Half the summer has gone by and our work on the “Social Determinants of Health Screening Project” in Pediatrics Associates continues! Over the weeks since I last wrote, Rebecca and I have continued to screen patients regularly. Last week we even reached our goal of screening 200 patients. Once we reached this number, we were able to analyze the data gathered from this first cohort.
This next step was new to me, as I had never before used excel to analyze data. It came time to learn! We had to figure out how to turn our data from “yes” and “no” answers into data that was numerical, conclusive and easy to communicate. Rebecca came up with a code in which 0 meant “no” and 1 meant “yes”. Using the summation feature on excel we could then total our positive screens and negative screens and present each as a percentage. Some of the less straightforward series of questions from the survey required more thought, but in the end, we were able to analyze all the data!
We also spent the last few weeks enrolling families in a pilot study. Using the general screener, we identified families that screened positive for food insecurity. Then we offered these families different resources and the option of being enrolled in Dr. Mogilner and Dr. Zajac’s pilot study called “The Food Insecurity Toolbox: Developing a Model for Addressing the Social Determinants of Health”. The study aims to assess the effectiveness of the resources being provided to patients. Families with food insecurity are referred to local community organizations and are contacted after one month to determine whether they have visited the organization and received services. To date, we have enrolled 45 families in the study.
As we screen and learn more about the issues at hand, we have also been updating our resources. We have reviewed our them with doctors as well as the social workers to ensure that we are providing patients with accurate resources. Sometimes patients can be referred directly to a community-based organization to address their needs. In other instances, patients need a referral form to be completed by a physician or social worker. In such a case, the screener needs to be able to connect the patient with the correct person. The endpoint of our referral can vary for different social determinants and different patients. We found this inconsistency to be a challenge when trying to identifying the appropriate resource to give a family. As such, we decided to create a clinic flow diagram to depict the process and end point of each screener question.
Creating the clinic flow diagram encouraged us to critically consider the efficiency and directness of the questions in our screener. Subsequently, we decided that our follow up asthma questions needed to be tweaked. These questions were open-ended and added unnecessary time to the survey duration. Dr. Mogilner then contacted an asthma specialist, who guided us in rewording these questions. In the next version of the screener, these questions will be updated.
We have also been busy writing up a manuscript for a paper which describes the process of implementing a screener into a pediatrics clinic. In order to begin writing, we did a major literature review of all related articles. We looked at articles about social determinants in general, as well as articles about the eight specific social determinants addressed in our screener. We also read articles about the implementation of screeners into clinics, the benefits, and challenges. We then researched different journals to which we could submit our paper. We needed to find a paper that accepted the kind of article we wanted to write and had guidelines which we thought we could follow. With Dr. Mogilner’s guidance, we were able to identify the journal where we hope to submit our manuscript.
With this decision made, we were able to get started actually writing the paper and sharing everything we have learned from our time working on the screener! The summer is flying by and it's time to get back to writing!