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Assaf RR, Assaf RD, Padlipsky PS, Young KDA. A family-centered approach to social needs awareness in the pediatric emergency department. PEC INNOVATION 2024; 4:100283. [PMID: 38689830 PMCID: PMC11059452 DOI: 10.1016/j.pecinn.2024.100283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/01/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024]
Abstract
Objective We aimed to understand family preferences around reporting and receiving health-related social needs (HRSN) information by assessment modality during pediatric emergency department (PED) visits. Methods Families were randomized into paper (control), cell phone, or tablet modality groups by their child's exam room. Nurses alerted families to complete a single HRSN assessment during routine workflow. We used logistic regression and McNemar's test to assess discordance in modality preference. Results Forty-seven percent of families disclosed at least one HRSN across a total 611 assessments. Disclosure of HRSN was similar by modality. Twenty-three percent of those assigned tablet preferred cell phone (p < 0.001). Two-thirds of families preferred receiving digitally formatted community resources (email or text). There was no difference in preferred timing of HRSN assessment completion. Conclusions Assessment modality did not appear to influence family HRSN disclosure. Families were generally satisfied with all HRSN assessment modalities but demonstrated a particular preference in using personal cell phones over tablets. Digitally formatted community referrals also pose numerous advantages over conventional paper handouts. Innovation Use of personal cell phones is a novel, streamlined method of HRSN interventions in the clinical setting, performing similar to more conventional modalities, with a preference among families when compared to tablets.
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Affiliation(s)
- Raymen Rammy Assaf
- Emergency Medicine Specialists of Orange County, Children's Hospital Orange County, Orange, USA
- Department of Pediatrics, University of California, Irvine (UCI) School of Medicine, Irvine, USA
| | - Ryan David Assaf
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, USA
| | - Patricia Sencer Padlipsky
- Department of Emergency Medicine, Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, USA
| | - Kelly Dee Ann Young
- Department of Emergency Medicine, Harbor-University of California, Los Angeles (UCLA) Medical Center, Torrance, USA
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Smithers LG, MacPhail C, Chan L, Downes M, Neadley K, Boyd M. In-person versus electronic screening for social risks among carers of pediatric inpatients: A mixed methods randomized trial. Eur J Pediatr 2024; 183:2301-2309. [PMID: 38427037 PMCID: PMC11035429 DOI: 10.1007/s00431-024-05470-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024]
Abstract
We aimed to compare disclosure of social risks according to self-report on an iPad versus face-to-face questions from a health professional and to explore carers' experiences of screening. This two-arm, parallel group, randomized trial was conducted from January 19, 2021, to December 17, 2021, in a public hospital pediatric ward serving a disadvantaged area of an Australian capital city. Carers of children aged ≤ 5 years admitted to the Children's Ward were eligible. The primary outcome was disclosure of social risks. The screener included nine items on food security, household utilities, transport, employment, personal and neighborhood safety, social support, housing and homelessness. Disclosure of social risks was similar between the self-completion (n = 193) and assisted-completion (n = 193) groups for all 9 items, ranging 4.1% higher for worrying about money for food (95% CI - 11.4, 3.1%) among the assisted-completion group, to 5.7% (-1.6, 13.0%) higher for unemployment among the self-completion group. In qualitative interviews, participants were positive about screening for social risks in the hospital ward setting and the majority indicated a preference for self-completion. Conclusion: Differences in the disclosure of social risks according to self- versus assisted-completion were small, suggesting that either method could be used. Most carers expressed a preference for self- completion, which is therefore recommended as the ideal mode for such data collection for Australian pediatric inpatient settings. Trial registration: Australia New Zealand Clinical Trial Registry ( www.anzctry.org.au ; #ACTRN12620001326987; date of registration 8 December 2020). What is Known: • Most evidence on screening of social risks in pediatric inpatient settings is from the USA. • Little is known about disclosure of social risks in countries with universal health care and social welfare. What is New: • Disclosure of social risks was similar for electronic compared with face-to-face screening. • Carers preferred electronic completion over face-to-face completion.
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Affiliation(s)
- Lisa Gaye Smithers
- School of Health and Society, University of Wollongong, Northfields Road, Wollongong, NSW, 2522, Australia.
