Background
Methods
Formative work
Description of the SDOH questionnaire and workflow
Pilot evaluation
Evaluation conceptual framework
Applicable RE-AIM Constructs | Evaluation objectives | Indicator(s) | Data Source(s) |
---|---|---|---|
Reach “The absolute number, proportion, and representativeness of individuals who are willing to participate in a given...intervention...” p.3 [32] | Examine reach in the eligible patient population and across sociodemographic groups | Proportion of 2020 eligible patients who responded to any survey question | EHR data extraction |
Sociodemographic comparability of 2020 eligible patients based on survey completeness, overall and by domain | EHR data extraction | ||
Effectiveness “The impact of an intervention on important outcomes, including potential negative effects...[as well as] heterogeneity of effects.” p.3 [32] | Understand effectiveness in identifying patient SDOH needs overall and across sociodemographic groups | Proportion of 2020 participating patients who had an identified SDOH need | EHR data extraction |
Sociodemographic comparability of 2020 participating patients based on identified SDOH need | EHR data extraction | ||
Discern staff perspectives on potential impact of pilot survey and standard work on patients | Proportion of staff who identify potential positive impacts on patients | Staff experience survey | |
Proportion of staff who identify potential negative impacts on patients | Staff experience survey | ||
Discern physician perspectives on the impact of having social needs information on medical decision making | Proportion of physician staff respondents who agreed that having patients’ social needs information would influence medical decision making | Staff experience survey | |
Adoption “The absolute number, proportion, and representativeness of...intervention agents who are willing to initiate a program [and]...Reasons for adoption or non-adoption.” p.3 [32] | Discern staff perspectives in relation to the utility and appropriateness of the pilot survey and standard work | Proportion of staff who agree with the relevance of collecting social needs information | Staff experience survey |
Proportion of staff who agree with the utility of collecting social needs information | Staff experience survey | ||
Implementation “At the setting level...the intervention agents’ fidelity to the various elements of an intervention’s protocol, including consistency of delivery as intended and the time required.” p.4 [32] | Assess impact on visit length across patient sociodemographic groups | Comparability of 2019 and 2020 visit lengths among eligible patients | EHR data extraction |
Sociodemographic comparability of visit length among 2020 eligible patients | EHR data extraction | ||
Discern staff perspectives on barriers to implementation of pilot survey and standard work | Proportion of staff who are knowledgeable about and confident in the implementation of the SDOH pilot survey and standard work | Staff experience survey | |
Proportion of staff who experienced barriers to implementing the SDOH pilot survey and standard work | Staff experience survey |
Pilot study setting and participants
Data sources
Evaluation metrics
Statistical analysis
Results
Reach
2019 | 2020 | P-values | |
---|---|---|---|
N(%) | N(%) | ||
Eligible patients | 283 (100%) | 289 (100%) | |
Age | |||
18-24 | 30 (10.60) | 35 (12.11) | 0.92281 |
25-34 | 68 (24.03) | 63 (21.80) | |
35-54 | 103 (36.40) | 101 (34.95) | |
55-64 | 37 (13.07) | 40 (13.84) | |
65+ | 45 (15.90) | 50 (17.30) | |
Sex | |||
Male | 120 (42.40) | 114 (39.45) | 0.52611 |
Female | 163 (57.60) | 175 (60.55) | |
Race/Ethnicity | |||
Non-Hispanic white | 92 (32.51) | 89 (30.79) | – |
Non-Hispanic Black | 54 (19.08) | 57 (19.72) | |
Non-Hispanic Asian | 10 (3.53) | 25 (8.65) | |
Hispanic/Latinx | 103 (36.40) | 92 (31.83) | |
Non-Hispanic Native Hawaiian/ Pacific Islander | 4 (1.41) | 5 (1.73) | |
Non-Hispanic American Indian/Alaska Native | 1 (0.35) | 0 (0.00) | |
Multiple races | 3 (1.06) | 4 (1.38) | |
Unknown/No Response | 16 (5.65) | 17 (5.88) | |
Insurance type | |||
Medicaid | 3 (1.06) | 8 (2.77) | 0.41671 |
Medicare | 49 (17.31) | 50 (17.30) | |
Private | 221 (78.09) | 215 (74.39) | |
Self-Pay/Not Listed | 4 (1.41) | 8 (2.77) | |
Other | 6 (2.131.05) | 8 (2.77) | |
Clinic | |||
Family Medicine | 171 (60.42) | 184 (63.67) | 0.47571 |
Internal Medicine | 112 (39.58) | 105 (36.33) | |
Visit Type | |||
New Patient/Transfer | 192 (67.84) | 188 (65.05) | 0.73341 |
Medicare Wellness | 18 (6.36) | 18 (6.23) | |
Adult Wellness | 73 (25.80) | 83 (28.72) |
Any response to SDOH surveya | Identified SDOH needb | No response to SDOH surveyc | |
