Screening For Social Determinants Of Health Research Articles

Food Insecurity Prevalence and Risk Factors at a Large Academic Medical Center in Michigan

Health care systems are increasingly adopting methods to screen for and integrate food insecurity and other social risk factors into electronic health records. However, there remain knowledge gaps regarding the cumulative burden of food insecurity in large clinical settings, which patients are most at risk, and the extent to which patients are interested in social assistance through their health care system. To evaluate the 5-year prevalence and associated risk factors of food insecurity among adult primary care patients, and to examine factors associated with patients' interest in social assistance among those with food insecurity. This cross-sectional analysis of a retrospective cohort study took place at a tertiary care academic medical center (encompassing 20 primary care clinics) in Michigan. Participants included adult patients who completed screening for social risk factors between August 1, 2017, and August 1, 2022. Data analysis was performed from November 2022 to June 2023. Food insecurity was assessed using the Hunger Vital Sign. The primary outcome was patients' interest in social assistance, and associated factors were examined using multivariate logistic regression models, adjusting for patients' demographic and health characteristics. Over the 5-year period, 106 087 adult primary care patients (mean [SD] age, 52.9 [17.9] years; 61 343 women [57.8%]) completed the standardized social risk factors questionnaire and were included in the analysis. The overall prevalence of food insecurity was 4.2% (4498 patients), with monthly trends ranging from 1.5% (70 positive screens) in August 2018 to 5.0% (193 positive screens) in June 2022. Food insecurity was significantly higher among patients who were younger, female, non-Hispanic Black or Hispanic, unmarried or unpartnered, and with public health insurance. Food insecurity was significantly associated with a higher cumulative burden of social needs, including social isolation, medical care insecurity, medication nonadherence, housing instability, and lack of transportation. Only 20.6% of patients with food insecurity (927 patients) expressed interest in social assistance. Factors associated with interest in social assistance including being non-Hispanic Black, unmarried or unpartnered, a current smoker, and having a higher burden of other social needs. In this retrospective cohort study, the overall prevalence of food insecurity was 4.2%, of whom approximately 1 in 5 patients with food insecurity expressed interest in assistance. This study highlights ongoing challenges in ensuring all patients complete routine social determinants of health screening and gaps in patients' interest in assistance for food insecurity and other social needs through their health care system.

Abstract 2230: Connecting Black men to point of prostate cancer diagnosis (PPCD) support using precision intervention based on Virtual Reality Assistant (ViRA)

Abstract Background: The point of prostate cancer (CaP) diagnosis (PPCD) instantly leads to a life changing experience for Black men, with diverse emotional reactions that includes fear, denial, overwhelmingness, cancer fatalism etc. Black men diagnosed with CaP expressed several needs at the PPCD, including time to reflect on the diagnosis, being comfortable, emotional support, psycho-oncology support and social determinants of health (SDOH) navigation. Given that Black men are diverse in terms of their needs at the PPCD, precision intervention is needed to support them. Aim: The aim was to develop, implement, and establish the acceptance and usability of a Virtual Reality Assistant (ViRA) that will provide precision intervention tailored to the needs of Black men at the PPCD. This study is one of the five iCCaRE for Black Men projects focused on survivorship care. Methodology: The development of the ViRA was guided by CaP survivors through qualitative study. Reflective, analytic, and interpretive memos were used to generate action plans for the development of the ViRA. Based on a comprehensive PPCD ViRA intervention guide created by the team, the ViRA prototype was developed with mobile immersive technologies that integrated SDOH navigation, standard CaP psycho-oncology support and emotional support. The goal was to have the intervention personalized to everyone based on participant-provided information. Alpha testing of the ViRA is ongoing and will be completed on November 20, 2023. Participants are three prostate cancer survivors and three clinicians. The assessments will confirm the accuracy of the ViRA predictions and the functionality of the ViRA. Results: We developed the ViRA SDOH screening and navigation tool to identify participants’ needs and appropriately connect them with relevant support services and resources in their communities. The emotional support intervention was based on four CaP survivors as virtual reality avatars, providing empathetic rapport through self-disclosure and sharing of survivorship stories in different settings (home, clinic, barbershop etc). The psycho-oncology support intervention was developed with the guidance of a psycho-oncologist, with her avatar providing psychoeducation about the PPCD experience, reify and concretize the PPCD experience, and foster hope using the basic tenets of Problem-Solving Therapy. The results of the alpha testing and the modified ViRA will be presented during the conference. Conclusion: Meeting the needs of Black men at the PPCD requires a personalized and decentralized approach, which would allow Black men to access support anywhere. The presentation will unveil the iCCaRE ViRA, a smart and connected personalized AR-enabled intervention that will deliver SDOH navigation, CaP psycho-oncology support and emotional support tailored to the needs of Black men. Citation Format: Folakemi T. Odedina, Che Ngufor, Arnold Merriweather, Deidre Pereira, Roxana Dronca, Ernest Kaninjing, Kimlin Ashing, Solomon Rotimi, Vinessa Gordon, iCCaRE for Black Men Consortium. Connecting Black men to point of prostate cancer diagnosis (PPCD) support using precision intervention based on Virtual Reality Assistant (ViRA) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2230.

