355 - Emergency Department Social Care Practices Survey and Toolkit: an Explanatory Sequential Mixed Methods Approach

Poster Number: 355
Publication Number: 355.313

Raymen R. Assaf, Harbor UCLA Medical Center, La Crescenta, CA, United States; Hannah Barber Doucet, Hasbro Children's Hospital at Rhode Island Hospital, Providence, RI, United States; Ryan D. Assaf, Fielding School of Public Health, UCLA, Los Angeles, CA, United States; Danielle Graff, University of Louisville School of Medicine, Louisville, KY, United States

Background: The emergence of social emergency medicine – incorporation of social context into the structure and practice of emergency care – has reaffirmed the relevance of social determinants of health (SDH) in medicine, yet workforce organization and training around social care remain elusive.

Objective: To assess the social care knowledge, perspectives, and training of PEM program directors (PDs) and fellows in a national cross-sectional sample. To develop a social care training toolkit for PEM training programs.

Design/Methods: An explanatory mixed methods approach was used in which foundational quantitative data informed the qualitative. In the first (quantitative) phase, a social care practices assessment tool was developed via snowball sampling interviews among 17 clinician-researcher experts and disseminated to PEM PDs and fellows nationally. Data was analyzed descriptively and under two threads: ED organizational structure and SDH training. In the second (qualitative) phase, a diverse national task force of experts systematically curated relevant documents and participate in Delphi rounds to develop an evidence-based and consensus-backed social care training toolkit.

Results: A total of 153 participants – 44 PDs (49% response) and 109 fellows (28%) – completed the assessment tool. PD and fellow responses were highly concordant. Social care was highly valued by 73% of participants. All felt providing social care training during PEM fellowship would be beneficial. Those working in EDs with a social care systematic workflow had higher odds of comfort with [OR 2.87 (95% CI: 1.24, 6.65)] and value of social care [OR 3.06 (95% CI: 1.07, 8.79)] compared to those without organizational level support. Likewise, they had higher odds of screening for social needs [OR 1.84 (95% CI: 0.93, 3.66)] and for making community referrals [OR 2.84 (95% CI: 1.45, 5.56)]. The majority of both fellows (80%) and PDs (70%) felt unprepared to assist families with social needs, despite markedly different rates of prior training in SDH (fellows 82% vs PDs 52%, p < 0.001) and screening/referral technique (fellows 46% vs PDs 7%, p < 0.001). PDs and fellows identified five priority areas for social care toolkit development by the national task force.Conclusion(s): PEM PDs and fellows have an overall favorable perception of social care yet report significant deficits in current practice organization and training. This study is part of a larger national collaborative advocacy project to organize and advance social care delivery across academic PEM training institutions through evidence-based approaches, best practices, and expert consensus.
R.Assaf CVR.Assaf_CV Dec 2021.pdf
Table 2. Social care perspectives and organizational level factors, PEM Fellows and Program Directors