Implementing an Electronic Social Needs Screener and Referral in a Rural Nurse Practitioner Owned and Operated Family Primary Care Clinic

Background: Many clinicians understand the connection between social determinants of health (SDoH) and poor health outcomes, yet there remains a reluctance to screen for social needs (Andermann, 2018). Reasons for reluctance include not knowing what to do if needs are found, where to refer patients, and not feeling it should be their responsibility (Andermann, 2018). Rural communities are more likely to experience SDoH (Rural Health Information Hub, 2022). Local Problem: Most of what is currently known about social needs screening has been conducted in urban settings; little is known about receptivity in rural settings. The purpose of this project was to implement a social needs screening tool, along with an electronic referral to United Way's 211 (UW 211) community resource information specialists, to all patients universally at a rural, NP operated, primary care clinic. Methods: This evidence-based quality improvement project used quantitative and qualitative data, via a pre-survey, to assess staff's comfort level, knowledge, and perceptions about screening for social needs. An educational session about screening for social needs was implemented. And a post-survey was developed using the Consolidated Framework for Implementation Research (CFIR) to assess five domains that impact the of success or failure of implementation. Interventions: This quality improvement project implemented in a rural, NP owned primary care clinic, was replicated after a previous research trial implemented in an academic, tertiary healthcare system's Emergency Department (Wallace et al., 2021). An electronic ten-question screener was implemented, and a REDCap data collection survey provided electronic referral to United Way 211, community resource information specialists. The medical assistances (MAs) 3 presented the screener to patients universally. At the end of the screener, patients could request a referral to UW 211 if they desired. Results: During the study period, 267 (12.5%) patients were approached out of 2,138 patients available to be screened. Of the patients approached, 134 (50%) were not screened and 128 (48%) completed the screener-64 (50%) had one or more social needs, and 22 (17%) had four or more social needs. Four patients (2%) requested referral to UW 211. Clinicians reported feeling comfortable screening, however 80% (n=4) reported they were unaware of their patients' social needs. MAs reported time as the most significant barrier to screening, however the average time to complete the screener was 0:02:59 with a median time of 0:01:04. It was reported that there was a need for a different workflow process. Despite little evidence of logistical barriers to universal screening, only 12.5% of targeted patients were screened, and none were connected with social services. Conclusion: Patients appear to be willing to state they have needs, but are reluctant to accept help. This demonstrates there is likely a need in this community. Strategies need to be developed that are acceptable to patients and clinicians to address the patients' social needs.