COVID-19 and Changes in Reported Social Risk Factors at a Primary Care Practice in the South Bronx.

INTRODUCTION: Historically, Black and Hispanic patient populations in the Bronx Borough of New York City have experienced the highest rates of social risk factors, and associated poor health outcomes, in New York State. During the pandemic, Bronx communities disproportionately experienced high rates of COVID-19 illness and death. To date, little is known regarding the COVID-19 pandemic's impact on social risk factors in urban, at-risk communities. This study aimed to determine how social risk factors changed during the pandemic in a Bronx-based patient population. METHODS: Study participants were adult patients seen at a Federally Qualified Health Center in the South Bronx. Using a paired longitudinal study design, 300 participants were randomly selected for telephonic outreach during the pandemic from a sample of 865 participants who had been offered a social risk factor screener in the year prior to the pandemic. The outreach survey used included the social risk factor screener and questions regarding COVID-19 illness burden and prior engagement in social services. The McNemar test was used to analyze trends in reported social risks. RESULTS: Housing quality needs, food insecurity, and legal care needs significantly increased during the pandemic. Participants who reported COVID-19 illness burden were 1.47 times more likely to report a social risk factor (P = .02). No significant relationship was found between prior enrollment in clinic-based social services and degree of reported social risk (P = .06). CONCLUSION: Housing quality needs, food insecurity, and legal care needs increased during the COVID-19 pandemic in a predominantly Black and Hispanic identifying urban patient population. Urgently addressing this increase is imperative to achieving health equity in ongoing COVID-19 mitigation efforts.

Social Determinants of Health Screening by Preclinical Medical Students During the COVID-19 Pandemic: Service-Based Learning Case Study.

BACKGROUND: The inclusion of social determinants of health is mandated for undergraduate medical education. However, little is known about how to prepare preclinical students for real-world screening and referrals for addressing social determinants of health. OBJECTIVE: This pilot project's objective was to evaluate the feasibility of using a real-world, service-based learning approach for training preclinical students to assess social needs and make relevant referrals via the electronic medical record during the COVID-19 pandemic (May to June 2020). METHODS: This project was designed to address an acute community service need and to teach preclinical, second-year medical student volunteers (n=11) how to assess social needs and make referrals by using the 10-item Social Determinants of Health Screening Questionnaire in the electronic health record (EHR; Epic platform; Epic Systems Corporation). Third-year medical student volunteers (n=3), who had completed 6 clinical rotations, led the 2-hour skills development orientation and were available for ongoing mentoring and peer support. All student-patient communication was conducted by telephone, and bilingual (English and Spanish) students called the patients who preferred to communicate in Spanish. We analyzed EHR data extracted from Epic to evaluate screening and data extracted from REDCap (Research Electronic Data Capture; Vanderbilt University) to evaluate community health workers' notes. We elicited feedback from the participating preclinical students to evaluate the future use of this community-based service learning approach in our preclinical curriculum. RESULTS: The preclinical students completed 45 screening interviews. Of the 45 screened patients, 20 (44%) screened positive for at least 1 social need. Almost all of these patients (19/20, 95%) were referred to the community health worker. Half (8/16, 50%) of the patients who had consultations with the community health worker were connected with a relevant social service resource. The preclinical students indicated that project participation increased their ability to assess social needs and make needed EHR referrals. Food insecurity was the most common social need. CONCLUSIONS: Practical exposure to social needs assessment has the potential to help preclinical medical students develop the ability to address social concerns prior to entering clinical clerkships in their third year of medical school. The students can also become familiar with the EHR prior to entering third-year clerkships. Physicians, who are aware of social needs and have the electronic medical record tools and staff resources needed to act, can create workflows to make social needs assessments and services integral components of health care. Research studies and quality improvement initiatives need to investigate how to integrate screening for social needs and connecting patients to the appropriate social services into routine primary care procedures.