) program use and housing subsidies at post-P1 and at post-P(1 + 2) (WIC, P = .01 and P = .03, respectively; housing, P = .02 and P = .04, respectively), and higher documentation rates of food stamp utilization at post-P(1 + 2) ( P = .04), as compared with baseline. Implementation of a simple teaching tool in the outpatient setting enabled residents to document income benefits and housing. Further studies should be done to evaluate effective teaching methods to elicit other important SDH.

Workforce Models to Screen for and Address Patients’ Unmet Social Needs in the Clinic Setting: A Scoping Review

“…Fifty-eight studies were conducted with primary care patients, [29][30][31][72][73][74]76,[78][79][80][81][82][83][84][85][86][87][88][89] 4 took place in a specialty clinics, 32,71,75,77 1 took place in urgent care, 27 and 3 took place across multiple settings (eg, primary, specialty, and urgent care). 26,28,90 Majority of studies reported including academic sites (n = 40), 29,[34][35][36][37][38][39][41][42][43][44][47][48][49][50][51][52][53][54][55][56][57][58]…”

Evaluating documentation of social history in paediatric medical notes at a regional paediatric centre – a quality improvement initiative

“…The use of various tools as memory aids and to trigger reminder of importance of documenting the paediatric social history as part of a child’s medical record may be helped by the use of standardised tools such as IHELLP (Income, Housing, Education, Legal Status, Literacy, Personal Safety). This tool has been shown to significantly improve documentation of the paediatric social history [ 45 ]. This tool triggers the interviewer to inquire about income supports, housing, education, legal and immigration status, language and personal safety.…”

County socioeconomic characteristics and pediatric renal transplantation outcomes

“…Due to these issues of using geographic measures to predict transplant outcomes, alternative strategies must be considered for evaluating socioeconomic disparities in transplantation. The implementation of systematic screening for social determinants of health (SDH) has been previously described in primary care settings [29, 30], and could be added to reporting requirements for transplant candidate registration. While such screening could provide accurate patient-level SES data, standardized collection of SDH in clinical settings entails its own challenges, including a lack of consensus on best measurements and data collection practices, lack of collaboration between health systems and social services organizations, and technological challenges to capturing and retaining these data [31].…”