Early Results from Doc 2 Doc: Provider Handoffs of Pediatric Unmet Social Needs at Hospital - PowerPoint Presentation

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Early Results from Doc 2 Doc: Provider Handoffs of Pediatric Unmet Social Needs at Hospital DischargeMadeline Mier, MD1; John Morrison, MD, PhD1,3,4; Raquel Hernandez, MD, MPH2,3,41Division of Pediatric Hospital Medicine, 2Division of General Pediatrics and Adolescent Medicine, Department of Medicine; 3Institute for Clinical and Translational Research; Johns Hopkins All Children’s Hospital, St. Petersburg FL4Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MDThe AAP currently recommends screening for unmet social needs (USN) at every patient encounterThere has been recent focus on the development & implementation of screening protocols in many outpatient and inpatient settings Critical gaps remain in understanding how to bridge identified USN from inpatient to outpatient settings Exploration of how USN can be handed off between inpatient and outpatient providers could inform best practices for communication and improve the health of hospitalized childrenAIM 1: Describe the self-identified beliefs, perceptions, benefits and barriers of both outpatient pediatricians and hospitalists regarding the concept of an USN handoffAIM 2: Among outpatient pediatricians, identify what factors are associated with perceived value in receiving an USN handoffAIM 3: Among hospitalists, identify what factors are associated with willingness to provide an USN handoffObjectivesIntroductionMaterials and MethodsCross-sectional, electronic survey of two provider populations –Pediatric hospitalistsAmbulatory general pediatriciansBoth samples were directly recruited via email from JHACH and the JHACH community provider networkSurveys developed based on the Health Beliefs Model (Fig. 1) with six major question domains (Fig. 2)Questions explored motivators associated with either willingness to provide an USN handoff (hospitalists) or confidence to utilize an USN handoff (general pediatricians)Reported frequencies, means and medians for responses, along with general sample trends and comparisons between inpatient and outpatient provider groups, performed with Fisher’s exact test as appropriateAll participants received remuneration with a $5 gift cardResultsConclusionOur early data demonstrate both hospitalists and general pediatricians in our community find an USN handoff to be valuable – with hospitalists willing to provide a handoff and general pediatricians confident to utilize USN information. Further analysis of our results are ongoing and may inform the most feasible way to implement the use of an USN handoff, as well as what unmet needs providers find the most important to be included in a handoff.Total of 32 participants completed the survey – 16 self-identified hospitalists and 16 self-identified general pediatricians81% of hospitalists stated they have ever provided a handoff including information on USN while only 25% of outpatient pediatricians reported they have ever received such a handoffMost participants of both groups recognize faxed written discharge summaries as the most realistic method for USN handoffsMore hospitalists ranked lack of transportation and housing conditions as the most important USN to be communicated among six clinical scenarios, while more outpatient providers ranked housing insecurity as the top issue; both groups based their prioritization on which issues they perceived to be most life-threateningAll hospitalists were “willing” or “very willing” to provide a USN handoff, while the median IQR of outpatient pediatricians’ confidence to utilize such a handoff was 8/10 (IQR 6-10)Figure 1. Health Beliefs ModelDemographic Variables age, location, clinical practice, etc.Psychological Characteristics Personality, peer group pressure, etc.Perceived Susceptibility of Patients to Unmet Social NeedsPerceived Severity of Impact of Unmet Social NeedsHealth MotivationPerceived Benefits of Unmet Social Needs HandoffPerceived Barriers to Unmet Social Needs HandoffAction - Providing / Receiving Unmet Social Needs HandoffCues to ActionFigure 2. Doc 2 Doc Survey DomainsTable 1. Motivating Factors and Discharge Handoff Practices/Preferences InpatientOutpatientPMean years since residency (SD)13.4 (11.0)20.4 (2.2).06Self-reported prevalence of patients with various SDOH, N (%)>20% Medically Complex 12 (75)6 (38).07>20% Publicly Insured16 (100)10 (63).02>20% Limited English Proficiency5 (31)6 (38)>.99>20% of Patients in Practice with ≥1 Unmet Social Need 11 (69)5 (31).08Poverty as the greatest impact on health and well-being, N (%)9 (56)6 (38).48Ever provided/received a discharge handoff that included information regarding a patient or family’s unmet social needs, N (%)13 (81)4 (25)<.01Preferred method for receiving USN handoff, N (%)1   Direct phone call11 (69)6 (38).16Voicemail3 (19)2 (13)>.99Message left with staff member1 (6)3 (19).60Faxed discharge summary12 (75)11 (69)>.99EMR message11 (69)9 (56).72Other1 (6)0 (0)>.99Most realistic method for receiving USN handoff, N (%)2   Direct phone call0 (0)1 (6).89Voicemail0 (0)1 (6) Message left with staff member1 (6)2 (13) Faxed discharge summary10 (63)8 (50) EMR message4 (25)3 (19) Other1 (6)1 (6) 1 Respondents could choose more than one answer2 Respondents could only choose one answerTable 2. Top rank order frequency (%) of Unmet Social Needs Clinical Scenarios.(Providers instructed to rank scenarios in order of importance with “1” reflecting highest priority social need and “6” lowest priority social need)  Inpatient OutpatientPScenario A – asthma, housing conditions4 (25)1 (6).33Scenario B – seizures, lack of transportation5 (31)4 (25)>.99Scenario C – cellulitis, living in shelter3 (19)7 (44).25Scenario D – DKA, immigration1 (6)3 (19).60Scenario E – gastroenteritis, food insecurity3 (19)1 (6).60Scenario F – bronchiolitis, utilities0 (0)0 (0)>.99