Social Determinants of Health Screening: Primary Care PRAPARE Tool Implementation

Social determinants of health (SDOH) substantially impact health. Evidence-based SDOH screening was implemented in a small urban primary care practice. This quality improvement project aimed to increase SDOH screening from 0% to 50%. The Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE) tool is a validated SDOH screener administered by a community health care worker during annual physical examinations over 12 weeks. PRAPARE was administered to 81 of 85 patients (95.3%), and 8 (9.9%) screened positive. Benchmarks were surpassed for SDOH screening and resulted in referrals to community resources. Research should use community health care workers as care extenders and test SDOH screening to identify needs toward improved health.

Bundling Colorectal Cancer Screening Outreach with Screening for Social Risk in Federally Qualified Health Centers: A Stepped-Wedge Implementation-Effectiveness Study

Abstract Background Bundling is combining individual interventions to meet quality metrics. Bundling offers of cancer screening with screening for social determinants of health (SDOH) may enable health centers to assist patients with social risks and yield efficiencies. Objective To measure effects of bundling fecal immunochemical testing (FIT) and SDOH screening in federally qualified health centers (FQHCs). Design Clustered stepped-wedge trial. Participants Four Massachusetts FQHCs randomized to implement bundled FIT-SDOH over 8-week “steps.” Intervention Outreach to 50–75-year-olds overdue for CRC screening to offer FIT with SDOH screening. The implementation strategy used facilitation and training for data monitoring and reporting. Main Measures Implementation process descriptions, data from facilitation meetings, and CRC and SDOH screening rates. Rates were compared between implementation and control FQHCs in each “step” by fitting generalized linear mixed-effects models with random intercepts for FQHCs, patients, and “step” by FQHC. Key Results FQHCs tailored implementation processes to their infrastructure, workflows, and staffing and prioritized different groups for outreach. Two FQHCs used population health outreach, and two integrated FIT-SDOH within established programs, such as pre-visit planning. Of 34,588 patients overdue for CRC screening, 54% were female; 20% Black, 11% Latino, 10% Asian, and 47% white; 32% had Medicaid, 16% Medicare, 32% private insurance, and 11% uninsured. Odds of CRC screening completion in implementation “steps” compared to controls were higher overall and among groups prioritized for outreach (overall: adjusted odds ratio (aOR) 2.41, p = 0.005; prioritized: aOR 2.88, p = 0.002). Odds of SDOH screening did not differ across “steps.” Conclusions As healthcare systems are required to conduct more screenings, it is notable that outreach for a long-standing cancer screening requirement increased screening, even when bundled with a newer screening requirement. This outreach was feasible in a real-world safety-net clinical population and may conserve resources, especially compared to more complex or intensive outreach strategies. Clinical Trials Registration NCT04585919

Maternal neighbourhood-level social determinants of health and their association with paediatric hepatitis C screening among children exposed to hepatitis C in pregnancy.

Current guidelines recommend HCV screening by 18 months of age for those exposed to HCV in utero; yet, screening occurs in the minority of children. To evaluate the association between maternal neighbourhood-level social determinants of health (SDOH) and paediatric HCV screening in the general population in a publicly funded healthcare system in Canada. Retrospective cohort study using administrative healthcare data held at ICES. Children born to individuals positive for HCV RNA in pregnancy from 2000 to 2016 were identified and followed for 2 years. Major SDOH were identified, and the primary outcome was HCV screening in exposed children (HCV antibody and/or RNA). Associations between SDOH and HCV screening were determined using multivariate Poisson regression models adjusting for confounding. A total of 1780 children born to persons with +HCV RNA were identified, and 29% (n = 516) were screened for HCV by age two. Most mothers resided in the lowest income quintile (42%), and most vulnerable quintiles for material deprivation (41%), housing instability (38%) and ethnic diversity (26%) with 11% living in rural locations. After adjustment for confounding, maternal rural residence (risk ratio [RR] 0.82, 95% confidence interval [CI] 0.62, 1.07) and living in the highest dependency quintile (RR 0.83, 95% CI 0.65, 1.07) were the SDOH most associated with paediatric HCV screening. Younger maternal age (RR 0.98 per 1-year increase, 95% CI 0.97, 0.99), HIV co-infection (RR 1.69, 95% CI 1.16, 2.48) and GI specialist involvement (RR 1.18, 95% CI 1.00, 1.39) were associated with higher probabilities of screening. Among children exposed to HCV during pregnancy, rural residences and living in highly dependent neighbourhoods showed a potential association with a lower probability of HCV screening by the age of 2. Future work evaluating barriers to paediatric HCV screening among rural residing and dependent residents is needed to enhance the screening.

