Improving health-related social needs screening and support across a pediatric health care system

BACKGROUND AND OBJECTIVES: Health-related social needs (HRSN) affect a wide range of short- and long-term outcomes, health care use, functioning, and quality of life. Although HRSN screening is valuable, it is likely ineffective unless coupled with interventions. This project integrated HRSN screening and intervention(s) across 9 inpatient and outpatient divisions, varied in composition, patient populations, process flows, and resource availability. 

METHODS: A quality improvement team with a standardized change package facilitated a multimodal initiative for divisions spanning hospital medicine, newborn nurseries, and specialty outpatient clinics at an urban, quaternary pediatric hospital system. We aimed for 80% of patient encounters to be screened for HRSN and that each positive screen receive an agreed upon resource intervention using a centralized resource bank. 

RESULTS: From January 2021 to October 2023, 31 834 screenings were conducted across 9 divisions. Performance increased to a mean 92%, with positive screens receiving interventions. The last 7 months of the project were sustained at 92% or higher. Food insecurity was identified in 17.6% of encounters (n = 10 007, 1765 positive), with a 56% decrease in prevalence on repeat screening after identification/intervention. 

CONCLUSIONS: A centralized quality team and change package can facilitate successful implementation of HRSN screening and connection to resources across multiple disciplines and sites. These interventions may lead to a decrease in subsequent HRSN positivity. Rescreening patients over time is important to capture the full spectrum of HRSN needs of a family.