- School of Public Health, University of Adelaide, Adelaide, SA, Australia.
| | - Catherine MacPhail
- School of Health and Society, University of Wollongong, Northfields Road, Wollongong, NSW, 2522, Australia
| | - Lily Chan
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Maeve Downes
- Northern Adelaide Local Health Network, Elizabeth Vale, SA, Australia
| | - Kate Neadley
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Mark Boyd
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Neshan M, Padmanaban V, Tsilimigras DI, Obeng-Gyasi S, Fareed N, Pawlik TM. Screening tools to address social determinants of health in the United States: A systematic review. J Clin Transl Sci 2024; 8:e60. [PMID: 38655456 PMCID: PMC11036426 DOI: 10.1017/cts.2024.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/07/2024] [Accepted: 03/19/2024] [Indexed: 04/26/2024] Open
Abstract
The Centers for Medicare & Medicaid Services have mandated that hospitals implement measures to screen social determinants of health (SDoH). We sought to report on available SDoH screening tools. PubMed, Scopus, Web of Science, as well as the grey literature were searched (1980 to November 2023). The included studies were US-based, written in English, and examined a screening tool to assess SDoH. Thirty studies were included in the analytic cohort. The number of questions in any given SDoH assessment tool varied considerably and ranged from 5 to 50 (mean: 16.6). A total of 19 SDoH domains were examined. Housing (n = 23, 92%) and safety/violence (n = 21, 84%) were the domains assessed most frequently. Food/nutrition (n = 17, 68%), income/financial (n = 16, 64%), transportation (n = 15, 60%), family/social support (n = 14, 56%), utilities (n = 13, 52%), and education/literacy (n = 13, 52%) were also commonly included domains in most screening tools. Eighteen studies proposed specific interventions to address SDoH. SDoH screening tools are critical to identify various social needs and vulnerabilities to help develop interventions to address patient needs. Moreover, there is marked heterogeneity of SDoH screening tools, as well as the significant variability in the SDoH domains assessed by currently available screening tools.
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Affiliation(s)
- Mahdi Neshan
- Department of General Surgery, Shahid Sadoughi University of
Medical Sciences and Health Services, Yazd,
Iran
| | - Vennila Padmanaban
- Department of Surgery, The Ohio State University Wexner
Medical Center and James Comprehensive Cancer Center, Columbus,
OH, USA
| | - Diamantis I. Tsilimigras
- Department of Surgery, The Ohio State University Wexner
Medical Center and James Comprehensive Cancer Center, Columbus,
OH, USA
| | - Samilia Obeng-Gyasi
- Department of Surgery, The Ohio State University Wexner
Medical Center and James Comprehensive Cancer Center, Columbus,
OH, USA
| | - Naleef Fareed
- Department of Biomedical Informatics, College of Medicine,
The Ohio State University, Columbus,
OH, USA
| | - Timothy M. Pawlik
- Department of Surgery, The Ohio State University Wexner
Medical Center and James Comprehensive Cancer Center, Columbus,
OH, USA
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Arroyave Caicedo NM, Parry E, Arslan N, Park S. Integration of social determinants of health information within the primary care electronic health record: a systematic review of patient perspectives and experiences. BJGP Open 2024; 8:BJGPO.2023.0155. [PMID: 37673433 PMCID: PMC11169979 DOI: 10.3399/bjgpo.2023.0155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Social determinants of health (SDOH) are the non-medical factors that impact health. Although geographical measures of deprivation are used, individual measures of social risk could identify those most at risk and generate more personalised care and targeted referrals to community resources. We know SDOH are important to health care, but it is not yet known whether their collection via the electronic health record (EHR) is acceptable and useful from the patient perspective. AIM To synthesise relevant literature to explore patient perspectives on integrating information about SDOH into primary care EHRs, and the opportunities and challenges of its implementation in a general practice setting. DESIGN & SETTING Systematic review of primary care-based qualitative and mixed-method studies using thematic framework analysis. METHOD Key databases were searched for articles reporting patient perspectives of SDOH collection within the primary care EHR. Qualitative and mixed-methods studies written in English were included. A framework analysis was conducted to identify themes. RESULTS From 14 included studies, the following five main themes were identified: rationale for SDOH screening and the anticipated outcomes; impact of the provider-patient relationship on patient perceptions; data, which included privacy concerns; screening process and referral; and recommendations for future research. CONCLUSION Integration of information on SDOH into the EHR appears acceptable to patients. This review has added to the discussion of whether and how to implement SDOH screening and referral programmes into UK primary care systems.