Descriptive Analysis of Community Based Needs among Asylum Seekers in the Greater Rhode Island Area before and after COVID-19: Evidence from a Student-Run Asylum Clinic

Abstract The Brown Human Rights Asylum Clinic (BHRAC) is a medical-student-run asylum clinic which provides pro-bono medical and psychological affidavits for people in immigration proceedings. At the time of the evaluations for affidavits, a BHRAC student administers a Social Determinants of Health (SDoH) screener, evaluating clients for access to healthcare and social needs such as assistance with utilities payments and housing. Medical students follow up later and connect clients with trusted resources. This descriptive analysis reviews the population demographics; demonstrates common resource requests within our population before and after the start of COVID-19; and suggests possible improvements to our clinic model. Of clients who completed the SDoH screening, 89 per cent requested at least one form of assistance; their most common request was for mental health services, followed by English classes and medical services. No change to community resource request trends appeared before and after the start of COVID-19. Barriers encountered included delays and difficulty administering the survey to clients who did not speak English or Spanish, the ethical concern of the evaluation team also offering community resources for future care, and the changes resulting from annual rotation in BHRAC student leadership.

Addressing adverse social determinants of health in pediatric primary care: Study protocol for a hybrid type 2 effectiveness-implementation randomized controlled trial in two national pediatric practice-based research networks

BackgroundGrowing evidence linking social determinants of health (SDOH) to child health outcomes has prompted widespread recommendations for pediatricians to screen and refer for adverse SDOH at primary care visits. Yet there is little evidence to date demonstrating the effectiveness of practice-based SDOH screening and referral interventions on increasing family engagement with resources. This hybrid type 2 effectiveness-implementation trial aims to demonstrate the non-inferiority of a low-touch implementation strategy in order to facilitate dissemination of an existing SDOH screening and referral system (WE CARE) and demonstrate its effectiveness and sustainability in various pediatric practices. MethodsWe recruited eighteen pediatric practices in fourteen US states through two pediatric practice-based research networks. For this stepped wedge cluster RCT, practices serve as their own controls during the Usual Care phase and implement WE CARE during the intervention phase via one of two randomized implementation strategies: self-directed, pre-recorded webinar vs. study team-facilitated, live webinar. We collect data at practice, clinician/staff, and parent levels to assess outcomes grounded in the Proctor Conceptual Model of Implementation Research. We use generalized mixed effects models and differences in proportions to compare rates of resource referrals by implementation strategy, and intention-to-treat analysis to compare odds of engagement with new resources among families enrolled in the Usual Care vs. WE CARE phases. DiscussionFindings from this trial may inform decisions about broader dissemination of SDOH screening systems into a diverse spectrum of pediatric practices across the US and potentially minimize the impact of adverse SDOH on children and families.

Evaluation of a Clinic-Based, Electronic Social Determinants of Health Screening and Intervention in Primary Care Pediatrics

ObjectiveSocial determinants of health (SDOH) significantly affect individuals' health outcomes, yet universal electronic SDOH screening is not standard in primary care. Our study explores the implementation of an electronic SDOH screening in the electronic health record (EHR) and follow-up intervention among primary care pediatric patients within an academic clinic. MethodsBeginning in August of 2022, patients and their families determined to have at least one SDOH need qualified for an in-clinic referral to a coordinated care team member. We assessed the overall efficacy and feasibility of the implementation. ResultsOver the 4-month pilot, 1473 of 2064 (71.4%) eligible patients were screened, with 472 (32%) patients screening positive on at least one SDOH domain. Of the 472 screened positive, 48 (10.2%) declined a referral. Two hundred and forty-seven of the 424 (58.3%) received a referral to a care coordination team member. ConclusionsThis study demonstrates the feasibility of a universal electronic SDOH screening tool within the EHR within an urban, academic-based clinic.

Social workers are key to addressing social determinants of health in integrated care settings

ABSTRACT Social workers play an important role in assessing social determinants of health (SDH) and providing behavioral health services in integrated care settings. Evidence suggests that integrated care interventions improve quality of life and other patient outcomes. However, the ambiguous role of social workers on the interdisciplinary team, the lack of protocol in SDH screening and intervention, and restrictions due to healthcare reimbursement limit social workers’ ability to intervene. Future directions include standardizing integrated care models, evaluating integrated care’s efficacy to address SDH, incorporating SDH into interprofessional training including role clarification and reimbursing for SDH assessment and intervention.

