25 college students and a conversation: Reading Hospital's atypical screening method for social determinants

At Tower Health's Reading Hospital in West Reading, Pa., college interns reach patients before they've even seen a provider, offering compassion and human connection as they screen for social determinants of health. 

That "Community Connection Program" now serves as a best practice model for CMS, which will require all hospitals to screen patients for SDOH by 2024. 

The program began as a project, Desha Dickson, Tower Health's vice president of diversity, equity and inclusion and community wellness, told Becker's. In 2016, CMS offered a cooperative agreement for health systems willing to test their theory: If patients were frequently and systematically screened for social determinants of health, care access would increase and overall emergency department utilization would decrease. 

Tower Health applied, and was one of 12 organizations to win a $4.5 million grant. They spent "every dollar" of that money, primarily on a workforce to conduct the screenings, according to Ms. Dickson. 

"What we needed was a person-to-person screen," Ms. Dickson said. "We needed individuals to work directly with patients to really amplify that we were here to help. To show that compassion is something you can't do just by looking at an iPad or phone."

In around 20 different settings from the ED to ambulatory clinics, college interns approach patients in the waiting room and ask to speak with them privately. They pull them off to the side — some waiting rooms have special spaces carved out — and ask questions related to food security, housing, transportation, utilities and personal violence. 

Using WellSky, a technology embedded into Epic, the health system connects patients who lack in any of the five domains with a community partner who can help. The community partner notifies the health system once the patient's need is met, bringing the intervention full circle.  

"It really is a huge paradigm shift to be asking patients these questions around food, housing, transportation, utilities and personal violence — not just asking them, but also connecting them to the services and being able to provide a closed-loop communication," Ms. Dickson said. 

Why choose a collegiate staff?

The health system conducts around 75,000 SDOH screenings per year, and couldn't afford to bring on full-time staff to match that volume. That's why they turned to part-time college interns. 

Each semester, between 20 and 25 college interns take part in the Community Connection Program. More mature than their high school counterparts and typically more comfortable asking difficult questions, higher-education students are a perfect fit for the health system's needs. 

The program is intentional about matching the demographics of patients to the intern who will screen them — for example, a young, Hispanic, Spanish-speaking woman might feel most comfortable speaking to another young, Hispanic, Spanish-speaking woman. It also targets students with healthcare-related majors, hoping to show them a side of the medical field they otherwise might not see. 

"We wanted to show them, here are some things that patients are struggling with that are directly impacting their ability to get well and stay well, and the intervention is not medical at all," Ms. Dickson said. "The intervention is not a prescription, it's a conversation." 

All of the health system's internship programs are guided by the students' experience, not the existing staffs', Ms. Dickson emphasized. And some students enjoy their experience so much that they choose to stay on after it's over: Five former interns are now full-time employees on her team. 

Community partnerships help close the loop 

The program would not be successful without community partners, Ms. Dickson said. CMS' grant required the health system to form a community collaborative with both clinical and nonclinical partners for each of the five domains they were screening. 

In the past, the health system could refer patients to outside organizations and hope they got the help they needed, but they would rarely receive confirmation that the need had been met. With established community relationships and a little help from WellSky, employees of both organizations know how to support a patient in need, and when that need has been met. 

'The power of a conversation' yields quantitative results 

CMS' program ended in 2022, but the health system is continuing on with an adapted version of their screening method. In addition to the college interns, a core staff of screeners works closely with clinical departments to identify and assist high-risk patients. 

For example, one outpatient department had a list of patients who were frequently missing appointments with a no-show rate around 36 percent. In only one month's time, using nonmedical interventions, the Community Connection Program reduced the no-show rate to around 27 percent. 

The health system has completed nearly 170,000 patient screens and has a 65 percent connect rate: When patients are identified with needs, 65 percent of those needs are taken care of. 

"That's really the power of a conversation," Ms. Dickson said.

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