A feasibility study of leveraging the electronic health record to measure social determinants of health in patients with gastrointestinal cancer.

Abstract

666 Background: Social determinants of health (SDOH) or circumstances influenced by a patient's neighborhood, social, political, and economic environment are not routinely assessed, and the prevalence and burden of individual SDOH needs among patients with cancer is not well-understood. The primary study aim was to evaluate feasibility of implementation of an electronic health record (EHR) instrument designed to measure SDOH into routine clinical practice. Methods: A prospective study was performed of all adult patients with gastrointestinal malignancy presenting to a regional cancer center for initial evaluation (11/2020-7/2021). An SDOH screening was administered by a nurse navigator or social worker or medical student using the EHR. Primary outcome measures included % eligible patients screened, median clinic visit time compared to historical control, and acceptability to the inter-professional care team. Secondary outcomes included the number of identified SDOH needs per patient and subsequent interventions. Results: Of 118 eligible patients, 113 (95.8%) were successfully screened for SDOH. Nearly half self-identified as Black (40.7%; n = 46) and the remainder White (58.4%; n = 66); 4.4% (n = 5) were uninsured and 17.7% (n = 20) Medicaid-insured. Median visit time was 97 minutes (95%CI 70-107) before implementation and 100 minutes after (95%CI 75-119; p = 0.95). Team members reported no significant clinic disruptions and were supportive of ongoing use. Most patients had 2-3 total needs with 1-2 moderate or 1-2 severe needs. In addition, 21 patients had 4 total needs and 13 patients had 5 or more needs. Most common severe needs included physical activity (n = 62), stress (n = 55), tobacco use (n = 23), and food insecurity (n = 9). Most common moderate needs included social connections (n = 76), tobacco use (n = 44), physical activity (n = 21), and financial strain (n = 12). Resources were offered to 20 patients (17.6%) to address SDOH needs. Conclusions: Routine collection of SDOH in an outpatient oncology setting using an EHR instrument is feasible and non-disruptive to workflow. Further investigation to determine if standardized SDOH assessment can improve cancer care delivery on an individual and population level is ongoing.