School-Based Screening of Social Determinants of Health: A Scoping Review

School-based screening instruments have traditionally focused on assessing within-child factors, such as a student’s academic, social, emotional, behavioral, or physical development. This emphasis in school-based screening may be a missed opportunity to assess and ameliorate contextual factors (i.e., social determinants of health) influencing child development. In this scoping review, we aim to describe the current landscape of screening for social determinants of health (SDOH) in school settings. Following established practices for scoping reviews, we searched PsycInfo, ERIC, and CINAHL Plus in December 2022 for articles describing the development or use of an SDOH measure in a school setting. From each eligible article, two coders independently extracted (1) study characteristics, (2) measure characteristics, (3) available psychometric or usability information, and (4) reported outcomes of measure implementation. Descriptive and content analyses were used to examine data. We identified six articles describing the development or use of SDOH measures in elementary, high school, or university settings. These articles yielded six unique SDOH measures, intended for either adolescent or young adult self-report, caregiver proxy-report, or both. Measures included 6–25 SDOH items, with additional items assessing demographics, health behaviors, or mental health (e.g., depression). Reported outcomes included increased referrals to services and implementation of school-based supports to reduce social risk (e.g., school food pantry). We discuss next steps for research evaluating the feasibility and social consequences of school-based SDOH screening.

Comparison of social determinants of health in Medicaid vs commercial health plans

Abstract Incorporating the measurement of social determinants of health (SDOH) into health care practice and US health policy reforms is a promising approach to improving population health nationwide. One way health care practitioners have started to incorporate consideration of SDOH in clinical care is by using International Classification of Diseases, Tenth Revision (ICD-10), Z-codes, a set of diagnosis codes spanning a range of social and economic circumstances. Our study summarizes Z-codes used by code type, setting, and patient demographics between Medicaid and commercial insurance to help identify strategies to optimize their use within each program and understand their differences. Overall, Z-code use was highly limited nationwide in Medicaid and commercial insurance between 2020 and 2021. Still, we found notable differences in the use of Z-codes between the programs; Medicaid beneficiaries were more likely to receive Z-codes related to financial and economic issues, while commercially insured beneficiaries were more likely to receive Z-codes indicating problems with social and familial relationships. Policy efforts focused on increasing the rate and ease of patient SDOH screening will potentially expand SDOH measurement and facilitate actions to address patient social needs.

Abstract A025: Empowering Latinas to obtain genetic services: Comparing precision cancer prevention strategies

Abstract Purpose: Precision cancer prevention strategies are critical for addressing the complex interplay of adverse social determinants of health (SDOH) and elevated biological risks for breast cancer (BC) among Latinas and other marginalized communities. FQHC-community-academic partnerships may have particularly high potential for operationalizing these strategies and reducing population-level disparities through enhancing genetic counseling and testing (GCT) and subsequent cascade testing/personalized care. Objective: To present emerging results from a RCT comparing the effectiveness of two precision cancer prevention strategies on increasing GCT among Latinas and networks with elevated biological and adverse SDOH risks. Methods: Latinas Lideres en Salud (LaLiSa) is an ongoing RCT is situated in a 14-site federally qualified health center (FQHC) in Chicago. This unique FQHC has a comprehensive GCT program, as part of its integration with an academic medical center. Eligibility criteria for patients include: 1) identification as Latina, Hispanic, Chicana, etc.; 2) age of 18+ years old; 3) personal or family history of BC or related cancers (e.g., ovarian); 4) no previous GCT uptake; and, 5) no prior volunteerism. Patients are randomly assigned to participate in one of two 3-week phone-based interventions from a community agency. Both interventions offer personalized BC education, SDOH screening and navigation, and free/low-cost GCT services. “Educate” offers education on risk reduction (diet, exercise). “Empower” offers skills training on sharing precision cancer prevention information with family and other network members, who can also be eligible for SDOH navigation and GCT services. Data collection includes two surveys (baseline, post-intervention) for relevant covariates and use of study/navigation records for GCT uptake. Results: Of 299 patients approached, 89 participants have enrolled in the RCT (42 educate, 45 empower), with 89% retention. Approximately 55% are 50+ years old, 85% prefer Spanish, 65% have less than a high school education, and 64% have Medicaid/Medicare. For BC and SDOH risks, 17% are cancer survivors, 81% have financial stress and 42% have other competing SDOH risks (intimate partner violence, housing instability, transit instability). No significant arm differences exist. About 76% have initiated GCT referrals and 43% of participants have received GCT services, including 70% who have been identified as having elevated hereditary risk. Empower participants have been more likely to obtain GCT services than Educate participants, (51% vs. 33%, aOR = 5.44, 95%CI[1.45, 20.40], p=.01) after adjusting for age and self-reported social desirability. Discussion: Emerging data suggest the feasibility of precision cancer prevention strategies through FQHC-community-academic partnerships. Empower approaches may be more effective for enhancing at-risk Latinas’ GCT uptake than Educate approaches, when combined with SDOH navigation and free/low-cost GCT services. Limitations concern generalizability due a small, non-probability based sample. Citation Format: Paola Torres, Carolina Bujanda, Celeste Charchalac-Zapeta, Juanita Arroyo, Pamela Ganschow, Vivian Pan, Nathan Stackhouse, Sage J. Kim, Araceli Lucio, Yamilé Molina. Empowering Latinas to obtain genetic services: Comparing precision cancer prevention strategies [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A025.

