Abstract TP67: Addressing Social Determinants Of Health In An Urban Safety Net Hospital A Quality Improvement Initiative

Abstract

Introduction: Over 10% of stroke survivors have a recurrent stroke, and studies indicate that Black people have a higher risk of stroke recurrence. Social Determinants of Health (SDoH) are associated with a high incidence of stroke, and there is emerging data on recurrence. Grady Memorial Hospital serves this vulnerable urban population at high risk of first and recurrent stroke. We sought to determine the prevalence of SDoH in our clinic population and address these unmet needs to reduce disparities. Methods: We implemented SDoH screening in the stroke clinic by training two medical assistants to fill out the SDoH questionnaire during patient check-in. Screening results were checked by the fellows/attending during the clinic visit. Social worker consultation was sought for unmet social needs. Data was collected in a prospectively maintained stroke clinic registry. Results: There were 131 patients seen between October 2021 and February 2022 in the stroke clinic. Of those, 108 patients (82%) were screened for unmet SDoH needs (financial, transportation, and food insecurity). Of the screened, 81% were black, mean age was 55 years, 51% were male, and 59% were from economically at-risk or distressed communities. The mean duration from stroke onset to clinic visit was 12 months. Fifty-eight of the screened patients had at least one unmet need (54%), 30 had none (28%), and 20 were unknown (19%). Eighty-one percent (47/58) of patients with unmet needs had BP ≥130/80 (Odds ratio 2.47 CI 0.91-6.66, p =0.07). Most patients had financial insecurity (74%), followed by transportation needs (55%) and food insecurity (50%). Of the patients with unmet needs, 59% (n=34/58) reside in economically at-risk or distressed communities. 55% (32/58) of patients received resources to address these needs during the clinic visit. Conclusions: We found a high prevalence of unmet social needs in our stroke population, and the needs persisted for at least a year post-stroke. Screening and addressing unmet social needs should be incorporated as a routine follow-up post-stroke care. Systematic ways of assessing SDoH to address their effects on stroke recurrence and recovery should be done in larger studies.