Background: Social determinants of health (SDH) are known to negatively influence medical outcomes and are prevalent among people with diabetes, but systematic screening and use in routine diabetes care remains limited.
Methods: We used quality improvement methodology to pilot a SDH screening protocol in our diabetes center in an underserved community, and included new adult diabetes patients of 2 providers from October to December 2019. We used a standardized SDH screen offered by the EPIC electronic health record system, which included 10 questions on transportation issues, food security, affordability of medication, housing stability, personal safety, and financial strain, among others. We performed iterative tests of the algorithm to improve reliability. Completion of the screen and responses were tracked electronically. Feasibility and acceptability were assessed with brief interviews of clinic staff and patients after each screen cycle.
Results: Following implementation of the SDH screen protocol, 50 out of 53 (94%) eligible patients were screened (mean age 30, 53% female, 72% Medicaid). Patients who did not complete screens refused due to privacy concerns or were unable to respond due to developmental delay. One-third of patients (n= 17, 32%) reported at least 1 SDH. The most common SDH noted were lack of transportation to visits and food insecurity. Participants who reported SDH and desired assistance were referred to a care coordinator trained to address social needs. In brief post-screen interviews, staff and patients alike expressed high feasibility and acceptability of the SDH screen.
Conclusions: Screening for SDH is important, uncovering social needs that are relevant and impactful for diabetes outcomes, while still maintaining high staff and patient acceptability. Given potential for linkage to future payment, SDH screening should be incorporated into routine diabetes care.
A. Manavalan: None. D. Lee: None. A. Jang: None. S. Agarwal: None.