Screening for the social determinants of health: Referring patients to community-based services.

Screening patients for the social determinants of health (SDOH) allows clinicians to identify those needs and tailor referral efforts. Due to constraints on clinic time and monetary resources, a simple screening tool incorporated into existing clinic workflow increases its usefulness and impact. Our free, nurse-led, mobile health clinic (MHC) needed an enhanced process or tool for screening patients for SDOH. The purpose of this quality-improvement project was to screen adult patients in the MHC for SDOH needs and to increase volunteer staff perceptions of their knowledge and confidence in referring patients to relevant community-based services. A screening process and tool was developed using guidelines from the Health Leads to identify patients' SDOH needs and related requests for assistance. The tool was introduced to and tested among volunteer staff through pretest/posttest surveys. Patients who visited the clinic were screened for the SDOH within the project period, and volunteer staff were surveyed about their perceptions of the screening tool. Sixty-four patients were screened for SDOH needs. Twenty-three percent reported food insecurity, 27% housing insecurity, 14% difficulty obtaining utilities, and 17% difficulty obtaining transportation; 28% requested assistance with their reported SDOH needs. Seventeen percent of patients reported two or more SDOH needs. At posttest, 100% of volunteer staff ( N = 9) indicated satisfaction with the SDOH screening questions, reported feeling knowledgeable about resources to use for patient referrals, and were confident in referring patients to needed resources. The screening tool aptly guided practice and was evaluated as "easy to use" for clinic patients and volunteer staff.

Patient and Care Team Perspectives on Social Determinants of Health Screening in Primary Care

Health systems in the US are increasingly screening for social determinants of health (SDOH). However, guidance incorporating stakeholder feedback is limited. To examine patient and care team experiences in early implementation of SDOH screening in primary care. This qualitative study included cross-sectional analysis of SDOH screenings during primary care visits from February 22 to May 10, 2022, primary care team member interviews from July 6, 2022, to March 8, 2023, and patient stakeholder engagement on June 30, 2022. The setting was a large southeastern US health care system. Eligible patients were aged 18 years or older with completed visits in primary care. Screening for SDOH in primary care. Multivariable logistic regression evaluated patient (eg, age, race and ethnicity) and care team characteristics (eg, practice type), and screening completeness. Interviews contextualized the quantitative analysis. There were 78 928 visits in practices conducting any SDOH screening. The population with visits had a mean (SD) age of 57.6 (18.1) years; 48 086 (60.9%) were female, 12 569 (15.9%) Black, 60 578 (76.8%) White, and 3088 (3.9%) Hispanic. A total of 54 611 visits (69.2%) were with a doctor of medicine and 13 035 (16.5%) with a nurse practitioner. Most had no SDOH questions answered (75 298 [95.4%]) followed by all questions (2976 [3.77%]). Logistic regression analysis found that clinician type, patient race, and primary payer were associated with screening likelihood: for clinician type, nurse practitioner (odds ratio [OR], 0.13; 95% CI, 0.03-0.62; P = .01) and physician assistant (OR, 3.11; 95% CI, 1.19-8.10; P = .02); for patient race, Asian (OR, 1.69; 95% CI, 1.25-2.28; P = .001); Black (OR, 1.49; 95% CI, 1.10-2.01; P = .009); or 2 or more races (OR, 1.48; 95% CI, 1.12-1.94; P = .006); and for primary payer, Medicaid (OR, 0.62; 95% CI, 0.48-0.80; P < .001); managed care (OR, 1.17; 95% CI, 1.07-1.29; P = .001); uninsured or with Access Health (OR, 0.26; 95% CI, 0.10-0.67; P = .005), and Tricare (OR, 0.71; 95% CI, 0.55-0.92; P = .01). Interview themes included barriers (patient hesitancy, time and resources for screening and referrals, and number of questions/content overlap) and facilitators (communication, practice champions, and support for patient needs). This qualitative study presents potential guidance regarding factors that could improve SDOH screening within busy clinical workflows.

