Text

theses

ETD doctoral

Introduction: Social determinants of health (SDOH) are the complex circumstances in which individuals are born and live that affects their health. Despite growing emphasis on the impact of SDOH on health outcomes, identification of patients’ social needs remains sporadic.

Purpose: The purpose of this project was to conduct a gap analysis between current primary care practices of screening for SDOH and evidence-based recommendations, and to develop a toolkit to addresses specific identified challenges.

Method: This was a quality improvement project. Plan-do-study-act cycles were used as a theoretical framework. All primary care providers (physicians, physician assistants, and nurse practitioners) at a large medical center were invited to participate via e-mail. Participants completed a 12-item survey assessing current screening and referral practices for the following SDOH: housing, financial problems and employment, food insecurity, social support, exposure to crime and violence, and access to transportation. An analysis was performed to identify specific gaps in the SDOH screening and referral process.

Results and Discussion: Ten providers completed the survey. The results of the survey demonstrated inconsistencies and unsatisfactory rates of screening for SDOH. Only 50% of providers routinely screened patients for financial problems and housing, 30% routinely screened for access to transportation, and only 10% of providers regularly screened for exposure to crime and violence. Most providers were unaware of local resources to which screened patients can be immediately referred. Based on the identified gaps in practice, a toolkit was developed that included recommended screening tools, algorithms for implementing screening and referral, and a list of available local community resources that address specific SDOH.

Implications for Practice: This study supports the body of literature substantiating the need for routine screening of SDOH in primary care by demonstrating that without standardized practice, screening for select SDOH is as low as 10%. Future scholarship can assess the efficacy of standardized screening practices by assessing the number of patients with social needs identified, rates of referrals to community resources, and rates of resolved social needs. Future research can focus also on the effect of screening on clinically important outcomes, such as decreased morbidity and mortality from chronic diseases and their acute complications.

ETD_11500

doi:10.7282/t3-j75s-nw20

DNP

Includes bibliographical references

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