ORIGINAL RESEARCH
Stacie M. Vilendrer, MD, MS, MBA; Samuel C. Thomas, MD, MSc, MS; Kim Brunisholz, PhD, MST; Grace Ann Kumar, MPH; Ishita Singh, BDS, MPH; Nancy Song, MD, MBA; Raj Srivastava, MD, MPH; Sara J. Singer, PhD, MBA
Corresponding Author: Stacie Vilendrer, MD, MBA, MS; Division of Primary Care and Population Health, Stanford University School of Medicine
Email: staciev@stanford.edu
DOI: 10.3122/jabfm.2023.230316R2
Keywords: Diagnostic Screening Programs, Health Plan Implementation, Health Services Research, Implementation Science, Integrated Health Care Systems, Primary Health Care, Qualitative Research, Social Determinants of Health, Social Factors
Dates: Submitted: 08-22-2023; Revised: 02-29-2024; 04-25-2024; Accepted: 05-28-2024
FINAL PUBLICATION: |HTML| |PDF|
INTRODUCTION: Health systems are increasingly pursuing efforts to screen for and address social drivers of health (SDOH), the non-medical factors that contribute to health outcomes and inequities. A large integrated health system (Intermountain Health) launched a program in 2019 to universally screen for and address SDOH.
METHODS: Five primary care clinics within Intermountain were purposefully chosen for diversity of setting and practice type (family medicine and pediatric). We conducted 20 semi-structured interviews with frontline clinicians and staff from 7/1/2020 to 9/1/2020 to explore attitudes related to feasibility, workflow processes, and facilitators and barriers to successful implementation. We conducted an inductive-deductive analysis to identify key themes and best practices.
RESULTS: Five clinics conducted 16,659 SDOH patient screenings from 12/1/2019 to 11/30/2020 (705-7,723 screens per clinic with rates ranging from 7.4% to 52.8% per clinic). Respondent perspectives about the program were mixed. Dominant implementation barriers included staff time constraints, limited availability of social services, and reduced morale. Key facilitators included triage protocols for positive screens independent of the primary care provider, standardizing pre-visit digital screening, and instilling a culture of shared ownership through education and team SDOH-focused huddles.
CONCLUSIONS: This evaluation of an early systemwide SDOH program implementation called into question the feasibility of universal screening in primary care given staff time constraints and social service availability. Future investigations should explore the impact of targeted screening approaches in diverse clinical settings and quantifying trade offs between SDOH programs and other clinical and organizational priorities.