Sickle Cell Disease Births and Social Vulnerability (2016-2020): A Report from the Sickle Cell Data Collection Program

Introduction Despite national implementation of universal newborn screening for sickle cell disease (SCD) since 2006, data on the prevalence of SCD births in the United States are scarce. Updated prevalence data by geographic location are needed to guide the allocation of resources and to connect newborns to comprehensive SCD care. The purposes of this study were to describe the 1) crude and race-adjusted SCD birth prevalence and 2) crude SCD birth prevalence by quartiles of the social vulnerability index (SVI, CDC, 2020) in 11 Sickle Cell Data Collection (SCDC) program states (Alabama, California, Colorado, Georgia, Indiana, Michigan, Minnesota, North Carolina, Tennessee, Virginia, and Wisconsin). Methods This retrospective cohort study used newborn screening (NBS) records from 2016 to 2020. Births were included if they were confirmed SCD births and the mother's county of residence at the time of birth was in an SCDC state. Mother's county and newborn's race, ethnicity, sex, date of birth, and genotype were extracted from NBS records or birth certificates, if available. Crude SCD birth prevalence per 10,000 was calculated by dividing the cumulative number of SCD births by the cumulative number of all live births from 2016 to 2020 and multiplying by 10,000. Race-adjusted SCD birth prevalence was calculated by dividing the cumulative number of Black SCD births by live non-Hispanic Black (NHB) births from 2016 to 2020 and multiplying by 10,000. Frequency of all births and NHB births were obtained from each state's health department. County characteristics were quantified by the SVI using the 2020 state-ranked CDC/ATSDR SVI datasets (CDC, 2020) and were matched to mother's county of residence at birth. SVI ranks counties on 16 social factors, including unemployment, minority status, and disability. Ranks were grouped into SVI quartiles: low (0 ≤ SVI ≤ 0.25), medium (0.25 &amp;lt; SVI ≤ 0.5), high (0.5 &amp;lt; SVI ≤ 0.75) and very high (0.75 &amp;lt; SVI ≤ 1.0) vulnerability. Crude SCD birth prevalence was calculated for each SVI quartile. Results From 2016 through 2020, there were 3,305 newborns with SCD across 11 SCDC states [ 49.6% male, 89.8% Black]. Georgia had the highest number of births (n=758) followed by North Carolina (n=435), California (n=419), and Alabama (n=386). The majority (57.0%) had Hb SS or Hb S Beta 0 thalassemia, 27.9% had Hb SC, and 9.6 % had Hb S Beta + thalassemia or other SCD type. The crude SCD birth prevalence ranged from 1.22 to 13.22 per 10,000 live births. The race-adjusted SCD birth prevalence for SCDC states was 28.55 per 10,000 or 1 in every 350 NHB births. Race-adjusted birth prevalence varied among states ranging from 19.53 to 34.11 per 10,000 NHB births (Table 1). Overall, the majority (67%) of mothers of newborns with SCD resided in high or very high social vulnerability counties (Figure 1). Except for Colorado, where the highest crude SCD birth prevalence was among mothers residing in medium social vulnerability counties, the remaining 10 SCDC states had the highest prevalence among mothers residing in high or very high social vulnerability counties. Limitations include using the mother's reported race for all births to calculate race-adjusted birth prevalence. Additionally, because of missing data on ethnicity for SCD births, we used all Black SCD births, rather than non-Hispanic Black SCD births, to calculate the race-adjusted SCD birth prevalence. Despite the limitations, the study provides crude and race-adjusted SCD birth prevalence data from 11 states in the South, Midwest, and Western United States, covering an estimated one third of the SCD population in the United States. Furthermore, providing the crude prevalence of SCD births by SVI quartile adds valuable information on county-level characteristics that might influence health outcomes for newborns with SCD. Conclusions The race-adjusted birth prevalence for SCD remains stable from previous estimates at 1 in every 350 BNH births. The finding that most mothers of newborns with SCD reside in high and very high social vulnerability counties at the time of birth underscores the importance of assessing social determinants of health (SDOH) that may impact health outcomes for newborns with SCD. Findings from this report can be used to guide state- and county-level programs that address SDOH for people with SCD and have implication for clinicians who must incorporate screening for SDOH in their practice and refer families to community resources as needed.