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Affiliation(s)
| | - Emma Parry
- School of Medicine, Keele University, Staffordshire, UK
| | - Nazan Arslan
- Department of Primary Care and Population Health, University College London, London, UK
| | - Sophie Park
- Department of Primary Care and Population Health, University College London, London, UK
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Griesemer I, Palmer JA, MacLaren RZ, Harvey KLL, Li M, Garikipati A, Linsky AM, Mohr DC, Gurewich D. Rural Veterans' Experiences with Social Risk Factors: Impacts, Challenges, and Care System Recommendations. J Gen Intern Med 2024; 39:782-789. [PMID: 38010459 PMCID: PMC11043235 DOI: 10.1007/s11606-023-08530-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Social risk factors, such as food insecurity and financial needs, are associated with increased risk of cardiovascular diseases, health conditions that are highly prevalent in rural populations. A better understanding of rural Veterans' experiences with social risk factors can inform expansion of Veterans Health Administration (VHA) efforts to address social needs. OBJECTIVE To examine social risk and need from rural Veterans' lived experiences and develop recommendations for VHA to address social needs. DESIGN We conducted semi-structured interviews with participants purposively sampled for racial diversity. The interview guide was informed by Andersen's Behavioral Model of Health Services Use and the Outcomes from Addressing Social Determinants of Health in Systems framework. PARTICIPANTS Rural Veterans with or at risk of cardiovascular disease who participated in a parent survey and agreed to be recontacted. APPROACH Interviews were recorded and transcribed. We analyzed transcripts using directed qualitative content analysis to identify themes. KEY RESULTS Interviews (n = 29) took place from March to June 2022. We identified four themes: (1) Social needs can impact access to healthcare, (2) Structural factors can make it difficult to get help for social needs, (3) Some Veterans are reluctant to seek help, and (4) Veterans recommended enhancing resource dissemination and navigation support. CONCLUSIONS VHA interventions should include active dissemination of information on social needs resources and navigation support to help Veterans access resources. Community-based organizations (e.g., Veteran Service Organizations) could be key partners in the design and implementation of future social need interventions.
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Affiliation(s)
- Ida Griesemer
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA.
| | - Jennifer A Palmer
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Risette Z MacLaren
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
| | - Kimberly L L Harvey
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
| | - Mingfei Li
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
- Department of Mathematical Sciences, Bentley University, Waltham, MA, USA
| | | | - Amy M Linsky
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - David C Mohr
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
- Department of Health Law, Policy & Management, School of Public Health, Boston University, Boston, MA, USA
| | - Deborah Gurewich
- Veterans Affairs Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Karran EL, G. Cashin A, Barker T, A. Boyd M, Chiarotto A, Dewidar O, Petkovic J, Sharma S, Tugwell P, Moseley GL. The ' what' and ' how' of screening for social needs in healthcare settings: a scoping review. PeerJ 2023; 11:e15263. [PMID: 37101795 PMCID: PMC10124546 DOI: 10.7717/peerj.15263] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/28/2023] [Indexed: 04/28/2023] Open
Abstract
Background Adverse social determinants of health give rise to individual-level social needs that have the potential to negatively impact health. Screening patients to identify unmet social needs is becoming more widespread. A review of the content of currently available screening tools is warranted. The aim of this scoping review was to determine what social needs categories are included in published Social Needs Screening Tools that have been developed for use in primary care settings, and how these social needs are screened. Methods We pre-registered the study on the Open Science Framework (https://osf.io/dqan2/). We searched MEDLINE and Embase from 01/01/2010 to 3/05/2022 to identify eligible studies reporting tools designed for use in primary healthcare settings. Two reviewers independently screened studies, a single reviewer extracted data. We summarised the characteristics of included studies descriptively and calculated the number of studies that collected data relevant to specific social needs categories. We identified sub-categories to classify the types of questions relevant to each of the main categories. Results We identified 420 unique citations, and 27 were included. Nine additional studies were retrieved by searching for tools that were used or referred to in excluded studies. Questions relating to food insecurity and the physical environment in which a person lives were the most frequently included items (92-94% of tools), followed by questions relating to economic stability and aspects of social and community context (81%). Seventy-five percent of the screening tools included items that evaluated five or more social needs categories (mean 6.5; standard deviation 1.75). One study reported that the tool had been 'validated'; 16 reported 'partial' validation; 12 reported that the tool was 'not validated' and seven studies did not report validation processes or outcomes.
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Affiliation(s)
- Emma L. Karran
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Aidan G. Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health and Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Trevor Barker
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Mark A. Boyd
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus University/Rotterdam, Rotterdam, Netherlands
| | - Omar Dewidar
- Bruyere Research Institute, University of Ottawa, Ottawa, Canada
| | | | - Saurab Sharma
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health and Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Peter Tugwell
- Department of Medicine and School of Epidemiology, University of Ottawa, Ottawa, Canada
| | - G. Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
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