O2039: Development and Implementation of a Health-Related Social Needs Screener in a Hospital-based Pediatric Cardiology Clinic

Background: Social determinants of health impact patients with congenital heart disease (CHD), with fewer resources and lower socioeconomic status linked to adverse cardiac outcomes. Patients with CHD have high healthcare utilization and rely on the cardiology clinic as their medical home; however, screening for health-related social needs (HRSN) is not done routinely in cardiology clinic.

Project Description: A multidisciplinary team adapted a validated HRSN screening tool (Figure 1) to incorporate into cardiology clinic visits. We designed a process map for screener distribution and data collection following numerous iterations involving administrators, medical assistants, nurses, cardiologists, fellows, advanced practitioners, social workers (SW), and research assistants. Urgent in-clinic SW evaluation was prompted by “no housing” or “no food today” responses; other needs were addressed through SW phone call, in-clinic SW evaluation if requested by family, or providing need-specific informational sheets. Beginning June 2023, we implemented the screener in 3 fellows’ clinics and gradually scaled up to 7 fellows, 7 cardiologists, and the heart failure and transplant clinic as of March 2024. We administered 341 screeners, with need(s) identified in 97 (28%) of patients (Table 1). SW spent a median of 45 minutes/referral (range 15-120 minutes, sample of 12 referrals). Based on feedback, changes made included rearranging questions based on urgency, translation into six languages, altering screener distribution strategies, making informational sheets accessible, and increasing project visibility and education to staff.

Discussion: Overall, clinical teams approached introduction of the screener with enthusiasm, and SW felt that more families with needs were being identified compared to prior. Facilitators included leadership and staff recognition of the importance of this work, multidisciplinary support (particularly from SW), and regular meetings with champions and staff to discuss progress and feedback. Barriers included finding an optimal method of screener administration among varied staff in the midst of a busy clinic (~30,000 visits annually), administering screeners only to patients of specific providers which created confusion and unintended omission, and using a paper tool with manual data input. Additionally, providers recognizing needs identified on the screener and responding to them in the moment was sometimes missed; ultimately, SW eventually reviewed all returned screeners and responded to any unaddressed needs via phone. While SW referral volume was manageable during this pilot phase, it became clear that we would need more resources if we were to screen all clinic patients.

Conclusion: Cardiology patients can have unmet social needs that can be identified in cardiology clinic by implementing a HRSN screener. While informational sheets can help, direct SW involvement plays a critical role, and additional SW resources will be needed to adequately address patient needs during scale-up across the entire clinic. Investment from leadership around the importance of HRSN evaluation in patients with CHD is essential to improve outcomes.