TY - JOUR
T1 - Learning in real world practice
T2 - Identifying implementation strategies to integrate health-related social needs screening within a large health system
AU - Fiori, Kevin
AU - Levano, Samantha
AU - Haughton, Jessica
AU - Whiskey-Lalanne, Renee
AU - Telzak, Andrew
AU - Hodgson, Sybil
AU - Spurrell-Huss, Elizabeth
AU - Stark, Allison
N1 - Publisher Copyright:
© The Author(s), 2023. Published by Cambridge University Press on behalf of The Association for Clinical and Translational Science.
PY - 2023/10/16
Y1 - 2023/10/16
N2 - Introduction: Health systems have many incentives to screen patients for health-related social needs (HRSNs) due to growing evidence that social determinants of health impact outcomes and a new regulatory context that requires health equity measures. This study describes the experience of one large urban health system in scaling HRSN screening by implementing improvement strategies over five years, from 2018 to 2023. Methods: In 2018, the health system adapted a 10-item HRSN screening tool from a widely used, validated instrument. Implementation strategies aimed to foster screening were retrospectively reviewed and categorized according to the Expert Recommendations for Implementing Change (ERIC) study. Statistical process control methods were utilized to determine whether implementation strategies contributed to improvements in HRSN screening activities. Results: There were 280,757 HRSN screens administered across 311 clinical teams in the health system between April 2018 and March 2023. Implementation strategies linked to increased screening included integrating screening within an online patient portal (ERIC strategy: involve patients/consumers and family members), expansion to discrete clinical teams (ERIC strategy: change service sites), providing data feedback loops (ERIC strategy: facilitate relay of clinical data to providers), and deploying Community Health Workers to address HRSNs (ERIC strategy: create new clinical teams). Conclusion: Implementation strategies designed to promote efficiency, foster universal screening, link patients to resources, and provide clinical teams with an easy-to-integrate tool appear to have the greatest impact on HRSN screening uptake. Sustained increases in screening demonstrate the cumulative effects of implementation strategies and the health system's commitment toward universal screening.
AB - Introduction: Health systems have many incentives to screen patients for health-related social needs (HRSNs) due to growing evidence that social determinants of health impact outcomes and a new regulatory context that requires health equity measures. This study describes the experience of one large urban health system in scaling HRSN screening by implementing improvement strategies over five years, from 2018 to 2023. Methods: In 2018, the health system adapted a 10-item HRSN screening tool from a widely used, validated instrument. Implementation strategies aimed to foster screening were retrospectively reviewed and categorized according to the Expert Recommendations for Implementing Change (ERIC) study. Statistical process control methods were utilized to determine whether implementation strategies contributed to improvements in HRSN screening activities. Results: There were 280,757 HRSN screens administered across 311 clinical teams in the health system between April 2018 and March 2023. Implementation strategies linked to increased screening included integrating screening within an online patient portal (ERIC strategy: involve patients/consumers and family members), expansion to discrete clinical teams (ERIC strategy: change service sites), providing data feedback loops (ERIC strategy: facilitate relay of clinical data to providers), and deploying Community Health Workers to address HRSNs (ERIC strategy: create new clinical teams). Conclusion: Implementation strategies designed to promote efficiency, foster universal screening, link patients to resources, and provide clinical teams with an easy-to-integrate tool appear to have the greatest impact on HRSN screening uptake. Sustained increases in screening demonstrate the cumulative effects of implementation strategies and the health system's commitment toward universal screening.
KW - Social determinants of health
KW - health equity
KW - health-related social needs
KW - learning health system
KW - quality improvement
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U2 - 10.1017/cts.2023.652
DO - 10.1017/cts.2023.652
M3 - Article
AN - SCOPUS:85174409118
SN - 2059-8661
VL - 7
JO - Journal of Clinical and Translational Science
JF - Journal of Clinical and Translational Science
IS - 1
M1 - e229
ER -