| Description |
Background: Pediatric constipation is a prevalent issue that disproportionately affects children from low socioeconomic backgrounds, where factors such as food insecurity and financial barriers can exacerbate symptoms. Routine management may not fully address social determinants of health (SDOH), which can impact treatment adherence and patient outcomes. Local Problem: The project site provided general recommendations for managing pediatric constipation-such as increasing fiber intake, fluid consumption, and using laxatives-are commonly provided. However, these recommendations did not account for the unique social and economic barriers the patient population faced. Furthermore, there was no structured process of integrating SDOH into personalized care plans for patients with constipation. This quality improvement project aimed to integrate SDOH considerations into clinical workflows, supporting comprehensive and accessible care for underserved pediatric populations. Methods: The project team modified existing constipation management protocols using the Johns Hopkins Evidence-Based Practice Model to incorporate interventions informed by SDOH. The team collected baseline data on SDOH screening frequency and documentation through retrospective chart reviews, assessing existing documentation practices and integration of SDOH factors in patient encounters prior to implementation. Evaluation metrics included the frequency and timeliness of SDOH screenings documented in the electronic health record (EHR), frequency of SDOH-informed documentation in clinic notes, and utilization of SDOH-informed intervention. Smart Phrases. A pre-intervention survey assessed provider-reported barriers to SDOH documentation and SmartPhrase use; however, no post-survey responses were received. Interventions: Key interventions included updates to the constipation action plan to improve clarity and usability and the creation of SmartPhrases in the EHR to facilitate SDOH-informed documentation. To support dietary modifications, Women, Infants, and Children and Supplemental Nutrition Assistance Program eligible high-fiber recipes were introduced, ensuring accessibility for families with limited resources. Additionally, a visual laxative guide was developed to address low health literacy and paired with a pharmacy benefit quick response code to provide access to real-time coupons, reducing medication costs and promoting treatment adherence by minimizing financial barriers. Monthly provider interviews and chart audits guided iterative adjustments to these interventions, ensuring alignment with clinical workflows and meeting provider needs. Results: SDOH documentation rates significantly increased over the course of the project, with the proportion of screenings completed within a year of the visit rising from 54.05% preimplementation to 100% post-implementation, χ²(1, N = 112) = 24.16, p < .001, indicating improved integration of SDOH data into the electronic health record during patient rooming. However, ICD-10 coding remained low, with only 11.8% of encounters including SDOH-related codes (p = 0.138). Provider documentation of social risk factors remained inconsistent, with no documentation for high-risk food insecurity cases. SmartPhrase adoption remained low, with no significant increase in use (p = 0.256). Conclusion: Addressing social factors in pediatric constipation management can reduce health disparities by supporting treatment adherence in vulnerable populations. This project highlights the potential of SDOH-informed interventions used to enhance care quality and provider confidence. Future efforts will focus on refining these strategies and expanding their application across diverse clinical settings, providing a model for addressing SDOH in other chronic pediatric conditions. |
