Waiting on the World to Change: How SDOH Screening Rates Make a Case for New Embedded SDOH Educational Curricula in Neurology Training Programs
Objective:
Mortality from neurologic disease is increasing in the USA despite medical advancements resulting in excess mortality for certain groups of people. Social determinants of health (SDOH) can account for some inequities in neurologic disease outcomes. We sought to evaluate the implementation of a SDOH screening tool within a new resident epilepsy outpatient clinic. We hypothesized that inclusion of SDOH screener in the note template would increase SDOH documentation with full penetrance.
Background:
Minority status and low socioeconomic status are associated with risk of epilepsy and are among key SDOH identified in this disease. The National Institute of Neurological Disorders and Stroke (NINDS) health equity (HE) strategic planning process signaled funding prioritization of efforts using SDOH and HE training. There is a gap in neurology trainee SDOH/HE medical education.
Our resident clinic is a catchment for many patients that are underinsured and/or from minoritized groups. A new resident clinic model was implemented on 7/1/2023 for patients with epilepsy including 1) embedded epileptologist attending and 2) use of a new seizure intake note template with embedded SDOH screener to standardize quality/breadth of data collected during clinical encounters.
Design/Methods:
As a retrospective observational study, all neurology resident clinic notes between 7/1/2023-10/1/2023 were reviewed to assess: 1) rates of seizure-intake template use and 2) rates of completion of SDOH screener. N=106 patients with epilepsy were seen in the clinic during this period.
Results:
56/106 (52.8%) of notes included the template. Of these, 34/56 (60.7%) completed the SDOH screener. Overall, 34/106 (32.1%) of patients had SDOH screener documented.
Conclusions:
Implementation of note template and SDOH screener did not reach full penetrance. The SDOH screener had the lowest rates of utilization. Educational methods may facilitate dissemination and implementation of SDOH screening in neurologic outpatient settings.