Abstract 11708: Examining the Impact of Social Determinants of Health in Cardiovascular Disease Risk Factors: Insights From an Implementation Study in a Rural Primary Care Clinic

Introduction: The social determinants of health (SDoH) are associated with uncontrolled cardiovascular disease (CVD) risk factors and warrant attention. Methods: We describe methods and cross-sectional results of the SDoH screening and referral system at a resident-run primary care clinic at Cayuga Medical Center (total 30 residents ~539 patients seen/month with 12% no shows) starting from Nov 2019. Eight domains of SDoH including food security, utility, housing, childcare, finances, transportation, literacy, and social support were selected based on local county data and focus group discussions. We developed an annual screening tool and referral system integrated into the electronic medical record for any SDoH positive patients to the community health and social workers (CHW/SW), who facilitated access to community resources. Patient education about available community resources, regular follow-up visits with the physician and CHW/SW, and periodic SDoH screening were other key components. Results: Among 741 patients (Hypertension and Diabetes), 607 (82%) patients underwent SDoH screening (Table). 200 (33%) patients had at least one domain of SDoH (SDoH +) and received SDoH interventions whereas, 407 (67%) did not have any SDoH. The three most common SDoH were lack of social support (61%), transportation (35%) and finance issues (25%). Patients in the SDoH+ group were younger, with higher percentage of non-White race/ethnicity, unemployment, disability, living alone, current smokers, illicit substance use, anxiety, depression, obesity, and opioid use with statistical significance. However, there were no significant differences in CVD risk factors like SBP (138.3 vs 138.4 mmHg), DBP (84 vs 83 mmHg), HbA1c (6.4 vs 6.2) and LDL-c (103.7 vs 101.5 mg/dL). Conclusions: In addition to controlling standard CVD risk factors, implementation of SDoH routine screening and referral system in a primary care clinic may help in mitigating CVD burden as seen in our study.

Abstract 15542: Social Determinants of Health Screening of Patients With Congestive Heart Failure Within Multiple Urban Ambulatory Clinics

Introduction: There is a growing body of literature dedicated to understanding the implications of social determinants of health (SDOH) on cardiovascular disease. This study evaluated a pilot of standardized SDOH screening questionnaires in two large urban ambulatory clinics within a quaternary integrated health network in the Northeastern United States. Goals/Aims: This study aims to investigate common social determinants of health which may influence patients with congestive heart failure (CHF). Methods: A retrospective review of the incidence of SDOH in adult patients from two Internal Medicine outpatient residency clinics between 2020 and 2023 was performed. SDOH assessment was performed at every visit. Multivariate logistic regression analysis was performed to assess the association of SDOH in patients with and without CHF. Results: A total of 14,516 patients were evaluated during this study period (mean age 66 years, 62% female). When matched for age and sex, 808 patients with CHF were compared to those without CHF. In matched data, those with CHF were significantly less likely to endorse food insecurity (64.2% vs 94.6%, p&lt;0.05), lack of safety (1.4% vs 2.8%, p&lt;0.05), lack of social connection (34.4% vs 86.8%, p&lt;0.05), and stress (29.1% vs 84.3%, p&lt;0.05). Patients with CHF were more likely (91% vs 26%, p&lt;0.05) to report a positive PHQ-9 depression screen [Table 1]. Patients with CHF were also noted to have a higher incidence of comorbid illnesses. Conclusions: Utilization of evidence-based SDOH screening questions in the workflow can help identify key barriers to cardiovascular diseases such as CHF. Multidisciplinary care in patients with CHF may contribute to improved SDOH reporting. Future studies should use qualitative and quantitative data in combination to further evaluate and address barriers to care in patients with CHF.

Help us help you using technology to maximize resource response to patient reported SDoH and depression screening.

576 Background: Social determinants of health (SDoH) are associated with inferior health outcomes, morbidity, life expectancy, and healthcare expenses. Screening for SDoH is increasingly incorporated into routine clinical practice, however clinical decision support and resources addressing positive SDoH screening are less robust. As part of the ASCO PC4, we developed an electronic workflow that utilizes SDoH and depression screening tools with prepopulated referrals to assist the clinician in directing the referral to the most appropriate supportive service. Methods: Smilow Cancer Hospital ASCO Patient Centered Care Certification Implementation Team collaborated with our social work, psycho oncology, and Community Health Worker (CHW) to optimally screen and respond to patients who screened positive for SDoH or depression. A workflow was established using Welcome Web software in combination with Epic to transfer patient results collected in the waiting room via iPad to the patient’s medical record. Positive screening results trigger a best practice advisory when clinician opens chart. The alert links to a Smartset prepopulating an order to the appropriate resource for the reported need. Patients with transportation, food insecurity, or housing concerns were referred to Community Healthcare Worker. Social workers received referrals for patients with social connection concerns and PHQ-9 scores between 9-14. Patients with a PHQ-9 score of 15 and above were referred to the psycho-oncology team. A specialized workflow was created for any patient who responded positively to thoughts of self-harm. These patients received an immediate intervention and were screened using the Columbia Suicide Severity Screening Tool. Results: See table. Conclusions: Incorporating SDoH screening alongside clinical decision support and automated referrals was feasible. Technology enabled screening enhances efficiency and assists clinicians with direct referrals to the appropriate resource, while allowing resources to operate at the top of their licensure and enhance efficiency. Future Directions for Research: 1. Monitor emergency room utilization, admissions, and unplanned visits for patients receiving services from CHW, Social Work, and Psycho-oncology services. 2. Monitor work queue volumes to assess if directed referrals expedite response.[Table: see text]

Comprehensive pediatric cancer care in the community oncology setting: 2022 Landscape survey results.

