Objective:

To Improve neurology residents' ability to identify and manage social determinants of health (SDoH) issues in their clinic.

Background:

A needs assessment found that residents lacked skills in recognizing SDoH issues, obtaining SDoH history and managing SDoH problems. A design thinking approach was used to determine the root of these problems, the scope of the need and a mechanism for improving SDH care skills in the outpatient clinic

Design/Methods:

Eight design thinking sessions (1-2 hours) over the course of 4 months were held to gain an understanding of  SDoH opportunities, engage stakeholders, develop a prototype and identify outcome measures. Residents collaborated with information technology and our SDoH department to develop an electronic health record (EHR) based tool that collected patient reported SDoH information for providers to review and a method to find SDoH solutions in our clinic.

Results:

Qualitative interviews found our residents’ SDoH history taking skills were limited, that they feared embarrassing patients or themselves, and that neither staff nor residents understood how to approach solving SDoH issues. The EHR tool was piloted over 9 months, screening 3108 patients (44% of clinic patients) of which 37.7% reported a need. Food insecurity (24%),transportation (11.5%), medications (8.8%) and utilities (7.8%) were the most common needs. Staff evaluation of the residents, pre/post implementation resident surveys and qualitative interviews showed improvements in residents’ confidence and skill in obtaining and addressing SDoH issues and improved ability of staff to manage SDoH issues. Staff evaluated residents more frequently as well.

Conclusions:

Design thinking was an effective method for educating residents regarding SDoH and system based practice through active engagement in quality improvement. Residents gained valuable skills in systems thinking, interprofessional collaboration, and patient-centered care. Future residents will benefit from the ongoing use of the EHR tool. Metrics on patient outcomes and care delivery will be measured.