Basic social resource needs screening in the gynecologic oncology clinic: a quality improvement initiative

• Published in: American journal of obstetrics and gynecology 2020-11, Vol.223 (5), p.735.e1-735.e14
• Main Authors: Beavis, Anna Louise, Sanneh, Awa, Stone, Rebecca L., Vitale, Margaret, Levinson, Kimberly, Rositch, Anne F., Fader, Amanda Nickles, Topel, Kristin, Abing, Ashley, Wethington, Stephanie L.
• Format: Article
• Language: English
• Subjects: Academic Medical Centers; Adult; Aged; Ambulatory Care; basic resources; cervical cancer; Child; Child Care - statistics & numerical data; Clothing - statistics & numerical data; Economic Status - statistics & numerical data; Ethnicity - statistics & numerical data; Female; Food Supply - statistics & numerical data; Genital Neoplasms, Female - diagnosis; Genital Neoplasms, Female - therapy; gynecologic cancer; Gynecology; Health Leads; healthcare disparities; Hospitals, Urban; Household Articles - statistics & numerical data; Housing - statistics & numerical data; Humans; Insurance, Health - statistics & numerical data; Literacy - statistics & numerical data; Marital Status - statistics & numerical data; Mass Screening; Medical Oncology; Middle Aged; Needs Assessment; ovarian cancer; Prospective Studies; Quality Improvement; routine screening; Smoking - epidemiology; Social Determinants of Health; supportive care; Transportation - statistics & numerical data; uterine cancer
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2020.05.028

Social determinants of health are known to contribute to disparities in health outcomes. Routine screening for basic social needs is not a part of standard care; however, the association of those needs with increased healthcare utilization and poor compliance with guideline-directed care is well established. In this study, we aimed to assess the prevalence of basic social resource needs identified through a quality improvement initiative in a gynecologic oncology outpatient clinic. In addition, we aimed to identify clinical and demographic factors associated with having basic social resource needs. We performed a prospective cohort study of women presenting to a gynecologic oncology clinic at an urban academic institution who were screened for basic social resource needs as part of a quality improvement initiative from July 2017 to May 2018. The following 8 domains of resource needs were assessed: food insecurity, housing insecurity, utility needs, financial strain, transportation, childcare, household items, and difficulty reading hospital materials. Women with needs were referred to resources to address those needs. Demographic and clinical information were collected for each patient. The prevalence of needs and successful follow-up interventions were calculated. Patient factors independently associated with having at least 1 basic social resource need were identified using multivariable Poisson regression. A total of 752 women were screened in the study period, of whom 274 (36%) reported 1 or more basic social resource need, with a median of 1 (range, 1–7) need. Financial strain was the most commonly reported need (171 of 752, 23%), followed by transportation (119 of 752, 16%), difficulty reading hospital materials (54 of 752, 7%), housing insecurity (31 of 752, 4%), food insecurity (28 of 752, 4%), household items (22 of 752, 3%), childcare (15 of 752, 2%), and utility needs (13 of 752, 2%). On multivariable analysis, independent factors associated with having at least 1 basic social resource need were being single, divorced or widowed, nonwhite race, current smoker, nonprivate insurance, and a history of anxiety or depression. A total of 36 of 274 (13%) women who screened positive requested assistance and were referred to resources to address those needs. Of the 36 women, 25 (69%) successfully accessed a resource or felt equipped to address their needs, 9 (25%) could not be reached despite repeated attempts, and 2 (6%) declined assistance. Basic socia