92 Background: A first step in providing guideline-endorsed, cancer-related psychosocial resources for children with cancer treated in community oncology settings is screening for need. We describe the current landscape of screening for distress and social determinants of health (SDoH) for children treated in NCI-Community Oncology Research Program (NCORP) practices. Methods: NCORP practice groups completed the Landscape Survey in 2022 to describe infrastructure, resources, and research capacity. Practice groups were assessed for capacity to provide oncology care for pediatric patients, presence of a Pediatric Oncology Program (POP), and the annual pediatric cancer cases seen. Among practice groups with a POP, we describe the proportion with routine screening for distress (psychosocial and financial) and SDoH. Results: Of 271 responding NCORP practice groups, 54 (20%) reported providing oncology care for children; 47 (87%) of these had a dedicated POP. Of these 47 practice groups, 33 reported the number of new pediatric cases seen per year (range 7-126). Of the seven practices that reported providing oncology care for children, but did not have a dedicated POP, the practice either did not report the number of pediatric cases (n=3) or fewer than 2% of annual cancer cases were children aged 0-14 years. Among the 47 practices with a dedicated POP, 12 were affiliated with a Minority- Underserved NCORP. Geographically, most of these NCORPs (n=18, 38%) were located within the South, followed by the Midwest (n=11, 23%), the Northeast and the West (both, n=9, 19%). Within the 47 NCORP practices with a POP, but not specifically within the POP, 41 (87%) conducted routine psychosocial distress screening, 39 (83%) routine financial screening (other than insurance/billing purposes), and 41 (87%) screened for SDoH with a variety of tools. Most of the practices (n=33, 70%) screened for all three indicators of need for cancer-related resources. Conclusions: This analysis describes the settings where children with cancer are treated in the community and the infrastructure across NCORP practices with a POP. These data are indicative of potential research capacity and will be used to develop future Cancer Care Delivery Research (CCDR) studies through the NCORP. Future research will seek to identify multi-level barriers and facilitators to linking families with identified needs to available resources and to resource uptake.

Words matter: How clinical encounters can be unknowingly stigmatizing to some patient communities.

356 Background: Lack of patient engagement around the content and approach to care conversations related to social determinants of health (SDOH) can negatively impact healthcare experiences and exacerbate disparities in outcomes. Lived environment, financial/logistical challenges, general access barriers and patient mistrust must be addressed on a systemic and individual level. Assumptions based on socioeconomic status, age, race, gender, and medical conditions can undermine communication and/or invalidate a patient's feelings and lived experiences. Accelerating the requirement of SDOH screenings without addressing the patient-centeredness of these conversations will likely contribute to health inequities and yield substandard patient experiences and outcomes. Methods: To better understand patient perspectives about language commonly used in SDOH screenings, we gathered views on terminology used towards patients through surveys, focus groups, and virtual workshops. Participants were recruited from a diverse pool of insured patients served by Patient Advocate Foundation representing various medical diagnoses, were lower income (&lt;$48,000), racially/ethnically reflective of the US, and experienced healthcare access and/or affordability challenges. Results: Patients had both positive and negative perspectives on SDOH screening in clinical settings, specifically focused on communication, bias, and privacy. Survey/focus group results revealed the discomfort of financial and non-medical information (SDOH) being included in their electronic medical record (EMR). “It’s important to find words that are less stigmatizing because it affects how we see ourselves and others.” Only 21% reported being extremely comfortable with SDOH information being recorded in their EMR and subsequently being available to multiple members of their healthcare team. Judgement, embarrassment, shame, and lack of action (i.e., linkage to resources) were often cited as reasons for not wanting to have uncomfortable conversations. Patients also felt that disclosing this information could (or would) influence the treatment options offered, creating bias solely regarding their perceived ability to manage their medical and non-medical financial obligations. Conclusions: We uncovered how, without patient engagement, language and processes the healthcare system uses can feel biased and stigmatizing to those it is designed to help. Stigmatizing conversations can perpetuate discriminatory attitudes, influence clinicians' decision-making when treating a patient, and affect patient trust and disclosure within care settings. This cycle impacts quality of care and contributes to health disparities. By listening to patient perspectives, researchers and health care professionals can become more culturally aware and reduce stigmatizing language, while making care more patient-centric and inclusive.