Social determinant screening useful for families with pediatric sickle cell disease
People with sickle cell disease (SCD) are confronted with the burden of chronic diseases and often racial differences, both of which can increase the vulnerability to adverse social determinants of health (SDoH). For children with SCD, living in poverty is associated with a lower quality of life, higher care use and higher complications. A new study by the Boston Medical Center (BMC), however, shows that hematologists can discover the needs of families and connect them to local resources within a clinic visit, hoping to improve the quality of life and clinical outcomes for their patients.
Published in Pediatric blood and cancer, this study provides insight into the feasibility of improving the quality of care for patients with SCD through universal screening to identify the specific needs of patients, mitigate the role of provider perception and facilitate referrals with societal organizations that use low-touch interventions.
The prospective study followed 156 patients diagnosed with SCD who were universally screened for SDoH between August 2017 and November 2018 at the pediatric haematological clinic. With the help of WECARE, the one-page, self-reporting paper screener discussed the safety of patients in the areas of housing, food, medication, transportation, utilities, childcare and employment, while also requesting information regarding interest in education and connection with relevant sources. For each screener administered to a patient, 1.2 SDoH needs were identified. Two-thirds of the patients scored positively for at least one unmet socio-economic need, usually food insecurity and problems with paying utilities.
Once identified, clinical staff referred patients to help programs based on identified needs. Forty-five percent of those patients reported contacting a community organization and 69 percent found the organization's help useful. If the family needed urgent help, families would also meet a social worker.
"As pediatricians and hematologists, we want to improve the well-being of the entire patient, not just their blood disease," said lead author Alexandra Power-Hays, MD, pediatrician at BMC. "Now that we have demonstrated that a simple method can begin to address socio-economic needs, we hope that pediatric hematologists across the country will also use this model for more long-term healing solutions."
In a follow-up to the clinic, patients on a 5-point Likert scale were asked how likely it was that they would continue to discuss socio-economic issues with the clinic. The average response was 4.1, which means a positive experience with the service. The authors note that this study is designed to overcome barriers for physicians who proactively ask patients for SDoH, and addressing it can be a cost-effective preventative measure by reducing recurring hospital admissions and first aid visits.
Funding for this study was provided through an ASH Scholar Award and under subsidy # NHLBI 1K23HL135436-01
About Boston Medical Center
Boston Medical Center is a private, non-profit, 514-bed, academic medical center that is the premier educational institution of the Boston University School of Medicine. It is the largest and busiest provider of trauma and emergency services in New England. Boston Medical Center offers specialized care for complex health problems and is a leading research institution, receiving more than $ 116 million in sponsored research funding in fiscal year 2017. It is the 15th largest recipient of funding in the US from the National Institutes of Health under independent hospitals. In 1997, BMC Boston Medical Center founded Health Plan, Inc. on, now one of the best-ranked Medicaid MCO's in the country, as a non-profit managed healthcare organization. Boston Medical Center and Boston University School of Medicine are partners in the Boston HealthNet – 14 community health centers focused on providing exceptional healthcare to Boston residents. For more information, go to http: // www.
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