Implementing Social Needs Screening in an Employee Health Clinic to Improve Healthcare Quality: An Evidence-Based Quality Improvement Project

Background: Social determinants of health (SDOH) are non-medical factors that influence health outcomes. Many healthcare settings do not systematically screen patients for SDOH, leading to missed opportunities to address unmet needs. Local Problem: There was no systematic process to screen for SDOH during annual wellness exams at a single-employee health clinic affiliated with a large academic teaching facility. While other primary care clinics within the health system had integrated SDOH screening into routine visits, this employee health clinic had not adopted this practice. This quality improvement initiative aimed to implement an electronic SDOH screening tool to improve the identification of social needs and referral rates to community resources. Methods: Participants included five nurse practitioners and two medical assistants who staffed the employee health clinic. Pre- and post-intervention surveys were administered to clinic staff to assess attitudes toward SDOH screening, perceived barriers, and facilitators. Patients at annual wellness exams completed a 4-item validated screening tool. Data on patient screenings identified social needs, and referrals were collected through the electronic health record (EHR). Interventions: An abbreviated version of the Screener for Intensifying Community Referrals for Health (SINCERE) tool was integrated into the clinic's EHR to screen for four key SDOH domains: food insecurity, utility needs, housing instability, and transportation. Clinic staff received training on the screening workflow, including assigning the questionnaire and making referrals to Utah 2-1-1. Utah 2-1-1 is a free, confidential service that connects individuals with local resources for food, housing, healthcare, and other essential needs. Results: Of 73 eligible patients, 72 (99%) completed the SDOH screener, with 10% (7/72) identifying at least one social need. All patients who screened positive were referred to Utah 2-1-1. Post-intervention surveys revealed that 80% of clinic staff found the screening tool feasible and practical for continued use, citing its integration into the EHR and minimal disruption to workflow. Staff reported increased confidence in addressing social needs and highlighted the efficiency of the referral process. Conclusion: Implementing an electronic SDOH screening tool in an employee health clinic proved feasible, sustainable, and effective in identifying and addressing patients' social needs. The project demonstrated the value of integrating SDOH screening into routine care, promoting health equity, and enhancing patient-centered care.