radhika.gore@nyulangone.org
Background: Safety–net healthcare systems are distinctly positioned to impact health disparities, but have little guidance on incorporating social needs screenings and referrals in electronic health records (EHR) and evaluating their implementation.
Objective: As a large Federally Qualified Health Center network in Brooklyn, NY, we have screened and connected patients to an in–house social–service center since 2017. In 2022 we integrated social care workflows in our EHR system. Post–integration, screenings can be conducted within the EHR and clinicians can refer patients with social needs to the social–service center through the EHR. We analyzed workflows, equity, and reach of social care 2 years post–integration at 2 clinic sites: Adult Medicine, where nurses routinely screen patients at new patient, annual physical, and hospital discharge visits, and Women's Health, where nurses screen patients at initial prenatal visits.
Methods: We analyzed screening and referrals data from 8/8/2022 to 8/31/2024 covering over 11,000 screenings for 9000 adult patients at 2 sites. Consultations with staff were used to describe site–specific workflows.
Results: At Adult Medicine, 97% of eligible visits were screened; 5% identified a need. At Women's Health, 79% of eligible visits were screened; 31% identified a need. At Women's Health, screening rates were higher among visits with a Latina patient (80%) relative to non–Latina (70%), and Latina patients with Spanish vs. English language preference were more likely to report a need (38% vs. 17%). In Women's Health, 7% of referrals were declined; staff perceived that reasons included fears about immigration, stigma around accessing public benefits, and gender dynamics if patient's partner was present during the visit.
Conclusion: EHR integration can support standardized screening–and–referral workflows. To explain and address differences by site and racial/ethnic identity, additional mixed–methods data are required on organizational factors (e.g., staff cultural concordance, visit type) and patient intersectionality (e.g., gender + economic class).