P2.O296: Pilot Implementation of a Health-Related Social Needs Screen in a Hospital-Based Pediatric Advanced Cardiac Therapies Clinic

Purpose/Objectives: Studies have shown an association between social determinants of health (SDOH) and health outcomes in patients with congenital heart disease, pediatric heart failure and transplant. We introduced a health-related social needs (HRSN) screening tool in our high-volume Advanced Cardiac Therapies (ACT) clinic to incorporate a standardized approach to assess unmet needs and provide more comprehensive support.

Design/Methods: Through a series of PDSA cycles, we developed and refined our processes in general cardiology clinic and then ACT, including tailoring HRSN questions to our population (Figure 1), translating the tool into 6 additional languages, developing workflow for distribution and review of screeners, modifying data collection tools and process, defining needs warranting urgent social work (SW) assessment, expanding to different clinics, providing in-person assistance in early cycles, and reviewing data weekly with a multi-disciplinary team. We aimed to distribute the screener to heart failure/ heart transplant patients from October 2023 to March 2024 in ACT clinic, and to evaluate our clinic’s ability to respond to the identified needs. Our process measure was number of screeners documented. Outcome measures were percent of patients with identified needs in different domains (housing, food, transportation, utilities, medical expenses), resources provided, and number of SW consults completed. Balancing measures were time spent by SW team around addressing needs, and qualitative feedback on implementation by team.

Results: Since implementation, 217 screeners were completed; 63 of the 217 documented screeners (29%) identified at least one unmet need in any domain, and 38 of the 63 screeners (60%) identified unmet needs in more than one domain. Urgent needs were reported in 6 unique families. Resources offered included: time with the SW team, information sheets, parking vouchers, transportation, referral to government agencies, and gas, gift and grocery cards. Of the documented social work interactions (n= 35 instances), the median SW time per ACT patient visit was 30 minutes (range 15 to 75 minutes). There was a mixed response from the clinic staff to the screener; the majority reported that the screening tool was important and helped to identify needs. Some challenges/concerns included limited or unavailable resources to address identified needs, and frequency of survey distribution.

Conclusion/Discussion: We found the use of a screening tool provided a standardized way to identify SDOH needs and connect patients with resources. Implementing a HRSN screening tool in a busy ACT clinic was feasible, but not without challenges. Future efforts will focus on increasing the percent of eligible patients screened, and further engaging clinic staff members in discussions on possible process improvements and resources necessary to expand.