JMIR Publications

ABSTRACT

Background:

Consistent and compelling evidence demonstrates that social and economic adversity impact health outcomes. In response, many healthcare professional organizations recommend screening patients for experiences of social and economic adversity or ‘social risks’—e.g., food, housing, and transportation insecurity—in the context of care. The guidance on how healthcare providers can act on documented social risk data to improve health outcomes is nascent. One strategy recommended by the National Academy of Medicine involves using social risk data to adapt care plans in ways that accommodate patients’ social risks.

Objective:

This study’s aims are to (1) develop electronic health record-based clinical decision support (CDS) tools that suggest social risk-informed care plan adaptations for patients with diabetes and/or hypertension; (2) assess tool adoption and its impact on selected Clinical Quality Measures in community health centers; and (3) examine perceptions of tool usability and impact on care quality.

Methods:

A systematic scoping review and several stakeholder activities will be conducted to inform development of the CDS tools. The tools will be pilot tested to obtain user input, and their content and form revised based on this input. A randomized quasi-experimental design will then be used to assess the revised tools’ impact. Eligible clinics will be randomized to a control group or potential intervention group; clinics will be recruited from the potential intervention group in a random order until six are enrolled in the study. Intervention clinics will have access to the CDS tools in their EHR, will receive minimal implementation support, and will be followed for 18 months to evaluate tool adoption and the impact of tool use on patient blood pressure and glucose control.

Results:

This study was funded in January 2020 by the National Institute on Minority Health and Health Disparities of the National Institutes of Health. Formative activities will take place from April 2020-July 2021; the CDS tools will be developed May 2021-November 2022; the pilot study will be conducted August 2021-July 2022; and the main trial will occur December 2022-May 2024. Study data will be analyzed, and results disseminated, in 2024.

Conclusions:

Patients’ social risk information must be presented to care teams in a way that facilitates social risk-informed care. To our knowledge, this study is the first to develop and test EHR-embedded CDS tools designed to support the provision of social risk-informed care. Study results will add needed understanding of how to use social risk data to improve health outcomes and reduce disparities.