M. J. Adair2, R. Schimmoeller1, L. Hammerling1, R. Oostra1, S. F. Markowiak2, C. Das2, F. C. Brunicardi1,2 1ProMedica Health System,Department Of Medicine,Toledo, OHIO, USA 2University Of Toledo,Department Of Surgery,Toledo, OHIO, USA
Introduction: Social determinants of health (SDOH) are described as the circumstances in which people live and the systems put in place to deal with illness. Collectively, they contribute to social patterning of health, disease, and illness. The increased interest in population health and the growing body of scientific evidence have driven a growing appreciation for the role social factors have in determining health outcomes. The objective of this project was to evaluate SDOH survey implementation, the efficacy of screening questions and whether adequate community resources were available to meet referral needs.
Methods: Data from surveys collected from 1/2017 – 8/2017 focused on ten SDOH risk domains: food insecurity, housing, education, transportation, financial strain, social support, behavioral health, childcare, domestic violence, and employment. Questionnaires were distributed to 558 patients in the ProMedica Health System. Collected were quantitative, categorical and nominal data describing the occurrence of SDOH risk domains across various zip codes in Toledo. Scoring of motivational questions assessed patients' willingness to 1) participate 2) change behaviors that negatively affect health 3) and accept referrals to community resources. Home care coordinators and social workers acted as navigators to manage referrals and coordinate interventions with community resources.
Results: Of 558 patients, 384 agreed to be screened and completed screenings consisting of clinically validated questions. 174 patients declined. Of patients encountered 54% had positive SDOH risks; their needs identified and they elected to have referrals to appropriate community services. The top three risk domains were financial strain (67%) training/employment (56%) and food insecurity (55%). 39% of those screened had needs in four domains or more. A total of 363 (91%) positively screened domains needs were either in the process of being resolved (47%) or have been confirmed resolved (44%). To date, 355 patient community resource referrals have been made as a result of SDOH screening (43% to a community food resource, 20% to a community financial strain resource, 10% to a community utilities resource and 9% to a community training or employment resource).
Conclusion: This study assessed the occurrence of SDOH risk domains, as well as determining prevalence of need, appropriate infrastructure, and availability of community resources to address the needs. The majority of patients surveyed agreed to be screened and participate. Over half those screened had unmet SDOH at risks, and referrals were processed for 91% of domains. This has resulted in the screening tool being embedded in clinical workflow and in electronic health care records, which will be used to screen all ProMedica Health System patients and to develop an evidence based-continuous evaluation system to address SDOH risk domains and appropriate referrals in the greater Toledo community.