Abstract 12554: A Quality Improvement Program to Promote Assessment of Social Determinants of Health among Patients in an Urban Community Clinic

Abstract

Introduction: Social determinants of health (SDoH) have been linked to poorer health outcomes and health disparities among patients (pts) with heart failure (HF). Attainment rates of selected SDoH indicators vary depending on the pt care environment. We sought to assess whether there are challenges in collecting SDoH indicators in an urban community clinic through a Plan-Do-Study-Act (PDSA) method of quality improvement (QI) using a physician-medical assistant team (PMAT). Methods: Using PDSA QI methodology, a trained PMAT tested use of an EHR-based survey to measure and record selected SDoH at each pt-visit over a span of four weeks. The survey includes questions about financial resource strain, housing stability, transportation needs, food insecurity and alcohol use. The target for improvement was input of SDoH indicators for 90% of consecutive patient visits. Successful completion of the survey required recording of responses for all SDoH measures. Results: Prior to the PDSA, SDoH indicators were collected in 51% of the pts seen between Jan 2019 and Dec 2020. Between April 26 and May 21, 2021, 114 pts were seen by the PMAT, with the SDoH indicators recorded in 88% of the pt-visits (n=101). Weekly rates ranged from 76.9%-100% (Week 1, 30/30 pts (100%); Week 2, 24/29 pts (82.7%); Week 3, 27/29 pts (93.1%); and Week 4, 20/26 pts (76.9%). Conclusion: The PMAT successfully increased measurement and recording of SDoH factors, although the target goal for improvement was not completely met 2 of the 4 weeks. Personnel substitutions and variable approaches to accessing the survey tool in the EHR resulted in smaller rates of improvement. Nonetheless the PDSA demonstrated the feasibility of increasing SDoH measurement. Expansion of the QI program will focus on clinic-wide staff training, standardization of SDoH assessment tool access in the EHR, and linking patients to resources with demonstrated social and economic needs identified by the SDoH survey tool.