Implementing a Social Determinants Screening and Referral Infrastructure During Routine Emergency Department Visits, Utah, 2017–2018

Implementing a Social Determinants Screening and Referral Infrastructure During Routine Emergency Department Visits, Utah, 2017–2018

IMPLEMENTATION EVALUATION — Volume 17 — June 18, 2020

Andrea S. Wallace, PhD, RN1; Brenda Luther, PhD, RN1; Jia-Wen Guo, PhD, RN1; Ching-Yu Wang, MS1; Shawna Sisler, MS, RN1; Bob Wong, PhD1 (View author affiliations)

Suggested citation for this article: Wallace AS, Luther B, Guo J, Wang C, Sisler S, Wong B. Implementing a Social Determinants Screening and Referral Infrastructure During Routine Emergency Department Visits, Utah, 2017–2018. Prev Chronic Dis 2020;17:190339. DOI: http://dx.doi.org/10.5888/pcd17.190339external icon.

PEER REVIEWED

On This Page

• Abstract
• Introduction
• Purpose and Objectives
• Intervention Approach
• Evaluations Methods
• Results
• Implications for Public Health
• Acknowledgments
• Author Information
• References
• Tables

Summary

What is already known on this topic?

Self-management of health conditions does not occur in isolation but in the context of patients’ physical, social, and family environment.

What is added by this report?

Implementation efforts should emphasize universal social screening during routine emergency department visits, with careful evaluation for potential bias and stigma among staff, providers, and patients.

What are the implications for public health practice?

Universal screening, referral, and aggregation of clinical and social resource data are possible by using existing resources, but training and the views of those engaged in screening and referrals need to be carefully considered in efforts to implement universal social needs screening.

Abstract

Purpose and Objectives

Emergency departments see a disproportionate share of low-income and uninsured patients. We developed and evaluated a process for identifying social needs among emergency department patients, for facilitating access to community-based resources, and for integrating clinical and community-based data.

Intervention Approach

We leveraged an academic–community partnership to develop a social needs screening tool and referral process.

Evaluation Methods

In a 25-day feasibility trial incorporating rapid improvement cycles, emergency department staff screened 210 patients for social needs. Observational and interview notes were analyzed, and data were linked from patient screenings, the United Way of Salt Lake 2-1-1 consumer information system, and electronic health records.

Results

Domains uncovered during pilot testing included screening based on appearance or insurance; discomfort asking stigmatizing questions; and lack of clarity regarding the screening’s purpose. During the trial, 61% (n = 129) of patients reported 1 or more need, 52% (n = 67) of whom wanted follow-up. Of the 65 patients with complete data who wanted referrals, 49% (n = 32) were ultimately reached by 2-1-1, which provided an average of 4 community referrals (eg, pharmacy programs, utility assistance). Service usage 3 months before versus 3 months after emergency department index dates demonstrated that patients with social needs experienced a significant increase in emergency department use compared with those without needs (1.07 vs 1.36, P = .03), while patients with no needs experienced increases in primary care visits compared with those patients with unmet needs (0.24 vs 0.56, P = .03).

Implications for Public Health

We demonstrated the ability to systematically screen and refer for emergency department patients’ unmet social needs by using existing resources and to link screening results, service referral details, and health service data. However, our experiences demonstrate that widespread implementation efforts should thoughtfully address staff perceptions and patient communication challenges.