775 - Improving Social Determinants of Health Screening in a High-Risk Infant Follow-Up Clinic: A Quality Improvement Initiative

Publication Number: 1751.775

Rachel N. LaFontaine, University of Washington School of Medicine, Seattle, WA, United States; Erin Baumler, Seattle Children's, Seattle, WA, United States; Kanika Nallaseth, University of Washington, Seattle, WA, United States; Emily Myers, University of Washington School of Medicine, Seatte, WA, United States; Sara K. Neches, University of Washington School of Medicine, Seattle, WA, United States

Background: Infants cared for in the neonatal intensive care unit (NICU) are at higher likelihood of developmental delay. Neurodevelopmental follow-up (NDFU) serves a critical role in identifying infants at risk of delay; however, social disparities are associated with reduced rates of NDFU clinic attendance. The American Academy of Pediatrics recommends universal social determinants of health (SDOH) screening, though data on the implementation of SDOH screening in NDFU clinics is lacking. The University of Washington (UW) Institute for Human Development and Disability (IHDD) follows infants discharged from regional NICUs at risk for developmental delay. A grant from Foundry10 was awarded to the IHDD in October 2024 to provide $100 gift cards to families screening positive for SDOH. Prior to this project, there was no formal SDOH screening performed in the clinic.

Objective: To improve SDOH screening documentation for all patients seen at two regional NDFU clinics from 0% to 90% within 20 months.

Design/Methods: We conducted Plan-Do-Study-Act (PDSA) cycles at two IHDD clinics, the Late and Moderately Preterm Baby clinic (LAMBs) and the Infant Development Follow-up Clinic (IDFC). from November 2024 through October 2025 (Figure 1). The primary outcome measure was the % completed SDOH screens per total number of clinic visits assessed monthly. Process measures included the % of monthly positive SDOH screens and the number of gift cards distributed to families monthly. Data is presented using descriptive statistics and Standard Process Control.

Results: SDOH screening documentation at IDFC and LAMBs clinic improved from 0% during the baseline period to an average of 91% after intervention, with a 14% monthly average of positive SDOH screens (Figure 2). A total of 131 families screened positive for at least one domain of SDOH, including housing insecurity N=9 (7%), utilities N=17 (13%), transportation N=33 (25%), and/or food insecurity N=75 (57%). The number of gift cards distributed closely matched the number of positive screens (Figure 3). A limited dataset was collected from 191 infants attending 3-5-month CA visits at the IDFC. Data collection is ongoing to explore whether SDOH screening at 3-5 months corrected age (CA) is associated with 6-9 month follow-up rates.

Conclusion(s): A systems-based quality improvement approach improved SDOH documentation in a regional NDFU clinic. Work towards integration of screening within the patient-facing electronic health record may further improve compliance, allowing providers advanced notification for positive screens and time to tailor specific community resources.

Figure 1. Key Driver Diagram
Key Driver Diagram highlighting SMART aim, key drivers, and change ideas for improving Social Determinants of Health Screening at a Neurodevelopmental Follow-Up Clinic.

Figure 2. Standard process control (SPC) charts tracking social determinants of health screening at a regional neurodevelopmental follow-up clinic
Panel A: p-chart depicting the percentage of total visits at LAMBs and IDFC clinics where SDOH screener was completed. Pre-intervention: January 2024-November 2024, post-intervention: December 2024-October 2025.
Panel B: p-chart depicting the percentage of patients screening positive for at least one SDOH domain monthly post-intervention (December 2024 - October 2025).

Figure 3. The number of positive SDOH screens for each domain, and gift cards received monthly
N=131 positive screens occurred for at least one SDOH domain (housing insecurity, utilities, transportation, and food insecurity), between November 2024 and October 2025. Note that some families may have screened positive for more than one SDOH domain.