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The overall objective of this study is to support emergency department management of patients' health-related social needs. This study will measure the impact of a decision support system that informs clinicians about which patients are likely to screen positive for a health-related social need. The system uses statistical models to create a health-related social need risk score for each patient. The main questions, the study aims to answer are:
The decision support system with health-related social needs risk scores will be introduced for all adult patients at one emergency department. Screening rates, referrals, and subsequent healthcare encounters will be compared with emergency departments that did not have access to the decision support system.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Decision support intervention group | Experimental | Adult ED patients seeking care the ED site with the health-related social needs decision support system live. |
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| Comparison group | No Intervention | Adult ED patients created using statistical matching from ED sites in the same metropolitan area. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Health-related social needs decision support system | Other | The clinical decision support intervention will present emergency department clinicians at an Indianapolis, IN ED with a likelihood score for an adult patient screening positive for the following health-related social needs (HRSNs): housing instability, food insecurity, transportation barriers, financial strain, and history of legal involvement. For each HRSN, the likelihood of screening positive is reported as "high", "medium", or "low". These categorizations are the product of logistic regression models. The clinical decision support intervention will be delivered through an existing FHIR (Fast Healthcare Interoperability Resources) standards-based clinical decision support platform. |
| Measure | Description | Time Frame |
|---|---|---|
| Percent of emergency department encounters screened for health-related social needs (HRSNs) | The numerator will be an emergency department encounter with any indication of HRSN screening using any tool or questionnaire, regardless of patient completion or results. The denominator will be all eligible ED encounters. | At time of emergency department encounter (or within 24 hours) |
| Percent of emergency department encounters that were referred for health-related social needs (HRSNs) services | The numerator will be emergency department encounters with a referral to social worker, case management, community health workers, or related services within 24 hours of the ED encounter. The denominator will be all eligible ED encounters | At time of emergency department encounter (or within 24 hours) |
| Measure | Description | Time Frame |
|---|---|---|
| Percent of encounters with an emergency department revisit measured at 3 days | The numerator will be an emergency department encounter at any facility included in the Indiana for Network Care database within 3 days of an ED encounter at an intervention or comparator site. ED revisits may serve as the index visit for subsequent revisits. The denominator will be all eligible ED encounters. Encounters resulting in an inpatient admission will be excluded from the numerator and denominator. |
| Measure | Description | Time Frame |
|---|---|---|
| Percent of emergency department encounters where the health-related social needs (HRSN) decision support system intervention was accessed. | The numerator will include encounters with access of the social needs section (containing the risk prediction scores) of the decision support system intervention during the study visit (defined as within 24 hours). Access will be defined as record of the end user visiting the HRSN page in the system user logs. The denominator will be all eligible ED encounters. Limited to the intervention site only. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Joshua R Vest, PhD,MPH | Indiana University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Indiana University Health | Indianapolis | Indiana | 46202 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39028248 | Background | Mazurenko O, Hirsh AT, Harle CA, McNamee C, Vest JR. Acceptance of Automated Social Risk Scoring in the Emergency Department: Clinician, Staff, and Patient Perspectives. West J Emerg Med. 2024 Jul;25(4):614-623. doi: 10.5811/westjem.18577. | |
| 40354398 | Derived | Mazurenko O, Harle CA, Blackburn J, Menachemi N, Hirsh A, Grannis S, Boustani M, Musey PI Jr, Schleyer TK, Sanner LM, Vest JR. Effectiveness of a clinical decision support system with prediction modeling to identify patients with health-related social needs in the emergency department: Study protocol. PLoS One. 2025 May 12;20(5):e0323094. doi: 10.1371/journal.pone.0323094. eCollection 2025. |
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All data produced during the project will be preserved, but raw and derived data (at the patient-level) will not be posted publicly because of our use of secondary data from privately held electronic health record and health information exchange systems. Due to the data use restrictions put in place by consortium agreements among the health system partners that contribute EHR data to the Indiana Network for Patient Care, patient-level data cannot be shared or disseminated outside this project. However, de-identified derived data (at the patient-level) used in this study may be shared with investigators whose formal request is approved by the data owners. Requests can be sent to askRDS@regenstrief.org. Access to these data requires investigator support for use and a signed data access agreement between the Regenstrief Institute and the investigator's institution.
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| ID | Term |
|---|---|
| D004630 | Emergencies |
| ID | Term |
|---|---|
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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The intervention will be at the ED level using a pre-post design with a matched comparison group.
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|
| within 3 days of emergency department encounter |
| Percent of encounters with an emergency department revisit measured at 7 days | The numerator will be an emergency department encounter at any facility included in the Indiana for Network Care database within 7 days of an ED encounter at an intervention or comparator site. ED revisits may serve as the index visit for subsequent revisits. The denominator will be all eligible ED encounters. Encounters resulting in an inpatient admission will be excluded from the numerator and denominator. | within 7 days of emergency department encounter |
| Percent of encounters with an emergency department revisit measured at 30 days | The numerator will be an emergency department encounter at any facility included in the Indiana for Network Care database within 30 days of an ED encounter at an intervention or comparator site. ED revisits may serve as the index visit for subsequent revisits. The denominator will be all eligible ED encounters. Encounters resulting in an inpatient admission will be excluded from the numerator and denominator | within 30 days of emergency department encounter |
| Percent of emergency department encounters with primary care visit within 7 days of an ED encounter | The numerator will include all emergency department encounters with a completed family medicine, internal medicine, OBGYN, or geriatrician visit64 within 7 days of the ED visit. The denominator will be all eligible ED encounters. Encounters resulting in an inpatient admission will be excluded from the numerator and denominator. | within 7 days of emergency department visit |
| At time of emergency department encounter (or within 24 hours) |
| Percent of emergency department encounters where the clinical decision support platform was accessed | The numerator will include encounters with access of clinical decision support platform during the study visit (defined as within 24 hours). Access will be defined as record of the end user visiting initiating a request to the decision support application from the EHR. Any portion of the decision support platform (not just the health-related social needs section) is included. The denominator will be all eligible ED encounters (see Inclusion criteria, above). Limited to the intervention site only | At time of emergency department encounter(or within 24 hours) |