---|---|---|---|
N (%) | N (%) | N (%) | |
At least one domain | 240 (83.04) | 123 (51.25) | 49 (16.96) |
All domains | 10 (3.46) | 0 (0.00) | 49 (16.96) |
Financial resource need | 152 (52.60) | 11 (4.58) | 137 (47.40) |
Transportation | 165 (57.09) | 6 (2.50) | 124 (42.91) |
Alcohol | 195 (67.47) | 29 (12.08) | 94 (32.53) |
Physical activities | 168 (58.13) | 52 (21.67) | 121 (41.87) |
Stress | 163 (56.40) | 78 (32.50) | 126 (43.60) |
Depression | 20 (6.92) | 5 (2.08) | 269 (93.08) |
Social connections | 159 (55.02) | 15 (6.25) | 130 (44.98) |
Intimate partner violence | 162 (56.06) | 13 (5.42) | 127 (43.94) |
Effectiveness
Statements | All (N = 20) | Physicians (N = 3) | MAs (N = 7) | PSRs (N = 5) | Other staff (N = 5) |
---|---|---|---|---|---|
Strongly agree/Agree N (%) | |||||
Effectiveness | |||||
Potential for SDOH survey and standard work to positively impact patients | |||||
Patients’ unmet social needs information could be used to improve patient care and health outcomes | 18 (90%) | 2 (67%) | 6 (86%) | 5 (100%) | 5 (100%) |
Patients’ unmet social needs information could be used to improve therapeutic relationship with patients | 18 (90%) | 2 (67%) | 6 (86%) | 5 (100%) | 5 (100%) |
Patients might feel uncomfortable answering questions about their unmet social needs | 16 (80%) | 2 (67%) | 6 (86%) | 4 (80%) | 4 (80%) |
Having access to patients’ unmet social needs information would influence physician’s medical decision | 0 (0%) | 1 (33%) | N/A | N/A | N/A |
Adoption | |||||
Relevance of SDOH survey and standard work in clinical setting | |||||
Collecting social needs information is within the scope of clinical care | 19 (95%) | 3 (100%) | 7 (100%) | 5 (100%) | 4 (80%) |
Many patients in the clinic have unmet social needs that impact their health | 16 (80%) | 3 (100%) | 4 (57%) | 4 (80%) | 5 (100%) |
Utility of SDOH survey and standard work for achieving intended aims | |||||
SDOH survey improves clinic’s ability to identify patients with unmet social needs | 18 (90%) | 2 (67%) | 7 (100%) | 5 (100%) | 4 (80%) |
The SDOH survey asks all relevant questions | 16 (80%) | 3 (100%) | 5 (71%) | 4 (80%) | 4 (80%) |
SDOH survey increases the likelihood that patients are connected with case management and social services | 17 (85%) | 2 (67%) | 7 (100%) | 4 (80%) | 4 (80%) |
Implementation | |||||
Knowledge and availability of needed resources in clinical setting to achieve positive impact for patients | |||||
I am aware of Sutter resources available to address patients’ social needs | 10 (50%) | 1 (33%) | 3 (43%) | 2 (40%) | 4 (80%) |
I am confident in my ability to help patients address their social needs | 10 (50%) | 0 (0%) | 4 (57%) | 2 (40%) | 3 (60%) |
I understand my role in offering the SDOH survey to patients | 17 (85%) | 2 (67%) | 7 (100%) | 4 (80%) | 4 (80%) |
Barriers to implementing SDOH survey and standard work | Major barrier/Barrier (N(%)) | ||||
Lack of time for patients to complete survey | 15 (75%) | 3 (100%) | 6 (86%) | 3 (60%) | 3 (60%) |
Lack of training about administering survey | 4 (20%) | 1 (33%) | 1 (14%) | 1 (20%) | 1 (20%) |
Lack of training about how to respond to social needs | 9 (45%) | 1 (33%) | 3 (43%) | 3 (60%) | 2 (40%) |
Lack of time to respond to social needs | 13 (65%) | 1 (33%) | 5 (71%) | 2 (40%) | 3 (60%) |
Lack of resources to address social needs | 9 (45%) | 2 (67%) | 2 (29%) | 2 (40%) | 3 (60%) |
Adoption
Implementation
2019 | 2020 | P values | |
---|---|---|---|
Mean (Standard Deviation) | |||
All eligible visits (N = 572) | N = 283 | N = 289 | |
Whole visit | 38.04 (14.77) | 39.75 (13.88) | 0.15371 |
Check-in to rooming | 7.59 (7.72) | 7.57 (6.74) | 0.18442 |
Rooming (time with MA) | 9.14 (6.85) | 9.8 (5.16) | 0.04092* |
Exam (time with provider) | 17.09 (10.37) | 16.22 (8.65) | 0.63232 |
New patient or Transfer (N = 380) | N = 192 | N = 188 | |
Whole visit | 38.79 (15.04) | 40.66 (13.92) | 0.20751 |
Check-in to rooming | 7.50 (7.93) | 7.78 (7.29) | 0.71871 |
Rooming (time with MA) | 9.21 (4.86) | 10.57 (5.05) | 0.00801* |
Exam (time with provider) | 18.48 (10.3) | 16.71 (8.62) | 0.18192 |
Medicare Wellness (N = 36) | N = 18 | N = 18 | |
Whole visit | 39.56 (15.36) | 43.22 (14.21) | 0.37513 |
Check-in to rooming | 9.5 (7.9) | 7.94 (6.58) | 0.58933 |
Rooming (time with MA) | 11.46 (4.05) | 12.7 (6.8) | 0.94953 |
Exam (time with provider) | 11.22 (4.46) | 15.95 (9.85) | 0.03143* |
Health Maintenance Exam (N = 156) | N = 73 | N = 83 | |
Whole visit | 35.7 (13.83) | 36.93 (13.44) | 0.57471 |
Check-in to rooming | 7.36 (7.13) | 7.02 (5.39) | 0.61022 |
Rooming (time with MA) | 8.37 (10.74) | 7.43 (4.12) | 0.72382 |
Exam (time with provider) | 14.89 (10.81) | 15.17 (8.47) | 0.58932 |