Emergency Service, Hospital, Social Determinants of Health
Conditions
Keywords
informatics
Brief summary
The overall objective of this study is to support emergency department management of patients' health-related social needs. This study will measure the impact of a decision support system that informs clinicians about which patients are likely to screen positive for a health-related social need. The system uses statistical models to create a health-related social need risk score for each patient. The main questions, the study aims to answer are: * Does providing emergency department clinicians with risk scores on health-related social needs increase screening and referral activities? * Does providing emergency department clinicians with risk scores on health-related social needs change patients' use of healthcare services? The decision support system with health-related social needs risk scores will be introduced for all adult patients at one emergency department. Screening rates, referrals, and subsequent healthcare encounters will be compared with emergency departments that did not have access to the decision support system.
Interventions
OTHERHealth-related social needs decision support system
The clinical decision support intervention will present emergency department clinicians at an Indianapolis, IN ED with a likelihood score for an adult patient screening positive for the following health-related social needs (HRSNs): housing instability, food insecurity, transportation barriers, financial strain, and history of legal involvement. For each HRSN, the likelihood of screening positive is reported as "high", "medium", or "low". These categorizations are the product of logistic regression models. The clinical decision support intervention will be delivered through an existing FHIR (Fast Healthcare Interoperability Resources) standards-based clinical decision support platform.
Sponsors
Indiana University
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
The intervention will be at the ED level using a pre-post design with a matched comparison group.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Adults (\>18 years old) * Seeking care at Indianapolis, Indiana area emergency departments (EDs).
Exclusion criteria
* Children * Encounters by patients that present with a critical illness/injury (e.g. severe trauma patients or those with Emergency Severity Index (ESI) classification level 1) * Encounters by patients who have been transferred from another inpatient facility * Patients that die during the ED encounter * Encounters among patients who were ultimately admitted during their ED visits from our analysis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percent of emergency department encounters screened for health-related social needs (HRSNs) | At time of emergency department encounter (or within 24 hours) | The numerator will be an emergency department encounter with any indication of HRSN screening using any tool or questionnaire, regardless of patient completion or results. The denominator will be all eligible ED encounters. |
| Percent of emergency department encounters that were referred for health-related social needs (HRSNs) services | At time of emergency department encounter (or within 24 hours) | The numerator will be emergency department encounters with a referral to social worker, case management, community health workers, or related services within 24 hours of the ED encounter. The denominator will be all eligible ED encounters |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percent of encounters with an emergency department revisit measured at 3 days | within 3 days of emergency department encounter | The numerator will be an emergency department encounter at any facility included in the Indiana for Network Care database within 3 days of an ED encounter at an intervention or comparator site. ED revisits may serve as the index visit for subsequent revisits. The denominator will be all eligible ED encounters. Encounters resulting in an inpatient admission will be excluded from the numerator and denominator. |
| Percent of encounters with an emergency department revisit measured at 7 days | within 7 days of emergency department encounter | The numerator will be an emergency department encounter at any facility included in the Indiana for Network Care database within 7 days of an ED encounter at an intervention or comparator site. ED revisits may serve as the index visit for subsequent revisits. The denominator will be all eligible ED encounters. Encounters resulting in an inpatient admission will be excluded from the numerator and denominator. |
| Percent of encounters with an emergency department revisit measured at 30 days | within 30 days of emergency department encounter | The numerator will be an emergency department encounter at any facility included in the Indiana for Network Care database within 30 days of an ED encounter at an intervention or comparator site. ED revisits may serve as the index visit for subsequent revisits. The denominator will be all eligible ED encounters. Encounters resulting in an inpatient admission will be excluded from the numerator and denominator |
| Percent of emergency department encounters with primary care visit within 7 days of an ED encounter | within 7 days of emergency department visit | The numerator will include all emergency department encounters with a completed family medicine, internal medicine, OBGYN, or geriatrician visit64 within 7 days of the ED visit. The denominator will be all eligible ED encounters. Encounters resulting in an inpatient admission will be excluded from the numerator and denominator. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORJoshua R Vest, PhD,MPH
Indiana University
Outcome results
None listed