Research Assistant II
Candace Feldman, MD, MPH, ScD; Rebecca Summit, BA; Karli Retzel, BA; Haelynn Gim, BA; Leah Santacroce, MS; Sarah Wilkie, MS; Virginia Bills, RN; Siobhan Case, MD, MHS; Caitlyn Wasserman, MD; Nancy Shadick, MD, MPH; Sara Schoenfeld, MD
Background: Social determinants of health (SDoH) contribute to inequities in rheumatic disease care and outcomes. Screening for SDoH is rarely done in the subspecialty setting likely due to inadequate infrastructure and resources to address needs that are uncovered.
Methods: We implemented SDoH screening in 9 MGB rheumatology clinics. Patients with a systemic rheumatic condition with inflammatory arthritis were identified by ICD-10 code and sent the SDoH questionnaire at e-check in, or at their appointment with an iPad. Patients who indicated SDoH needs received resource sheets and patients requesting additional assistance received outreach from a trained, rheumatology-based community resource specialist.
Results: From 6/23/22 – 4/18/23, 7,146 adults completed the SDoH questionnaire; 6,309 (88%) in association with a rheumatology visit and 837 (12%) with primary care and re-reviewed in rheumatology. There were 2,015 SDoH needs among 1,143 (16%) of patients; 120 others requested resources without specifying needs. The most prevalent needs were food insecurity (36% of patients with needs), difficulty paying utility bills (30%) and difficulty paying for medications (26%). The rCRS connected patient to varied resources to address needs.
Conclusions: Screening and addressing SDoH in rheumatology clinics was feasible and revealed a significant burden of social needs not being met elsewhere.
Social determinants of health (SDoH) result in social needs such as difficulty with transportation or paying for food, and contribute to inequities in rheumatology care and outcomes. Screening for these needs rarely occurs in the subspecialty setting. We implemented a SDoH screening in 9 rheumatology clinics to determine how to best uncover and address needs in a subspecialty setting. The SDoH screening questionnaire was given to patients with systemic rheumatic conditions at e-check in or at their visit. Patients who indicated needs were given resource sheets and those requesting additional information received outreach from the rheumatology-based community resource specialist. From 6/23/22 – 4/18/23, 7,146 adults completed the SDoH questionnaire. There were 2,015 SDoH needs among 1,143 of patients. The most commonly reported needs were food insecurity (36% of patients with needs), difficulty paying utility bills (30%) and difficulty paying for medications (26%). Screening and addressing SDoH in rheumatology clinics proved feasible and revealed patient needs that were not being addressed elsewhere.