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BackgroundSocial determinants of health (SDOH) significantly impact health and quality of life, with physical environment and socioeconomic circumstances accounting for 80% of factors affecting health. SDOH are an underlying cause of today’s health crises including obesity, heart disease, diabetes, and depression. Addressing inequities requires a reliable way of identifying them. This is difficult in a large enterprise spanning inpatient, specialty, and ambulatory care. This pediatric service line coordinated efforts across 11 unique teams to initiate SDOH screening.ObjectivesThe objectives developed and matured over 3 years, expanding from only a few divisions testing only the screening process to many divisions, more SDOH domains, and a bundled goal of screening with interventions (table 1). The goal is for 80% of target population encounters to be appropriately screened AND each for positive screen to successfully receive appropriate resource referral or intervention with EMR documentation. This will be achieved and maintained for at least 3 consecutive months (6 months in the second year) by October 31, 2023.MethodsThe Model for Improvement and rapid cycle PDSAs provided the framework, including aim, measures, and Key Driver Diagram (figure 1). PDSA cycles sought the best fit for the environment being targeted, given each of the 11 divisions has a unique set of care team members and physical plant. Run charts evaluated performance and intervention effectiveness.ResultsThe teams improved from virtually zero screenings performed to 82% of patient visits meeting criteria of a screen with appropriate intervention at each visit or within 12 months prior (figure 2). Preliminary analysis demonstrates 41% of patients since April 2022 who had at least one positive screen responded most recently that this is no longer true.ConclusionsMany families have been helped with community resources who were unknown prior to this initiative (figure 3). This highly spreadable work helps build a more equitable, inclusive healthcare landscape.Abstract 9 Table 1Divisions and domainsAbstract 9 Figure 1Key driver diagramAbstract 9 Figure 2SDOH screening data-bundle compliance October 2020 through March 2023Abstract 9 Figure 3Flow map

BackgroundIndividuals with sickle cell disease (SCD) experience poor clinical outcomes while transitioning from paediatric to adult care. Standards for SCD transition are needed. We established a Quality Improvement (QI) Collaborative that aimed to improve the quality of care for all young adults with SCD by establishing a standardised SCD transition process. This study evaluates the implementation of the Six Core Elements (6CE) of Health Care Transition, which was a fundamental component of the cluster-randomised Sickle Cell Trevor Thompson Transition Project (ST3P-UP) study.MethodsA central QI team trained 14 ST3P-UP study sites on QI methodologies, 6CE and Got Transition’s process measurement tool (PMT). Site-level QI teams included a transition coordinator, clinic physicians/staff, patients/parents with SCD and community representatives. Sites completed the PMT every 6 months for 54 months and monthly audits of 10 randomly-selected charts to verify readiness/self-care assessments and emergency care plans.ResultsOf a possible 100, the aggregate mean (±SD) PMT score for paediatric clinics was 23.9 (±13.8) at baseline, 95.9 (±6.0) at 24 months and 98.9 (±2.1) at 54 months. The aggregate mean PMT score for adult clinics was 15.0 (±13.5) at baseline, 88.4 (±11.8) at 24 months and 95.8 (±6.8) at 54 months. The overall QI Collaborative PMT score improved by 402%. At baseline, readiness/self-care assessments were current for 38% of paediatric and 20% of adult patients; emergency care plans were current for 20% of paediatric and 3% of adult patients. Paediatric clinics had one median readiness assessment shift (76%) and four median emergency care plan shifts (65%, 77%, 79%, 84%). Adult clinics experienced three median self-care assessment shifts (58%, 63%, 70%) and two median emergency care plan shifts (57%, 70%).ConclusionsThe ST3P-UP QI Collaborative successfully embedded the 6CE of Health Care Transition into routine care and increased administration of assessments and emergency care plans for transition-aged patients with SCD.