WIP 130 - Screening for health-related social needs in children with hematologic and oncologic diagnoses: a quality improvement project

Poster Number: WIP 130
Publication Number: WIP 130.2545

Background: Previous studies on childhood cancer and hematologic conditions reveal disparities in outcomes related to social determinants of health. For example, children with leukemia growing up in families with lower socioeconomic status have two-fold increase in death rates, and youth with sickle cell disease living below the poverty line report lower quality of life and have higher rates of medical complications. Evidence supports the significant impact of social and economic factors in hematologic and oncologic diseases, suggesting a need to screen for intervenable health-related social needs (HRSN) in the hematology/oncology outpatient setting.

Objective: To implement standardized HRSN screening in a pediatric hematology/oncology clinic, achieving at least 30% screening of eligible patients within a 10-month period.

Design/Methods: We are conducting an IRB-approved quality improvement (QI) study to increase HRSN screening via a standardized, self-administered 10-item questionnaire. Families treated in a single-center pediatric hematology/oncology clinic in a large, urban health system from 5/2023 to 3/2024 are eligible for study inclusion. The outcome measure is the percentage of eligible patients with a completed screen. Process measures include the number of 1) staff trained to administer screens and 2) positive screens. Balancing measures include 1) the time burden on patients and staff (assessed through negative HRSN screens) and 2) brief provider satisfaction surveys. Run charts monitor monthly progress and identify special cause variation. Plan-do-study-act cycles were developed from retrospectively identified issues via root cause analysis and prospectively via failure modes and effect analysis to identify vulnerable areas in the processes. Interventions include use of a multidisciplinary team, standardized workflow, and utilization of community health workers to address positive screens. Outpatient screening began 3/2022; QI methods started 5/2023 with the first two PDSA cycles completed 10/2023. The final cycle will end 2/2024 followed by analysis in 3/2024.