(357) Implementing a Social Determinants of Health (SDoH) screener in a large pediatric Cystic Fibrosis Center

Background: Socioeconomic stressors have been linked to poor health outcomes in people with CF (PwCF). Although resources exist to combat food, housing, and other financial insecurities, individuals may not feel comfortable disclosing such stressors with their care teams. Therefore, the Boston Children’s Hospital (BCH) Pediatric CF Social Workers (SW) developed a SDoH screener for caregivers or young adult PwCF (“respondents”) to complete during their clinic visits and a process for intervention. Aims were to screen 80% of our pediatric CF population within the first year of implementation and to follow-up with 100% of the respondents that endorsed a need.

Methods: A literature review was conducted and previously developed SDoH tools were referenced. The screener included eight targeted questions about five identified domains (transportation, utility and medical bills, food insecurity, and housing). Using a quality improvement (QI) approach, an algorithm was developed to determine level of intervention and follow-up. The screener was piloted from May-August 2021 and went through three PDSA cycles. Feedback from care team members, respondents, and the BCH Health Equity Committee were integrated into a final screener which was implemented universally in September 2021. Paper versions were provided during in-person clinic visits when SW were present to address urgent matters. SDoH screeners were incorporated into our weekly multidisciplinary review and responses documented in a database. Respondents identified preferred timeframe for follow-up. Positive screens were defined as any respondent who reported at least one area of concern. Statistical analysis looking at potential disparities among respondents was completed.

Results: During the pilot phase, 52 patients were screened (41 caregivers and 11 young adults); 21% were positive. The average monthly screening rate was 25%. After implementing universally, 99 patients were screened (88 caregivers and 11 young adults); 32% were positive. The average monthly screening rate increased to 51%. From May-March 2021, 55% of our pediatric CF population had been screened. Among all positive screens, 65% identified as White, non-Hispanic, 15% Hispanic, 2% Black, non-Hispanic, 2% Multiracial, non-Hispanic, and 16% were Unknown. 47% had public insurance, 33% had private insurance, and 20% had both. An initial analysis identified disparities among Hispanic respondents when compared to White, non-Hispanic respondents and respondents with public insurance versus those with private insurance (Figure 1). 30% of positive respondents had less than the recommended quarterly visits. The three most frequent areas of concern were financial stress due to medical care (20%), transportation costs (17%), and utility bills (16%); 100% of respondents received intervention. Resources provided included parking vouchers, gift cards, referrals, and application assistance.

Conclusions: Piloting and rapidly expanding a routine SDoH screener in our pediatric CF center identified PwCF and caregivers in need of concrete resource support. Our QI-driven process revealed potential health disparities among Hispanic respondents, respondents with public insurance, and those coming to clinic less. Next steps are increasing rates of screening, re-screening of positive patients, and addressing identified disparities and screening limitations.

Acknowledgements: Boston Children’s Hospital Department of Pediatrics Quality Team; Boston Children’s Hospital Health Equity Committee

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