Background/Purpose: There is a profound need to improve outcomes in children with systemic lupus erythematosus (SLE) given this disease is complicated by significant morbidity. Disparities in pediatric SLE (pSLE) outcomes are also rampant and may be better understood through a social drivers of health (SDOH) framework. SDOH are conditions in the environment where patients live, work, learn, and play, and they have been found to have a significant influence on health outcomes. Children’s Mercy Integrated Care Solutions (CMICS), our hospital’s population health management subsidiary, has created Lift Up KC, a social care platform linking patients and families to community resources. Our patients with SLE have low disease activity at 85.7% of visits, and 67.7% of SLE visits have a low patient/parent global assessment of overall wellbeing. We aimed to increase the percent of patients with SLE seen in the rheumatology clinic who receive screening of SDOH at follow-up clinic visits from 0% to 50% by June 30, 2025. We also aimed to increase the percent of patients with SLE who have low disease activity (based on SLEDAI-2k) from 85.7% to 90% by June 30, 2025.

Methods: We utilized quality improvement (QI) methodology including QI tools such as a key driver diagram (Figure 1), fishbone diagram, process map, and failure modes effects analysis. Our outcome measures include percent of SLE visits with low disease activity (SLEDAI-2k ≤4) and low patient/parent global assessment of overall wellbeing score (≤2). Process measures include SDOH screening being sent, completion of screening form, screen positive rate, patients/parents wanting assistance, successful referral to a community-based organization, and no-show rate. Our balancing measure is an average physician satisfaction score. Interventions included meeting with local experts, education on our screening tool and referral process, identification of a super user, education to physicians and nurses, and partnership with social work. We evaluated our data on run charts.

Results: SDOH screening started in November 2024 and the screening tool has been sent to 100% of patients/families since this time. The form completion rate is 63.9%. Social needs identified in 1-3 screens per month and help wanted 0-4 times per month for a positive screen rate of 9.1-28.6% (median 15%) (Figure 2). All families wanting assistance were referred to a partner community organization. No show visits and last-minute cancellations occurred in 16.7% of scheduled SLE visits. Our outcome measures remained stable – 85.7% of visits with low disease activity (Figure 3) and 67.7% with low patient/parent global assessment of overall wellbeing.

Conclusion: We have successfully implemented SDOH screening in our SLE population. Although outcomes remain stable at this point, we hope to improve the care of SLE patients over time by addressing social needs that can have a significant impact on their disease and overall health.

Figure 1. Key driver diagram for social drivers of health screening in patients with SLE.

Figure 2. Run chart of positive SDOH screens.

Figure 3. Annotated run chart of SLE visits with low disease activity.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/implementing-social-drivers-of-health-screening-for-patients-with-pediatric-systemic-lupus-erythematosus/