Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

4-24-2025

Graduate Advisor

Vanessa Loyd PhD, DNP, RN

Committee

Wilma Calvert, PhD, MPE, RN

Kim Tankel, PhD, APRN, PMH-BC

Abstract

Problem: Approximately 14.1 million Americans are diagnosed with a Serious Mental Illness (SMI). These individuals experience death 10-20 years earlier compared to the general population, primarily due to chronic medical comorbidities and unmet health-related social needs (HRSNs). Mortality rates, increased healthcare utilization, and frequent readmissions in patients with multiple, unmet HRSNs are likely to remain high unless developments such as the incorporation of standardized, multi-domain, social determinants of health (SDOH) screenings into electronic health records (EHRs). The purpose of this quality improvement (QI) project, guided by the Institute for Healthcare (IHI) model for change utilizing the Plan-Do-Study-Act (PDSA) cycle, was to evaluate the effectiveness of implementing a multi-domain, EHR-based, SDOH screening tool on its ability to comprehensively identify and address unmet HRSNs of adult patients with SMI and its impact on readmission rates.

Methods: EHR-based, validated screening tools that assessed food insecurity and housing instability were administered to adults ages 18-75 years old, admitted to the inpatient Behavioral Health Unit (BHU), with a diagnosis or history of SMI. This study utilized a descriptive, observational design with a pre-and post-intervention approach to assess the frequency of psychiatric readmissions. Data was analyzed using a Wilcoxon Signed Rank Test, binary logistic regression, and descriptive statistics.

Results: There were (N=119) patients who met the inclusion criteria. There were (n=34, 28.6%) patients who screened positive, with (n=24,20.2%) for housing instability, (n=22,18.5%) for food insecurity, and (n=12,10.1%) for both food and housing instability. The frequency of readmissions did not show a statistical difference (p = .291). The readmission rate was 10.9%, while 89.1% did not experience readmission. The readmission rate of 10.9% (n=13) correlates with the results of housing instability, which has higher odds of readmissions. The results revealed a statistically significant coefficient for endorsing housing instability (β=3.65), with an associated z-value = 13.2, p < .001.

Implications for Practice: Utilization of standardized screening tools integrated into the EHR can be beneficial for identifying food insecurity and housing instability in patients with SMI admitted to an inpatient psychiatric unit.

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