Dana Kliewer

Inpatient Screening for Social Determinants of Health: A Quality Improvement Initiative

Background: Social determinants of health (SDOH) can contribute to related health disparities and inequities that negatively impact health outcomes and healthcare utilization. Comprehensive screening is frequently overlooked as an integral component to inpatient clinical care.

Purpose: The aims of the project were to evaluate the feasibility of implementing a multi-domain SDOH screening tool during hospital admissions, the effectiveness in identifying unmet SDOH needs, and the effectiveness in identifying patients at risk for readmissions.

Methods: The PRAPARE screening tool was implemented on admission with adult inpatients at an academic tertiary care hospital in central Pennsylvania. Quantitative methods were utilized to compare PRAPARE findings to the current standard of care screening and to analyze readmission rates. Qualitative methods were utilized to analyze the content of project coordinator journals for themes surrounding screening sustainability.

Results: Over an 8-week pilot period, 80 patients were screened using the PRAPARE tool. 43.7% of participants were identified as having at least 1 unmet SDOH need and 21.2% were identified as having 2 or more needs. Patients were more likely to have SDOH needs identified through PRAPARE screening compared to current standards of care, with statistically significant differences in identification of difficulty with access to or affording aspects of healthcare (X2 =4.0097, p=0.04524), food insecurity (X2 =9.000, p=0.002687), and concern for housing instability (X2 =9.009, p=0.002687). Of those identified as having at least 1 unmet SDOH need, 48.5% experienced a readmission within 30-days, compared to 13% readmissions among those with no identified SDOH needs.

Conclusions and Implications: Utilization of the PRAPARE screening tool to identify unmet SDOH needs has a higher capture ability when compared to current standards of practice. Implementation of a SDOH screening tool was successful within the pilot with all data collection by the project coordinator. This project will lead to discussion of a more sustainable method for universal SDOH screening within the health system to ensure identification of these upstream drivers of health outcomes, to be followed by development of future targeted interventions.

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