Incorporation and Utilization of an Additional Needs Screener by Surgical Trainees for Comprehensive Care of Underserved and Underinsured Surgical Patients.

OBJECTIVE: Comprehensive, socially-minded healthcare has historically been delivered in the primary care setting. For underserved patient populations, however, a surgical care episode may serve as the health care access point. To maximize patient wellbeing during the perioperative period, our surgical center developed the Additional Needs Screener (ANS). Operationalized into practice by GME and UME trainees, this tool screens surgical patients across 3 domains (social, emotional, and immigration needs) and connects patients to partner organizations if appropriate. This study describes the pilot utilization of the ANS among underserved and underinsured surgical patients. DESIGN: Clinical quality improvement and retrospective cohort study of patients completing the ANS from imple-mentation in September 2021 to September 2022. SETTING: The Hospital of the University of Pennsylvania, PA-a tertiary care center. PARTICIPANTS: One hundred and 10 underinsured and/ or underserved patients completed at least 1 ANS domain. RESULTS: Patients were majority female (55F, 53M, 2 other) and Hispanic/Latinx (72%) with a median age of 38 (IQR = 34-48). Most patients spoke a primary lan-guage other than English (77%), and nearly all were either uninsured (82%) or received emergency medical assistance or Medicaid (14%) at referral. Patients demon-strated significant needs; 39% endorsed difficulty affording housing, 32% endorsed difficulty paying for food, 29% endorsed experiencing current life-interfering distress, and 75% had undocumented immigration status. Ultimately, 57% of screened patients accepted referrals to our needs response teams. CONCLUSIONS: Underserved and underinsured patients presenting for surgical care face significant challenges relat-ing to social, emotional, and immigration needs. Through adoption of the ANS, trainees gained competency identify-ing and addressing these barriers in the perioperative period. Future works will focus on categorizing referral outcomes, developing interventions to increase patient trust, and improving screener dissemination. (J Surg Ed 80:1287-1295. & COPY; 2023 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.) ABBREVIATIONS: ANS, additional needs screener CSH, Center for Surgical Health PPN, personal patient navigator HIAS-PA Hebrew Immigrant Aid Society of Pennsylvania