SAT114 Global Social Determinants Of Health Needs And Response For Those New To Insulin At Discharge
Authors: Bullock Cydney A , Davis Ka'Derricka , Carthy Kevin , Wax Pamela , Smyrniotis Colleen , Pollack Teresa , Barnard Cynthia , Holl Jane , Wallia Amisha 
Published: October 2023

Disclosure: C.A. Bullock: None. K. Davis: None. K. Carthy: None. P. Wax: None. C. Smyrniotis: None. T. Pollack: None. C. Barnard: None. J. Holl: None. A. Wallia: Grant Recipient; Self; Novo Nordisk. Research Investigator; Self; UnitedHealth Group.

Unmet social determinant of health (SDoH) needs of patients with diabetes who are discharged with newly prescribed insulin place these patients at high risk of poor outcomes. Yet, few system level initiatives exist to identify patients with these needs and address them. An SDoH screening and referral initiative, consisting of an integrated screening tool administered by nursing upon hospital admission, was launched at a Chicago academic health system that cares for a diverse patient population. The electronic health record (EHR) screener assesses six specific domains including medication affordability, transportation barriers, food insecurity, housing stability, usual source of care, and mental health needs and a follow-up question if the patient would like assistance (leading to social work consultation). Our goal was to review the identified SDOH needs of patients newly prescribed insulin at discharge, and for whom a certified diabetes care and education specialist consultation (CDCES) was placed. From 05/01/22- 09/30/22, 279 patients had a CDCES consultation at Northwestern Memorial Hospital (NMH) of which 3 expired during admission. Of the 131 patients (47%) discharged with a new prescription for insulin, 18 (14%) were non-English, of which 17 (95%) had a complete SDOH screener, and 113 were English-speaking (86%), of which 74% (N=84) had a complete SDoH screener. The 113 English speaking patients had an age range from 20-84 (mean 56, SD + 14), 37 (33%) identified as black, 58 (51%) were female, and a majority (N= 55 [49%]) had Medicaid, Medicare coverage or were uninsured.  Of those who had a screener completed (N=84), 28 (33%) reported at least 1 need, while 8% (N=7) identified &gt;=3 needs, and 11% (N=9) requested assistance. The most reported need was a usual source of care (N=14, 17%). Other identified SDoH needs included medication affordability (N=8), transportation need (N=8), food insecurity (N=7), and housing stability issue (N=6), but few (N=2) identified any mental health needs. Sixty-five patients in total had a Social Work consultation and of those patients who identified needs 58% had their SDoH needs addressed by a Social Worker. Of the 14 patients without a usual source of care, 5 (43%) were readmitted or seen in the emergency department within 90 days of discharge and 1 had &gt; 8 visit, despite enrollment in a hospital transitional care program. Only one patient established a usual source of care. Overall, 2 patients (2%), both with no identified needs, died within 90 days. Our findings reveal that many hospitalized patients who had a CDCES consultation before discharge and were newly prescribed insulin, identified global (&gt; 3 SDoH or requiring assistance) needs. The findings also suggest that CDCES, nurses, pharmacists, and/or social workers may need to facilitate and/or create new pathways to address the needs of hospitalized patients newly prescribed insulin.   

Presentation: Saturday, June 17, 2023