Improving Screening Rates for Social Determinants of Health in Pediatric Primary Care Practices

Area of Science:

• Pediatric Primary Care
• Health Services Research
• Quality Improvement Science

Background:

• The COVID-19 pandemic exposed pediatric health disparities and disrupted essential care, including social needs assessments.
• Despite American Academy of Pediatrics recommendations for universal Social Determinants of Health (SDOH) screening, primary care implementation is inconsistent.
• Existing screening processes lack standardization and sustainability, hindering effective identification of patient needs.

Purpose of the Study:

• To implement and evaluate a standardized, sustainable SDOH screening and referral process in pediatric primary care settings.
• To improve SDOH screening rates through structured quality improvement interventions.
• To test the hypothesis that systematic interventions would enhance SDOH screening compliance.

Main Methods:

• A quality improvement (QI) project conducted across six pediatric practices from January to September 2023.
• Utilized the Consolidated Framework for Implementation Research and Plan-Do-Study-Act cycles to address barriers and refine interventions.
• Measured screening completion rates against a SMART aim of increasing compliance from 28% to 42%, with screening refusals as a balancing measure.

Main Results:

• SDOH screening rates significantly increased from a baseline of 28% to 55% across practices.
• All six participating practices achieved statistically significant improvements in screening rates (P < 0.001).
• Positive screens identified social needs in 3.3% to 8% of screened patients, while screening refusals also significantly increased (P < 0.001).

Conclusions:

• Standardized SDOH screening, facilitated by QI methods and stakeholder engagement, effectively boosted screening rates in pediatric primary care.
• Further research is needed to evaluate referral effectiveness, clinical outcomes, and cost-effectiveness of SDOH screening.
• Strategies to mitigate patient discomfort and address systemic barriers to screening and referral require future investigation.