P2.284: Improving Social Determinants of Health Screening in a Community based Pediatric Primary Care Hospital

Purpose/Objectives: Social determinants of health (SDH) are the conditions in people's environments that influence health outcomes and risks. Healthy People 2030 categorizes SDH into five domains: economic stability, education, social/community context, health care, and neighborhood environment. These factors contribute to health disparities. In Central Harlem, 21% of residents live in poverty, higher than the NYC average of 18%. Harlem Hospital’s pediatrics clinic serves an underserved population facing significant social disadvantages, contributing to disparities such as double the rate of child asthma emergency visits compared to the city average. Additionally, 10.4% of maternity patients receive late or no prenatal care, compared to 5.3% in Manhattan. This study aims to increase SDH screening in the pediatric clinic from 7% to 60% by January 2025.

Design/Methods: Starting in July 2024, an interdisciplinary team was convened to improve SDH screening rates using the Institute for Healthcare Improvement's Model for Improvement as guidance. A key driver diagram directed the improvement efforts (Figure 1). The outcome measure was the percentage of clinic patients screened for SDH. The process measure was the utilization of tablets for SDH screening. As a balancing measure, the time it took for nurses to complete the forms was tracked. To ensure equity, the preferred language of non-screened patients was analyzed. To drive improvement, monthly meetings were held to enhance clinic staff engagement and promote the consistent use of SDH screening practices. In September 2024, tablets were introduced to streamline the screening process. Data were graphed on run charts to measure improvement over time.

Results: After four months, screening rates increased from a baseline of 7% to 35% (Figure 2). Among those screened, 41% tested positive for at least one SDH need (n=2,118). The most common needs identified were employment, food insecurity, transportation, and education. Regarding tablet usage, utilization increased from 0% to 25%. Of those screened, 69% spoke English, while 31% spoke a non-English language, highlighting a language equity gap. Staffing issues and patient hesitancy emerged as key themes in barriers to screening.

Conclusion/Discussion: Addressing SDH is crucial for improving quality and outcomes for pediatric patients. SDH screening rates improved with quality improvement interventions, but there is still room to further improve screening to better identify and support Harlem pediatric primary care clinic patients. Further improvement work will focus on ensuring patients who screen positive are connected to necessary resources.