Boston Medical Center's new screening tool has shown promise for addressing patients' social needs in primary-care settings and developing better clinical strategies, according to a study published Wednesday.
The hospital has embedded a screening program for identifying social needs within its electronic health record system that automatically processes responses and prints out a list of appropriate resources.
Using the tool, BMC was able to identify social determinants of health in more than a quarter of more than 1,600 patients from August 2017 through January 2018, the study in the journal Medical Care said.
Study lead author Dr. Pablo Buitron de la Vega, a general internal medicine physician at BMC, said using the EHR is a more seamless way to make addressing social needs a part of clinicians' daily workflow, which saves time and lessens their administrative burden so that they can spend more time with patients.
"The ability to successfully incorporate this critical information into the electronic medical record is a true game changer when it comes to addressing the whole patient," Buitron de la Vega said. "As a physician, this information is vital to the health and well-being of my patients and their families."
The study found a lack of employment, food insecurity, and problems affording medications were the most prevalent social needs among respondents. Among those who reported having a social need, 22% requested help connecting to resources, and 86% of those who requested help were referred to resources.
Buitron de la Vega said an initial paper questionnaire asking patients about their social needs was ruled out because it was too much of an administrative burden and too time consuming for clinical staff to process. That's when they started incorporating the screener questions within BMC's electronic medical record system along with an automated dashboard to speed up the reporting process. Medical assistants spent an average of one minute entering patient responses from the screening into the patient's medical record.
Patients answer questions related to eight social needs including homelessness, food insecurity, inability to afford medications and lack of transportation to medical appointments.
Patients who request assistance receive information about community resources, and care navigators are available to connect them with the appropriate resources.
Buitron de la Vega said the data collected helps clinicians in determining the most effective to address social factors. The data could also inform health systems about better investments in interventions or how to improve government policies by identifying gaps in community resources.
"We don't only want to address the acute needs, but we want to prevent the needs from happening," Buitron de la Vega said.
BMC uses the same program to screen all patients for social needs across all clinical departments, Buitron de la Vega said. More than 57,000 patients have been screened, with 28% reporting at least one need. Twenty out of every 100 patients screened request help, and 14 of those patients get connected to resources.
More healthcare providers have started screening patients for social determinants as they recognize the impact those issues have on health outcomes.
Last week, Kaiser Permanente announced a three-year plan to launch a social care network beginning this summer that when completed would have the potential to connect the system's more than 12 million members to community services that address their social needs.
Yet only some health systems have taken steps to use the information they collect regarding social needs to make systemwide changes. A 2017 survey by the Deloitte Center for Health Solutions of 300 hospitals and health systems found while 88% reported screening patients for social needs, 72% of hospitals had not made any investments and nearly 40% were not measuring the outcomes of their initiatives.
