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Show Addressing Social Determinants of Health (SDOH) in Pediatric Constipation: A Quality Improvement Project L. Ashley Wegrowski, BSN, RN, DNP Student; Robert J. Sylvester, DNP, APRN, CPNP; Amy Thorsen, APRN; Catherine McDonald, PhD, RDN, CSP Key Findings: SDOH screening documentation in the electronic health record (EHR) increased significantly (62.3% → 96.1%, p < .001), improving provider access to structured social data. Among documented SDOH screens, the proportion completed or updated within the past year also rose significantly (52.6% → 100%, p < .001), reflecting a marked improvement in timeliness. However, ICD-10 coding, SmartPhrase usage, and clinical note documentation remained limited, hindering full integration of SDOH into care. Ongoing efforts are needed to support provider adoption through targeted training, workflow optimization, and improved documentation tools. Background SDOH Screen Results in EHR • Pediatric constipation negatively impacts quality of life, social interactions, and healthcare costs, especially in vulnerable populations. • SDOH – such as food insecurity, financial instability, low health literacy – worsen outcomes in underserved communities. • Effective constipation management requires addressing broader social and economic factors. • Interventions such as visual tools, plain-language aftervisit summaries, produce prescriptions, recipes, and realtime prescription benefits can improve nutritional intake and reduce costs, effectively addressing both SDOH and pediatric constipation. Methods Assessed • Baseline SDOH screening practices, documentation in clinic notes, and pediatric constipation management through manual retrospective chart review. Developed • Simplified constipation action plan (CAP) • WIC/SNAP-friendly high-fiber recipe handout • Visual laxative guide with pharmacy benefit QR codes • Provider video tutorial and quick-reference handouts Implemented • Constipation-specific SmartPhrases to standardize SDOHinformed care documentation Evaluated • Rates of SDOH screening documentation, clinical note integration, and SmartPhrase utilization 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Pre-Implementation Not on File Post-Implementation On File SmartPhrase Use Before and After Implementation 6.00 5.00 4.00 Statistical Significance: • SDOH screening documentation in the EHR increased significantly (62.3% → 96.1%, p < .001). • Among SDOH screens, those completed or updated within the past year increased significantly (52.6% → 100%, p < .001). • ICD-10 coding and SmartPhrase use both showed modest, non-significant increases (p = .138; p = .2909). Clinical Impact: • Enhanced screening improved provider access to structured, up-to-date SDOH data. • Inconsistent ICD-10 coding and limited documentation continue to hinder full SDOH integration into care. Feasibility & Usability: • Low SmartPhrase usage (9/51 encounters) suggests ongoing workflow barriers and unmet training needs. Sustainability: • Long-term adoption will require streamlined workflows, consistent provider education, and better integration of SDOH tools into documentation practices. Conclusions 3.00 2.00 1.00 0.00 Results Constipation Fiber SDOH Results Constipation Self-Pay Action Plan Note Coupon Pre-Implementation Post Implementation • The increase in both overall SDOH screening documentation and screening timeliness represents a meaningful step toward integrating SDOH-informed care into routine practice. • However, inconsistent ICD-10 coding, limited SmartPhrase use, and other documentation challenges highlight the ongoing need for further workflow adjustments. • Sustained improvements will depend on ongoing provider education, training, and system-level support to enhance SmartPhrase adoption and fully integrate SDOH-informed care. @uofunursing @utnurseresearch |
