Title: Addressing Social Determinants of Health in Primary Care Project Leaders: Mary Alice Scott, Ivan de la Rosa, NMSU; Rachel Ceballos, Fred Hutch [The content of this Pilot Proposal is identical in the NMSU and Fred Hutch proposals] PROECT SUMMARY/ABSTRACT Social determinants of health (SDH), such as low food security, personal safety, employment, housing, and access to health care, are strongly associated with poor health outcomes and cancer health disparities. Recognizing the importance of SDH to health outcomes, including cancer prevention and control, state and federal agencies have issued recommendations for clinical settings to implement collection of SDH data in electronic medical records (EMR) as part of their clinical care. However, a major gap exists between recommendations for use of SDH screening tools and knowledge about how to implement SDH screening tools in a clinical setting. Current efforts to implement a SDH screening tool in a New Mexico primary care practice in a primary care residency program that serves a high need population, offers a unique opportunity to examine the tool?s implementation process, consider methods of educating medical providers about use of the tool, and explore patient and physicians? perceptions of the tool?s usefulness. Using multiple methods to ensure high scientific rigor, the proposed project will gather the formative data needed as a step toward development of an educational intervention for medical providers. We will conduct an assessment using the PRECEDE (Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation) portion of the PRECEDE-PROCEED intervention development model in a medical facility that has implemented use of the screening tool for all patient appointments. The study?s specific aims are to: 1) identify PRECEDE factors that contribute to the patient-centered use of the SDH screening tool and subsequent referrals by primary care providers in a community health clinic serving predominantly Latino patients and 2) calculate the rate of utilization of the SDH screening tool and rate of patient-centered referrals to appropriate social services by primary care providers.
These specific aims will be achieved using several data collection methods: 1) qualitative interviews and clinical observations to identify predisposing, enabling, and reinforcing factors that can affect the behavior, attitude and environment (including administration and policies) of primary care provider implementation of the screening tool; 2) chart review to record documentation of referrals in patient EMR; 3) qualitative interviews with providers to document uncharted discussions and/or referrals; and 4) qualitative interviews with patients to document patient experience with the screening tool use. This project will contribute critical descriptions of SDH screening tool implementation processes, gaps, and successes to the larger scientific literature and lead to development of an educational intervention that can be tested using expanded collaborations among investigators of the U54 Partnership.
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