Table.
Final ranked research priorities pertaining to implementation of social risks and needs screening in the emergency department. Total points are weighted (3 points for priority 1 vote, 2 points for priority 2 vote, and 1 point for priority 3 vote).
| Question | Priority | Total points | Priority category | Gap addressed* | ||
|---|---|---|---|---|---|---|
| 1 | 2 | 3 | ||||
| How can EDs work effectively with and leverage existing expertise and resources of community organizations to optimize ED screening for social risk/needs? | 10 | 3 | 4 | 40 | High | OCE |
| What combination of interpersonal engagement and technology (eg, chatbots, kiosks, and EHR alerts and algorithms) in the screening process optimizes patient comfort disclosing their needs, maximizes efficiency, and facilitates successful referrals to community resources? | 3 | 11 | 1 | 32 | High | SIM |
| When should the screening be completed during the ED course? Where/how should it be done (eg, triage desk, registration, or alone in a treatment room; technology-assisted)? Where and with whom are results of screening discussed? | 7 | 3 | 4 | 31 | High | SIM |
| What are patient-, clinician-, and systems-level barriers to social risk/need screening in the ED? What strategies can be used to address the barriers to screening for social risk/needs in the ED? Do patient and clinician acceptability and accurate completion of screening improve when these barriers are addressed? | 3 | 7 | 2 | 25 | High | BFS |
| What is the ideal team structure and skill-mix of personnel for supporting screening in the ED? How might community health workers, trained peers, and/or health system navigators be incorporated into the screening process? | 2 | 2 | 4 | 14 | Medium | SIM |
| What is the comparative effectiveness of conducting a brief screening (eg, 1–2 items) for social risk/needs and then more detailed questions for those with potential risks/needs identified in the general screener versus starting with a more comprehensive screening for multiple discrete social risk/needs? | 3 | 1 | 2 | 13 | Medium | SIM |
| What is the “return on investment” for social risk/need screening in the ED, considering broadly defined “returns” as well as costs (including time and resources) in the ED? | 0 | 3 | 7 | 13 | Medium | BFS |
| How does the effectiveness of a given ED-based, social risk/need screening intervention vary across settings (ie, urban vs rural, academic vs community, and across multiple sites in general)? How can implementation of screening for social risk/needs be tailored based on setting to maximize effectiveness? | 4 | 0 | 0 | 12 | Medium | OCE |
| What strategies should be used to screen for social risk/needs among patients with psychiatric or high acuity presentations? Non-English-speaking patients? Undocumented patients? | 0 | 3 | 5 | 11 | Low | BFS |
| What is the comparative effectiveness and feasibility of strategies where interventions are triggered by positive social risk/need screening versus universal offers of social needs assistance to ED patients? | 2 | 0 | 2 | 8 | Low | SIM |
| What is the role of universal screening vs targeting certain patient groups (eg, patients with frequent ED visits)? | 1 | 1 | 1 | 6 | Low | SIM |
| What factors of the payment and policy landscape (eg, mandates and funding) encourage/incentivize or discourage EDs from implementing social risk/need screening? | 0 | 1 | 2 | 4 | Low | BFS |
*
SIM, screening implementation mechanics (Gap 1); OCE, outreach and community engagement (Gap 2); BFS, barriers and facilitators to screening (Gap 3); ED, emergency department; EHR, electronic health record.