Scaling-up social needs screening in practice: a retrospective, cross-sectional analysis of data from electronic health records from Bronx county, New York, USA.
Scaling-up social needs screening in practice: a retrospective, cross-sectional analysis of data from electronic health records from Bronx county, New York, USA.
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DOI：
10.1136/bmjopen-2021-053633
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发表时间：
2021-09-29
期刊：
影响因子：
2.9
通讯作者：
Racine AD
中科院分区：
文献类型：
--
作者：
Fiori KP;Heller CG;Flattau A;Harris-Hollingsworth NR;Parsons A;Rinke ML;Chambers E;Hodgson S;Chodon T;Racine AD
人们重新将重点放在卫生系统上，整合社会保健以改善健康结果，而相对较少的相关研究侧重于“现实世界”实践。这项研究描述了一个卫生系统在2017年成功试点后，从2018年到2020年在一个大型城市初级保健门诊网络中扩大对患者的社会需求筛查的经验。位于美国纽约市一个城市县的学术医疗中心，有一个由18个初级保健诊所组成的流动网络。这项回顾性的横断面研究使用了244764名患者的电子健康记录，这些患者在2018年4月10日至2019年12月8日期间进行了18种初级保健做法中的任何一种的临床访问。我们使用RE-AIM框架的REACH和采纳域组织措施，以确定分别接受筛查的患者数量和采用筛查和相关文件的提供者数量。我们使用描述性统计来总结比较筛查患者和未筛查患者的因素、社会需求筛查的流行率和18个实践中的采用情况。在2018年4月至2019年12月期间，对53093名患者进行了社交需求筛查，约占就诊患者的21.7%。近五分之一(19.6%)的患者报告至少有一项社会需求未得到满足。筛查患者的百分比因诊所地点(1.6%-81.6%)和诊所内的专业而异。51.8%的提供者(n=1316)至少筛查了一名患者。这些发现既显示了将社会护理纳入实践的潜力，也说明了将其纳入实践的挑战。我们观察到整个卫生系统的摄取率存在显著的差异。需要更多的研究来更好地了解推动采用的因素，可能包括协调工作流程、建立统一的目标和使用数据来推动改进。
There has been renewed focus on health systems integrating social care to improve health outcomes with relatively less related research focusing on ‘real-world’ practice. This study describes a health system’s experience from 2018 to 2020, following the successful pilot in 2017, to scale social needs screening of patients within a large urban primary care ambulatory network. Academic medical centre with an ambulatory network of 18 primary care practices located in an urban county in New York City (USA). This retrospective, cross-sectional study used electronic health records of 244 764 patients who had a clinical visit between 10 April 2018 and 8 December 2019 across any one of 18 primary care practices. We organised measures using the RE-AIM framework domains of reach and adoption to ascertain the number of patients who were screened and the number of providers who adopted screening and associated documentation, respectively. We used descriptive statistics to summarise factors comparing patients screened versus those not screened, the prevalence of social needs screening and adoption across 18 practices. Between April 2018 and December 2019, 53 093 patients were screened for social needs, representing approximately 21.7% of the patients seen. Almost one-fifth (19.6%) of patients reported at least one unmet social need. The percentage of screened patients varied by both practice location (range 1.6%–81.6%) and specialty within practices. 51.8% of providers (n=1316) screened at least one patient. These findings demonstrate both the potential and challenges of integrating social care in practice. We observed significant variability in uptake across the health system. More research is needed to better understand factors driving adoption and may include harmonising workflows, establishing unified targets and using data to drive improvement.
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