Innovating to Improve Care Now and In the Future: Screening for and Addressing Social Determinant of Health Needs

Authors

Bonnie Ewald, MA, is a Program Coordinator at the Center for Health and Social Care Integration at the Rush University Medical Center. 
Christopher Nolan, MPA, is the Manager for Community Benefit and Population Health at Rush University Medical Center. 
Rachel Smith Kovarsky, MBA, is a Program Coordinator for the department of Social Work and Community Health (SWaCH) at Rush University Medical Center in Chicago. 

Rachel Smith Kovarsky, MBA

Bonnie Ewald, MA

Christopher Nolan, MPA

Physicians and other health care providers can learn a lot from the world of social work. Social work, as a discipline, has long been engaged in addressing social factors that influence health. Through interprofessional collaboration with social workers as part of the team, we can both address social determinant needs today and improve the capacity of healthcare providers less seasoned in doing so. Many interprofessional education initiatives, such as the Camden Coalition’s student hotspotting program, aim to have student groups work with individuals and community resources, which will enhance those students’ care in the future. But we must also focus on how to adapt health care now to better identify and address social determinant of health needs.

Rush University Medical Center developed an interprofessional leadership group and partnered with other hospitals and agencies on the West Side of Chicago including Catholic Charities, Patient Innovation Center, UI Health, Presence Health, and Sinai Health System to form what is now known as West Side ConnectED. In this effort, the institutions are working to identify and mitigate the health and social needs of those living on the West Side of Chicago and being served by the hospitals respective emergency departments: including areas such as food insecurity, housing instability, utility needs, transportation, and access to care (including having a primary care provider and insurance). This screener was designed at Rush for discrete data collection and integration into the Epic electronic health record system, allowing for better reporting and care management. (Similar initiatives are underway across the country; if interested, we recommend reading about efforts by Health Leads, Oregon Community Health Information Network, and the Centers for Medicare and Medicaid Services.)

Since fall 2017, the screening tool has been rolled out at Rush with adult patients in the Emergency Department and three primary care clinics, and this spring, it was rolled out to additional primary are clinics. We also have begun using it in ongoing Rush programming in the community (i.e., workshops hosted at faith-based organizations and school-based health centers, community talks, health fairs). To date, the Rush team has used various individuals to administer the screener (including patient care navigators, certified medical assistants, students, social workers, and residents), and an interpreter has sometimes been needed as well. This summer, we are testing having the patient complete the screener on own, either via MyChart or on a tablet in the waiting room prior to their appointment.
While rolling out a systemic screening tool to identify social and economic areas of need is a significant step in and of itself, we know how important it is to equip care teams to respond to the findings and address identified needs. For several years, in multiple clinics, providers have been able to refer to a social worker to address such issues. Additionally, to increase our capacity to respond to needs, Rush initiated a contractual partnership with NowPow, a social services resource inventory and closed-loop referral system powered by MAPSCorps, a youth employment program that maps the assets and services available in underserved neighborhoods. Rush has also built out various other initiatives to address specific resource needs, including a partnership with CommunityHealth and the Greater Chicago Food Depository. Individuals who screen positively are for a need are referred to a social worker or given other identified resources using NowPow and the other initiatives.
To date, nearly 1,000 patients in the emergency department have been screened, with about 1 in 3 screening positive for at least one resource need. Moving forward with our screening efforts, we will continue to monitor screening rates, referrals to social workers and external resources, differences between care settings, and implications for provider workflow. Additionally, we are partnering with a coalition of hospitals and community-based organizations across the West side of Chicago to expand the use of the screening tool and to streamline efforts across institutions.
At Rush, this process has been an opportunity to engage students in addition to staff. Medical and health administration students work on completing the screening tool with patients as well as assessing its impact, embedding the importance of addressing social determinants of health (and an example of a tool to do so) into their practical education. Supporting the importance of this, one individual who was screened stated, “because Rush is a teaching hospital, it’s nice to have questions like these.”
Having a future healthcare system that addresses the needs of our patients comprehensively, including addressing social determinants of health, is critical. The path toward a better future focuses on educating current healthcare professionals inexperienced in these areas as well as providing collaborative tools to help healthcare professionals expand their capacity to address such needs. Interprofessional collaboration, especially with the field of social work, can go a long way towards achieving this goal, and our initiatives at Rush are just one example of this. It is our hope that those in the Beyond Flexner community can be a catalyst for similar change at their institutions