Social determinants of health screening in stroke clinic at an urban safety net hospital - A quality improvement initiative

Black patients have a higher risk of stroke recurrence in the early timeframe after index stroke compared to White patients. Social Determinants of Health (SDOH) are non-medical factors that influence health outcomes and could affect post stroke outcomes. We screened for SDOH in a stroke clinic at an urban safety net hospital as a quality improvement initiative to determine prevalence of unmet needs post stroke. This is a retrospective cohort study that included adult stroke patients seen in clinic. We trained two medical assistants to administer SDOH questionnaire during clinic visit. A follow up phone call was conducted 3-6 months after clinic visit to identify ongoing unmet social needs. Results are described using descriptive statistics and odds ratios. 154 patients were seen between October 2021 and February 2022 in clinic. 90 patients met eligibility criteria. The average age was 57, 87% were Black. 64% had at least one unmet social need- financial need 72%, food insecurity 53%, and transportation needs 53%. 81% (47/58) with unmet need had BP ≥ 130/80 (OR 2.47 (0.91 – 6.66)), 59% (34/58) had LDL ≥70 (OR 2.71 (0.97 – 7.67)), and 24% (14/58) had HbA1c ≥ 7 (OR 1.34 (0.46 – 3.99). 69 of screened patients participated in follow up phone call. We were successfully able to screen stroke patients in clinic for SDOH. We found a high prevalence of unmet social needs in our population and uncontrolled risk factors. Systematic ways of assessing and addressing SDOH to determine their effects on stroke recurrence, recovery, and proposed frequency of screening should be done in larger studies.