Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.
Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts.
Pediatr Blood Cancer. 2020 Jan;67(1):e28006. doi: 10.1002/pbc.28006. Epub 2019 Oct 1.
Social determinants of health (SDoH) are socioeconomic factors that influence health outcomes. Guidelines recommend universal screening for SDoH at clinic visits; however, models that do not require additional resources are limited in subspecialty clinics. Individuals with sickle cell disease (SCD) face the burdens of chronic illness and often racial disparities, both of which may increase their vulnerability to adverse SDoH. Hematologists can impact both quality of life and clinical outcomes for their patients by implementing screening and referral programs addressing SDoH.
Through prospective, quality-improvement methods, we introduced universal screening for SDoH into our pediatric hematology clinic. The intervention was a paper screener followed by a referral to local community organizations for the specific needs endorsed. The aims of this study were to determine the feasibility of universal screening for SDoH in a busy subspeciality clinic using pre-existing resources to identify the needs of our patients and to facilitate referrals between our patients and community organizations via this low touch intervention.
Between August 2017 and November 2018, 156 screens were completed. Sixty-six percent were positive for at least one unmet social need for which 80% were referred to a relevant community organization. Forty-five percent of patients available via follow-up phone call reached out to the community organization.
There is a high burden of SDoH in families of children with SCD. Universal screening at a pediatric hematology clinic with the subsequent connection of patients with SCD to community resources is feasible using existing clinic resources.
健康的社会决定因素（SDoH）是影响健康结果的社会经济因素。指南建议在诊所就诊时对 SDoH 进行普遍筛查；然而，不需要额外资源的模型在专科诊所中是有限的。镰状细胞病（SCD）患者面临着慢性疾病的负担，并且经常存在种族差异，这两者都可能增加他们受到不利 SDoH 的影响的脆弱性。血液学家可以通过实施针对 SDoH 的筛查和转介计划，对其患者的生活质量和临床结果产生影响。
通过前瞻性的质量改进方法，我们在儿科血液科诊所引入了 SDoH 的普遍筛查。干预措施是纸质筛查器，然后根据具体需求将患者转介给当地社区组织。本研究的目的是确定在繁忙的专科诊所中使用现有资源进行 SDoH 普遍筛查的可行性，以确定我们患者的需求，并通过这种低接触干预促进我们的患者和社区组织之间的转介。
在 2017 年 8 月至 2018 年 11 月期间，完成了 156 次筛查。66%的筛查结果至少存在一项未满足的社会需求，其中 80%的患者被转介到相关社区组织。通过后续电话随访，有 45%的患者联系了社区组织。
SCD 儿童家庭存在着较高的 SDoH 负担。在儿科血液科诊所进行普遍筛查，随后将 SCD 患者与社区资源联系起来，使用现有的诊所资源是可行的。
