Screen to intervene: Social needs screening and food distribution at a Federally Qualified Health Center
研究在联邦合格健康中心实施电子健康记录工具和临床决策支持，以筛查患者的社会健康需求并引导转诊至支持团队，发现转诊量增加约3倍，有助于改善健康公平。
Background: In October 2018, we implemented electronic health record (EHR) tools for discrete capture of social drivers of health (SDOH).In January 2021 EHR integration of NCCARE360, 1,2 an electronic social care referral platform, encouraged development of systematic workflows for screening and connection of patients with health-related social needs (HRSN) to resources.We have screened 458,434 patients with 80,973 (17.5%) reporting at least one HRSN.However, successfully connecting our patients to resources is much harder.Recognizing multiple barriers to connection including patient, clinic, and community factors, we deployed a centralized social support (CSS) team in December 2022 to play the role of a key connector and focus solely on social needs.Objective: To improve recognition of HRSN and referral of those who want help, we developed clinical decision support at the time of the visit to alert clinicians of the need and facilitate referral to CSS or for higher medical acuity, to care management (CM).Methods: We designed an electronic health record (EHR) practice advisory (PA) to alert clinicians of patients with HRSN who ask for help and refer them to CSS or CM.We analyzed referral numbers before and after implementation in May 2024.We analyzed referral patterns between May 2024 and Dec 2024 in clinical areas that did and did not have PA implemented.We also investigated difference in referral patterns by gender and race/ ethnicity.Results: Since December 2022 until deployment of the BPA, 2420 referrals were made to CSS (average 32/week).Since May 2024, using the Epic advisory dashboard, we can see that the practice advisories have signaled the clinical team on 4340 patients with 1911 (44%) orders to the CSS Team on patients and 623 patients with 286 (13.2%) orders to Duke WELL care management.Referrals to CSS have quadrupled to an average of 120 per week.Using a data retrieval application called slicer dicer in our EHR (Epic of Verona, WI), we filtered on completed visits and certain encounter types excluding telephone and telemedicine, filtered on patients with HRSN in 4 domains who requested help and then sorted by whether PA was shown or not.In this way we can review orders to CSS and CM based on whether PA was shown or not.Referrals increases approximately 3 fold.Conclusion: Clinical decision support can help alert clinicians of patients' social needs and guide them to a support team.Addressing HRSN, the burden of which disproportionately affects Black, Latinx, and Indigenous people is one step to improve health equity.