Implementing Social Needs Screening in Primary Care Using an Electronic Screener with Automated Referral

Background: Social needs are widespread and significantly affect health. When social needs are met, health improves. Primary care is an optimal setting for screening for social needs, yet providers and clinical staff express concerns that screening is time-intensive and difficult to address. Local Problem: Primary care settings lack the skills and strategies to screen for and address social needs. Primary care providers understand the importance of meeting social needs and how this affects health outcomes, but screening practices rarely align with these beliefs. Methods: This evidence-based practice quality improvement project took place in a large, urban, academic healthcare internal medicine and geriatric clinic in northern Utah. A pre-intervention chart review assessed evidence of discussion of social needs with patients. Pre- and post-surveys measured clinicians' and staff's perceptions about and perceived barriers and facilitators. Patients completed a 10- item validated screener on an electronic tablet and an optional referral to United Way 2-1-1 for assistance. Intervention: This project implemented universal screening for social needs in a primary care setting using an electronic screening tool and automated referral to United Way 2-1-1. Results: During the screening period, 450 of 590 patients completed all or part of the screener. Of these, 142 (32%) identified at least one social need and 25 (6%) requested a referral to United Way 2-1-1. Patients completed the screener in an average of 98 seconds. Patients expressed positive sentiments about the screening. Clinician and staff perspectives remained relatively stable before and after the intervention, expressing that screening for social needs is important, but barriers include a lack of time and resources. While clinicians and staff noted screening as important, the pre-study chart review revealed sparse evidence of patient and provider discussion of social needs. After the intervention, more clinicians and staff identified an automated referral as a facilitator for addressing social needs, having medical assistants or registration staff screen via electronic screening tablets, or optimally having patients complete the screener online before their office visit. Conclusions: Screening for social needs in primary care can be time-efficient and effective, identifying and addressing needs with minimal burden to clinicians and medical staff. Healthcare organizations should partner with community resource specialists to provide needed resources to patients