Development and Implementation of a Standardized Social Determinants of Health Screening Program at Northwell Health Christy Leung MPH1, Debbie Salas-Lopez MD MPH2, Johanna Martinez MD MS2, Barbara Felker2, Taylor Klavans MHA2, Olushola Latus-Olaifa2 1Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 2Northwell Health
Background
Results
• Social determinants of health (SDoH) are defined as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”1 • SDoH – encompassing the socioeconomic factors, physical environment, and health behaviors of our patients – are thought to drive more than 80% of health outcomes • Direct impacts of health inequity due to SDoH factors was highlighted by the COVID-19 pandemic, which disproportionately affected low-income racial and ethnic communities2 • Payment models are moving away from traditional fee-for-service to value-based payments, which incentivize improving population health and preventing poor health outcomes • Addressing SDoH is one of the key methods through which health systems can improve health, reduce health disparities, and provide comprehensive care to its communities
Northwell Health SDoH Screener
Goal: Develop a standardized SDoH Screening Tool and workflow process that will be utilized across all care settings and facilities across Northwell Health. Create the infrastructure needed to collect and analyze SDoH data necessary for the development of future community and population health interventions.
TRANSPORTATION
LIVING SITUATION 1. What is your living situation today? 2. Think about the place you live. Do you have problems with any of the following? FOOD 3. Within the past 12 months, you worried that your food would run out before you got money to buy more 4. Within the past 12 months, the food you bought just didn’t last and you don’t have money to get more
5. In the past 12 months, has lack of transportation kept you from medical appointments, meetings, work or from getting things needed for daily living? UTILITIES 6. In the past 12 months has the electric, gas, oil, or Water Company threatened to shut off services in your home? 3
SAFETY 7. How often does anyone, including family and friends, physically hurt you? 8. How often does anyone, including family or friends, insult or talk down to you? 9. How often does anyone, including family and friends, threaten you with harm? 10.How often does anyone, including family and friends, scream or curse at you? INCOME / BASIC NEEDS
Develop the Northwell Health SDoH Screener 1.Gather individuals with expertise in SDoH that can develop a standardized screener tool 2.Gather information on best practices across the country and validated screening tools already being used in different health systems Implement the Standardized Core Questions and Workflow 1.Gather individuals from different stakeholder groups to collaborate on a workflow process that is both standardized but adaptable enough for different care settings 2.Build the technological infrastructure and workforce capacity needed for successful implementation of the Screener tool and workflow process 3.Develop and track outcome measures to continually evaluate performance
Figure 2: Clinical workflow for SDoH needs
The Northwell Health Social Determinants of Health Core Screener consists of fifteen (15) questions covering eight (8) domains that have been chosen in order to provide a comprehensive view of a patient’s behavioral health and social needs. Questions were adapted from the Center of Medicare & Medicaid Services’ (CMS) Health-Related Social Needs Screening Tool.4
Methods Figure 1: Nominal Group Technique utilized for stakeholder meetings
Results
11.Do you ever skip medications that you need, or going to the doctor, to save money? 12.Do you need help getting public benefits like food stamps (SNAP), WIC, welfare, disability income (SSI)? 13.How hard is it for you to pay for the very basics like food, housing, medical care, and heating? Would you say it is… LEGAL ASSISTANCE 14.Do you need help from a lawyer with the following: housing, immigration, custody, child support, other?
• A standardized approach to addressing SDoH needs was developed, consisting of three key phases: (1) Initial Screening, (2) Intervention, and (3) Follow-Up • Data collected from each stage of the Screening Process is documented within the health system’s EMR system and community referral platform – ability to leverage the health system’s Health Information Exchange (HIE) to ensure visibility across care settings
Future Direction • Implementation of the new SDoH Screener Tool will occur first, with standardization of workflows and development of technology infrastructure coming afterwards • Ongoing evaluation and quality improvement efforts are crucial as the program is rolled out across the health system • Publication of the Northwell Health SDoH Screening Program Toolkit will allow the dissemination of information to other healthcare organizations seeking to implement similar programs
Acknowledgements • This project was made possible through the Klar Leadership Development and Innovation Management Program. Thank you to Dr. Judith Brenner, Tiffany Jordan, and Steven Klar for their support and mentorship throughout the program
Resources 1 Healthy
People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved September 2021, from https://health.gov/healthypeople/objectives-and-data/social-determinants-health 2 Kim
EJ, Marrast L, Conigliaro J. COVID-19: Magnifying the Effect of Health Disparities. J Gen Intern Med. 2020;35(8):2441-2442. doi:10.1007/s11606-020-05881-4 3 Willis,
DIGITAL DIVIDE 15.Do you or any member of your residence own or use any of the following devices?
Ian & Varga-Atkins, Tünde & McIsaac, Jaye. (2015). Focus Group meets Nominal Group Technique: an effective combination for student evaluation?. Innovations in Education and Teaching International. 54. 10.1080/14703297.2015.1058721. 4 U.S.
Department of Health and Human Services, Centers for Medicare & Medicaid Services. The Accountable Health Communities Health-Related Social Needs Screening Tool. https://innovation.cms.gov/files/worksheets/ahcm-screeningtool.pdf.