352 - Social Determinants of Health Identification in Rural Outpatient Pediatrics

Poster Number: 352
Publication Number: 352.345

Rumbidzai Mutikani, Marshfield Children's Hospital, Marshfield, WI, United States; Samhita Bhattarai, Marshfield Children's Hospital, Marshfield, WI, United States

Background: Social Determinants of Health (SDOH) are factors which can significantly impact access and utilization of health resources, as well as overall child health and development. In recent years, there has been increasing focus on SDOH with hopes of improving health outcomes by addressing these patient needs.

Objective: The goal of this QI project was to better identify and provide resources for patients with needs through system-based interventions and partnership with appropriate social services.

Design/Methods: This project was done in conjunction with the AAP (American Academy of Pediatrics) as part of a yearlong QI project called ASHEW (Addressing Social Health and Early Childhood Wellness). A screening survey to determine social needs was created and provided initially for 4 and 15 month WCV (Well Child visits), and then broadened to WCV for patients aged 0-5 in the outpatient General Pediatric department.  An automatic system of referral was created for positive screens, sending patient information to our community resource partner. Monthly chart reviews (Nf40) were completed for qualifying WCV were reviewed to assess the percentage of screening survey usage and discussion of screening by providers. The number of referrals made to our community resource partner following positive screening was also quantified. Data analysis was performed using the AAP’s QIDA (Quality Improvement Data Aggregator). Data was collected in cycles over a total of 11 months. As an adjunct, determination of family strengths as a measure of resiliency was incorporated into the WCV template.

Results: As the cycles progressed, increasing SDOH screening survey usage was noted (3.23% to 63.16%; Table 1). Documentation of screening survey discussion by providers was as low as 50% in the early cycles, which increased to 100%. Out of the patients screened, 5.7% were positive for SDOH needs. Referrals to the community resource partner for positive screens were nearly 100% throughout the cycles. Documentation of family strengths showed a remarkable increase over the cycles (0% to 100%).Conclusion(s): Implementation of a SDOH screening survey as part of the intake process for Well Child visits resulted in increased identification of need for resources and referral to appropriate services.  Our current project could be expanded to include Well Child visits of all ages to broaden the population impacted. Further evaluation can be considered to determine the direct patient outcome of these efforts, and patient-level experience. Future projects can similarly implement screening tools to target other adverse childhood experiences (ACEs).  
Table 1. SDOH screening over project periodThe percentage of SDOH screenings performed per 1 month cycle over the 11 cycle project period gradually increased. Our data (blue) is compared with that of the other Pediatric clinics participating in this project in Wisconsin (red).