428 - Electronic Tablet Screening Increases Social Need Disclosure in Pediatric Primary Care

Poster Number: 428
Publication Number: 428.33

Background: Prior studies have shown lower rates of health-related social needs disclosure with verbal screening compared to electronic or paper screening. Studies comparing electronic to paper screening are lacking. Studies linking screening to intervention (e.g., referrals to office-based services) are also limited.

Objective: 1) Assess whether disclosure of health-related social needs differs when questions are administered electronically (via tablet) vs. paper. 2) Evaluate whether changes in need identification affect referral rates to interventions.

Design/Methods: This retrospective review of health-related social needs screening in patients 0-18 years with public insurance presenting for well child visits (WCV) occurred in three primary care practices. The paper period was 2/2018-12/2018; the electronic tablet period was 2/2019-12/2019. The first WCV per period was included for patients with >1 WCV to avoid duplication. Our primary outcome was frequency of reported social need, comparing the proportion of positive social needs screens during the 11 months before and after the screening modality change. Generalized estimating equations (GEE) and interrupted time series (ITS) were used to assess changes in needs disclosure over time. Mediation analyses assessed the indirect effect of reporting a social need with change in referrals to legal aid and social work during the electronic screening period.

Results: From 2/2018-12/2018, 16,151 unique patients had paper-based social needs screens. From 2/2019-12/2019, 13,019 patients had electronic screens (7057 (54%) of these, repeat visits). Across both time periods, 69% of patients identified as Black and 7% as Hispanic (Table 1). A total of 11% of paper social need screens identified ≥1 positive social need compared to 26% of electronic screens (p < 0.001). Using GEE adjusting for site, there was a significant increase in positive screens with electronic compared to paper (across the three sites, odds ratios [OR] ranged from 1.54 to 4.23, p< 0.001). In ITS, two of three sites had significantly increased odds of positive screen electronically compared to paper (Figure 1, Urban site 1 OR 3.0, 95% confidence interval [CI] 2.5, 3.6; and Suburban site OR 1.7, 95%CI 1.2, 2.4). An increase in referrals to legal aid and social work during the electronic period were mediated by increases in reporting of social needs (Table 2, indirect effects at each site of 2.2, 1.6, and 1.3, p< 0.05).

Conclusion(s): Electronic tablet screening was associated with increased disclosure of social needs compared to paper screening, this led to increased referrals to office-based interventions.