Evaluation of a Pilot Study to Standardize Social Determinants of Health Data Collection within an Integrated, Multi-Specialty Healthcare System
Public Health and Recreation
AcademyHealth Annual Research Meeting
Research Objective: As part of the work to address health inequities within an integrated health system in Northern California, Sutter Health implemented an 11-question paper questionnaire and standard work to gather patient information on social determinants of health (SDOH). The eight SDOH domains were alcohol, financial, transportation, physical activity, stress, social connections, intimate partner violence, and depression. The information was integrated into the electronic health record (EHR). This studyevaluated a pilot project within an outpatient clinic in order to inform best practices and the standardization of SDOH data collection throughout the system.
Study Design: This cross-sectional evaluation was grounded in the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. The evaluation assessed elements of the reach, effectiveness, adoption, and implementation of the SDOH questionnaire and standard work and observed differences across patient sociodemographic groups. All patients receiving a Medicare wellness, adult annual, or new patient visit at the clinic during the five-week period (February-March, 2020) were eligible to participate in the pilot, and a comparison group of eligible patients from the same time period in 2019 was identified. Sociodemographic data (age, gender, race/ethnicity, and payment type), visit type, length of visit, and responses to SDOH questions were extracted from the EHR. A survey was administered at the end of the pilot to assess staff’s perspectives on acceptability and utility of the questionnaire and the impact on workflow. Descriptive and bivariate statistical analyses were conducted.
Population Studied: Patients receiving a Medicare wellness, adult annual, or new patient visit at the outpatient clinic.
Principal Findings: 289 patients were eligible for the pilot. Sociodemographic characteristics of the pilot patients were similar to those of the 2019 comparison group. Responsiveness by domain ranged from 55% to 67%, except for depression. Half of the patients had at least one identified social need, the most common social needs being stress, physical activities, alcohol, and social connections. Differences in social needs for physical activities and intimate partner violence across sociodemographic groups were found. Average length of visit increased by 1.7 minutes between 2019 (38.0 minutes) and 2020 (38.7 minutes). Visit lengths were longer among older patients and patients having public insurance. Most staff agreed that collecting SDOH data was relevant and accepted the SDOH questionnaire and workflow but highlighted opportunities for improvement in training and connecting patients to resources.
Conclusions: Using evidence-based SDOH questions embedded within EHR systems with associated workflow changes was effective in gathering patient SDOH information and identifying social needs in outpatient setting within Sutter Health. Future studies should use qualitative data to further understand patient and staff experiences with collecting SDOH information in healthcare settings.
Implications for Policy or Practice: This study provides insights into the process of creating an outpatient SDOH intervention in an integrated health system and can inform the standardization of SDOH data collection and use in other clinical settings. The evaluation demonstrates the utility of considering implementation in the developmental stages of an intervention.
Rachel Berkowitz, Linh Bui, Zijun Shen, Alice Pressman, Maria Moreno, Stephanie Brown, Anne Nilon, Chris Miller-Rosales, and Kristen Azar. "Evaluation of a Pilot Study to Standardize Social Determinants of Health Data Collection within an Integrated, Multi-Specialty Healthcare System" AcademyHealth Annual Research Meeting (2021).