A feasibility study of leveraging the electronic health record to measure social determinants of health in patients with gastrointestinal cancer.

Authors

null

Scarlett Hao

Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC

Scarlett Hao , Patrycja Popowicz , Jack Iasiello , Christopher Mejia , Ashley Wercholuk , Alexander A. Parikh , Rebecca A Snyder

Organizations

Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, Brody School of Medicine, Greenville, NC

Research Funding

No funding received

Background: Social determinants of health (SDOH) or circumstances influenced by a patient's neighborhood, social, political, and economic environment are not routinely assessed, and the prevalence and burden of individual SDOH needs among patients with cancer is not well-understood. The primary study aim was to evaluate feasibility of implementation of an electronic health record (EHR) instrument designed to measure SDOH into routine clinical practice. Methods: A prospective study was performed of all adult patients with gastrointestinal malignancy presenting to a regional cancer center for initial evaluation (11/2020-7/2021). An SDOH screening was administered by a nurse navigator or social worker or medical student using the EHR. Primary outcome measures included % eligible patients screened, median clinic visit time compared to historical control, and acceptability to the inter-professional care team. Secondary outcomes included the number of identified SDOH needs per patient and subsequent interventions. Results: Of 118 eligible patients, 113 (95.8%) were successfully screened for SDOH. Nearly half self-identified as Black (40.7%; n = 46) and the remainder White (58.4%; n = 66); 4.4% (n = 5) were uninsured and 17.7% (n = 20) Medicaid-insured. Median visit time was 97 minutes (95%CI 70-107) before implementation and 100 minutes after (95%CI 75-119; p = 0.95). Team members reported no significant clinic disruptions and were supportive of ongoing use. Most patients had 2-3 total needs with 1-2 moderate or 1-2 severe needs. In addition, 21 patients had 4 total needs and 13 patients had 5 or more needs. Most common severe needs included physical activity (n = 62), stress (n = 55), tobacco use (n = 23), and food insecurity (n = 9). Most common moderate needs included social connections (n = 76), tobacco use (n = 44), physical activity (n = 21), and financial strain (n = 12). Resources were offered to 20 patients (17.6%) to address SDOH needs. Conclusions: Routine collection of SDOH in an outpatient oncology setting using an EHR instrument is feasible and non-disruptive to workflow. Further investigation to determine if standardized SDOH assessment can improve cancer care delivery on an individual and population level is ongoing.

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Abstract Details

Meeting

2022 ASCO Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session A: Cancers of the Esophagus and Stomach and Other GI Cancers

Track

Esophageal and Gastric Cancer,Other GI Cancer

Sub Track

Other

DOI

10.1200/JCO.2022.40.4_suppl.666

Abstract #

666

Poster Bd #

Online Only

Abstract Disclosures

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