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Integrating social needs screening and resource referral into standard ambulatory oncology care: A quality improvement project

Wethington SL, Rositch AF, Yu R, Bielman M, Topel K, Stone RL, Ferriss JS, Fader AN, Beavis AL
JCO oncology practice

PURPOSE: We previously implemented paper-based screening for health-related social resource needs (HRSN) in our gynecologic oncology clinic and found that 36% of patients who completed the screening reported HRSN. We identified two primary deficiencies with our process. First, only 52% of patients completed the screening. Second, 37% of patients with needs failed to indicate if they desired resource referral or not. Therefore, we conducted a quality improvement project to integrate screening and referral processes into the electronic medical record (EMR) and routine clinic workflow to achieve at least 90% screening compliance and 90% elicited referral preference.

METHODS: A multidisciplinary team consisting of physicians, a health outcomes researcher, a computer programmer, project assistants, and the staff of a partner community organization designed and implemented an intervention that screened for HRSN online via the EMR patient platform or in person during visits. The primary outcome was the percentage of eligible patients who completed the HRSN screening (ie, reach). Outcomes were reviewed weekly, and feedback was provided to stakeholders monthly. Iterative changes were incorporated into five successive Plan-Do-Study-Act (PDSA) cycles completed from January 2021 to March 2023.

RESULTS: Screening compliance increased from the baseline of 52% (paper-based) to 97% in PDSA 4. Completion via the online patient portal increased from 17% in prelaunch to 49% in PDSA 4. Of patients who reported needs, 100% had a documented referral preference.

CONCLUSION: Compared with paper-based screening, an EMR-integrated HRSN screening and referral system significantly improved reach to patients at a gynecologic oncology clinic. Implementation efforts to expand to other ambulatory clinic settings are in process.

Wethington SL, Rositch AF, Yu R, et al. Integrating social needs screening and resource referral into standard ambulatory oncology care: a quality improvement project. JCO oncology practice. 2024;20(4):566-571. DOI:10.1200/OP.23.00485. PMID: 38277618

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Publication year
Resource type
Peer Reviewed Research
Outcomes
Process
Social Needs/ SDH
Screening research
Yes
Social Determinant of Health
Childcare
Economic Security
Food/Hunger
Housing Quality
Housing Stability
Transportation
Utilities
Study design
Other Study Design