Health Disparities and Social Determinants of Health: Current Clinical Practice of Screening and Referrals in Erie County
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Background and Significance: Social Determinants of Health (SDoH) are economic and social circumstances, impacting health outcomes. These have disproportionately impacted minority communities. Healthcare policy reform objectives have moved toward value-based care to include SDoH, anticipated to impact health disparity. Purpose Aims and Objective(s): The purpose of this project was to assess SDoH screening and referral practices among primary care advanced practice registered nurses (APRNs) and clinicians in Erie County, impacting at-risk minority communities. The aim was to uncover practice plan differences, and barriers in addressing social care in the medical model. The objectives were to: survey clinicians on the implementation of social care in their medical practice. Theoretical Framework: The Donabedian Quality Model created by Avedis Donabedian, which focuses on structure, process, outcomes, and quality of care. Method and Design: Original, self-administered, anonymous, single web-based Survey Monkey. Recruitment included convenience sampling of APRN’s and clinicians in primary care in Erie County. Results: The Chi-Square test of screening frequency based on practice plan type was not statistically significant x2 (12) = 6.245, p=.903. 26% of participants reported that they are collecting SDoH in paper form or not at all. The single domain that showed a statistically significant association when examining practice plan differences was socialization/ isolation /communication x2 (16) = 27.83, p=.033. Clinician’s most frequent perception of barriers for screening and referrals was limited time and patient’s unwillingness to disclose information. Conclusions: This DNP project advanced academic scholarship by exposing the need for consistent screening of domains with an individualized workflow plan to include SDoH screening and referrals in the EHR. This project informed that continuing education is needed on healthcare policy reform that directly impacts patient care. Future Implications: Consistency for screening should be a regional policy goal imbedded within the EHR. Partnering with community organizations who address health equity for bidirectional care should be a priority. The gap in policy level knowledge by APRN’s and clinicians provides an area of opportunity for healthcare leadership. This would serve to improve the patients plan of care, health outcomes, lower cost, and reduce health disparity.