Implementing a Social Determinants of Health Screening Tool to Improve Appointment Attendance in Primary Care Practice

Purpose The purpose of this quality improvement (QI) project was to implement a screening tool to identify the social determinants of health (SDoH) that may prevent patients from attending their scheduled appointment and to improve patient’s attendance adherence. The project was conducted at a primary care clinic in La Grange, Texas Background Missed appointments negatively impact a person’s health status. Missed appointments have been associated with a variety of social factors such as transportation access, socioeconomic status, health literacy, and insurance status. Methodology The Logic Model and PDSA model for improvement were used to guide this project. The project utilized the Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE) to screen for SDoH. The staff were educated on the use of the tool prior to implementation. Adult patients presented to the clinic during the 3-month project period were asked to complete the screening form. Patients with identified needs on the screening were referred to a specialist for assistance. Descriptive statistics were used to illustrate number of completed screening and no-show rates. Results There was an 8% decrease in the no-show rates one month after the implementation of the intervention (Pre-intervention=17.5%; Post-intervention=9.1%). PRAPARE was administered to 70 of 581 patients (and 60 screened positive). A total of five SDoH domains were identified. Social/Emotional/Stress (N=29, 48%), Transportation (N=12, 20%), Housing (N=8, 12%), Food (N=6, 11%), and Financial (N=5, 9%). All patients with positive screenings received referral to an appropriate behavioral health counselor. Implications Findings indicate that social needs have a significant association with missed appointments. Implementing a SDOH screening tool in primary care using PRAPARE was successful in identifying and providing social needs to patients with SDOH needs. Key words: screening tool,social needs, social determinants of health, SDoH, missed appointment, no-show