250 - Characterizing Clinicians Documentation of Social Risk Factors in Free Text Clinical Notes

Poster Number: 250
Publication Number: 250.1105

Background: Many professional organizations endorse screening for social risk factors – adverse social determinants of health (SDOH) - in clinical settings. The National Academies of Science, Engineering, and Medicine also recommends responding to social risks identified in healthcare settings though: 1) social risk assistance, providing resources to address social risks themselves (e.g., providing a food bank referral to address food insecurity); and 2) social risk adjustment, adjusting medical care to circumvent social challenges to care (e.g., not prescribing a medication that needs to be taken with food to families experiencing food insecurity). Documentation of SDOH assistance and adjustment activities facilitates communication about the status of ongoing social interventions. However, no study of which we are aware has explored how often clinicians document assistance and adjustment activities after patients screen positive for social risks.

Objective: We sought to characterize the frequency of social risk factor assistance and adjustment documentation in a pediatric population.

Design/Methods: We leveraged data from a completed randomized clinical trial based in an urban, safety net, pediatric acute care clinic. We examined rates of social risk assistance and adjustment documentation among patients with identified social risks in patient clinical note free text, as prior work has shown that SDOH is more commonly documented in free text notes than in structured SDOH electronic health record data elements. We tabulated rates of social risk assistance and adjustment activities.

Results: Table 1 displays sample characteristics (N=617). Among the 14.7% of patients with documented social risks, social risk assistance documentation varied widely by risk factor (4.76-100%; Table 2). Social risk adjustment documentation was universally low (Table 2). Table 3 provides examples of assistance and adjustment documentation.

Conclusion(s): In a pediatric sample, we found wide variation in social risk assistance documentation based on the type of social risk. We also found universally low documentation of social risk adjustment activities. Our findings of a mismatch between clinician documentation of social risks and how they respond echo concerns about SDOH screening without offering resources to address identified social needs. Since documentation of adjustment and assistance activities may help to ensure that social risk factor screening data is responded to appropriately, our findings suggest a need to support clinicians to both offer resources to address social needs and document actions taken.