One Size Fits One – Customizing Approaches to Implementing a Social Needs Questionnaire at Health Clinics in Pennsylvania

Posted on June 14, 2024 by Sarah Papperman

This entry is part 2 of 7 in the series CVD Prevention 1

Individualized approaches are critical for implementing process changes across a diverse range of clinical settings.

Implementing a Social Needs Questionnaire at Health Clinics

Read the Article in JPHMP

Implementing process changes is an important part of continuous program improvement. How else can we integrate new knowledge and tools into healthcare? However, the steps and timeline for implementing change depend on individual and program-level context. For example, health clinic staff haven’t traditionally asked patients about their social needs. By social needs we mean needs related to food, clothing, housing, transportation, finances, and safety. Clinicians are increasingly recognizing that these social needs affect patient health. Once clinicians know patients’ social needs, they may use this knowledge to bolster the patients’ care plans. For example, they may refer patients to additional resources that support the care plan such as financial assistance or transportation. However, it is one thing for clinicians to recognize the relevance of social needs and another thing for clinicians to ask patients about their social needs (and be prepared to respond!). For the clinic staff to routinely ask patients about social needs they must change clinic processes and procedures.

The Pennsylvania Department of Health (PADOH) decided to support clinicians in documenting the social needs of patients. They encouraged clinical practices to use the PRAPARE questionnaire. The tool contains detailed questions on the patients’ various social needs. PADOH hired a non-profit company called Quality Insights to work with one hundred clinics across the Commonwealth. Quality Insights supported clinics in adding the PRAPARE (or another similar) tool to the patient visit process to make sure that patients completed the questionnaire when they came for appointments. Our evaluation team at the University of Pittsburgh assessed progress toward this goal by documenting activities, surveying health clinics, and interviewing Quality Insights staff. While adding the PRAPARE questionnaire into the process for patient appointments might seem like a simple change to make, it was no small feat!

What We Found

Through our evaluation activities, Quality Insights staff and the University of Pittsburgh team found three main types of challenges for the clinics and Quality Insights:

For one, employees at different clinics varied in their understanding of how social needs impact health. The clinician and staff members’ level of understanding could in turn affect if and how they incorporated the questionnaire.
Additionally, some clinics faced technology barriers. As examples, some clinics’ databases didn’t have the functionality to build in the questionnaire. Other clinics couldn’t get data pulled and reported out from their databases.
Finally, clinics assigned different employee roles the responsibility of administering the questionnaire to patients. This last challenge made it difficult for Quality Insights to develop generalized training for clinics.

To address these challenges, Quality Insights took an individualized approach to help make change easy among clinics. For example, Quality Insights staff members took the time to get to know each individual clinic. They developed training and strategies tailored to clinics’ readiness to add social needs questions into their patient visits, and their readiness to collect and use information on patients’ social needs. Quality Insights developed quick-guides, podcasts, and recommendations. Over time, Quality Insights saw improvements in clinic staff members’ understanding and use of the social needs questionnaire. By the last year of the five-year project, 74% of clinics reported asking patients about social needs, compared with 65% at the beginning of the project.

Other state departments, large health systems, and private contractors can benefit from taking the time to individualize their approach when they need to implement a process change across a large number of sites. Future evaluation efforts and research can examine clinic characteristics that may predict early success at change implementation.

For more information, read “Preparing to Address SDOH: Approaches to Clinic Transformation” in the July 2024 Journal of Public Health Management and Practice Supplemental Issue on Cardiovascular Disease and Public Health.

Funding Statement: This evaluation work was supported by Pennsylvania Department of Health for the work supported by the CDC DP18-1815 grant “Improving the Health of Americans Through Prevention and Management of Diabetes and Heart Disease and Stroke.”

Acknowledgement of co-authors:

Thistle Elias, DrPH, MPA, is the senior Associate Director of the Evaluation Institute for Public Health at the University of Pittsburgh. She was the principal investigator of the evaluation team for the Program.

Molly M. Eggleston, MPH, CPH, MCHES, and Brandi Boak, MPH, are members of the Evaluation Institute for Public Health at the University of Pittsburgh.

Ashwini Chaudhari, MPH, BDS, is a rising first year doctoral student at University of Pittsburgh School of Public Health. She supports the Evaluation Institute for Public Health across two projects.

About the Author

Sarah Papperman: Sarah Papperman, MPH, CPH, is a staff member of the Evaluation Institute for Public Health at the University of Pittsburgh and has supported two federally funded grants thus far.