Abstract
BackgroundConsistent and compelling evidence demonstrates that social and economic adversity has an impact on health outcomes. In response, many health care professional organizations recommend screening patients for experiences of social and economic adversity or social risks—for example, food, housing, and transportation insecurity—in the context of care. Guidance on how health care providers can act on documented social risk data to improve health outcomes is nascent. A strategy recommended by the National Academy of Medicine involves using social risk data to adapt care plans in ways that accommodate patients’ social risks.ObjectiveThis study’s aims are to develop electronic health record (EHR)–based clinical decision support (CDS) tools that suggest social risk–informed care plan adaptations for patients with diabetes or hypertension, assess tool adoption and its impact on selected clinical quality measures in community health centers, and examine perceptions of tool usability and impact on care quality.MethodsA systematic scoping review and several stakeholder activities will be conducted to inform development of the CDS tools. The tools will be pilot-tested to obtain user input, and their content and form will be revised based on this input. A randomized quasi-experimental design will then be used to assess the impact of the revised tools. Eligible clinics will be randomized to a control group or potential intervention group; clinics will be recruited from the potential intervention group in random order until 6 are enrolled in the study. Intervention clinics will have access to the CDS tools in their EHR, will receive minimal implementation support, and will be followed for 18 months to evaluate tool adoption and the impact of tool use on patient blood pressure and glucose control.ResultsThis study was funded in January 2020 by the National Institute on Minority Health and Health Disparities of the National Institutes of Health. Formative activities will take place from April 2020 to July 2021, the CDS tools will be developed between May 2021 and November 2022, the pilot study will be conducted from August 2021 to July 2022, and the main trial will occur from December 2022 to May 2024. Study data will be analyzed, and the results will be disseminated in 2024.ConclusionsPatients’ social risk information must be presented to care teams in a way that facilitates social risk–informed care. To our knowledge, this study is the first to develop and test EHR-embedded CDS tools designed to support the provision of social risk–informed care. The study results will add a needed understanding of how to use social risk data to improve health outcomes and reduce disparities.International Registered Report Identifier (IRRID)PRR1-10.2196/31733
Highlights
BackgroundThe conditions in which people live, work, and play—known as social determinants of health (SDH)—have well-documented impacts on health care access and quality and on health outcomes [1,2,3]
Formative activities will take place from April 2020 to July 2021, the clinical decision support (CDS) tools will be developed between May 2021 and November 2022, the pilot study will be conducted from August 2021 to July 2022, and the main trial will occur from December 2022 to May 2024
This study is the first to develop and test electronic health record (EHR)-embedded CDS tools designed to support the provision of social risk–informed care
Summary
BackgroundThe conditions in which people live, work, and play—known as social determinants of health (SDH)—have well-documented impacts on health care access and quality and on health outcomes [1,2,3]. Given the growing recognition of the impact of SDH on health, many health and health care professional organizations (eg, the American College of Physicians and the National Academy of Medicine) recommend systematically screening for and documenting patients’ experiences of social adversity, including social risk factors related to food, transportation, and housing insecurity, in electronic health records (EHRs) [4,5,6,7,8]. A 2019 National Academies of Sciences, Engineering, and Medicine [9] report on integrating social and medical care describes a range of uses for reported social risk data in clinical settings. A strategy recommended by the National Academy of Medicine involves using social risk data to adapt care plans in ways that accommodate patients’ social risks
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