Medstar Health Research Institute, Healthcare Delivery Research, Washington, DC, United States of America.
Department of Psychiatry, Georgetown University School of Medicine, Washington, DC, United States of America.
PLoS One. 2023 Apr 13;18(4):e0283815. doi: 10.1371/journal.pone.0283815. eCollection 2023.
The District of Columbia (DC) has striking disparities in maternal and infant outcomes comparing Black to White women and babies. Social determinants of health (SDoH) are widely recognized as a significant contributor to these disparities in health outcomes. Screening for social risk factors and referral for appropriate services is a critical step in addressing social needs and reducing outcome disparities.
We conducted interviews among employees (n = 18) and patients (n = 9) across three diverse, urban clinics within a healthcare system and one community-based organization involved in a five-year initiative to reduce maternal and infant disparities in DC. Interviews were guided by the Consolidated Framework for Implementation Research to understand current processes and organizational factors that contributed to or impeded delivery of social risk factor screening and referral for indicated needs.
We found that current processes for social risk factor screening and referral differed between and within clinics depending on the patient population. Key facilitators of successful screening included a supportive organizational culture and adaptability of more patient-centered screening processes. Key barriers to delivery included high patient volume and limited electronic health record capabilities to record results and track the status of internal and community referrals. Areas identified for improvement included additional social risk factor assessment training for new providers, patient-centered approaches to screening, improved tracking processes, and facilitation of connections to social services within clinical settings.
Despite proliferation of social risk factor screeners and recognition of their importance within health care settings, few studies detail implementation processes for social risk factor screening and referrals. Future studies should test implementation strategies for screening and referral services to address identified barriers to implementation.
与白人女性和婴儿相比，哥伦比亚特区（DC）在母婴结局方面存在显著的黑人和白人差异。健康的社会决定因素（SDoH）被广泛认为是造成这些健康结果差异的重要因素。对社会风险因素进行筛查并为适当的服务提供转介是解决社会需求和减少结果差异的关键步骤。
我们在医疗保健系统内的三家不同的城市诊所和一家参与减少 DC 母婴差异的五年倡议的社区组织中，对员工（n=18）和患者（n=9）进行了访谈。访谈以实施研究综合框架为指导，以了解当前的流程和组织因素，这些因素有助于或阻碍社会风险因素筛查和转介以满足指示性需求。
我们发现，根据患者人群的不同，诊所之间和内部的社会风险因素筛查和转介流程存在差异。成功筛查的关键促进因素包括支持性的组织文化和更以患者为中心的筛查流程的适应性。交付的关键障碍包括高患者量和记录结果和跟踪内部和社区转介状态的电子健康记录能力有限。需要改进的领域包括为新提供者提供更多的社会风险因素评估培训、以患者为中心的筛查方法、改进的跟踪流程以及在临床环境中促进与社会服务的联系。
尽管社会风险因素筛查器大量涌现，并在医疗保健环境中认识到其重要性，但很少有研究详细描述社会风险因素筛查和转介的实施过程。未来的研究应该测试筛查和转介服务的实施策略，以解决实施过程中的障碍。
